Health Screenings Women Need and When to Get Them

Update, August 29, 2026. This post first ran on August 8, 2012, and almost every number in it has moved. Colorectal screening now starts at 45 instead of 50. Mammography now starts at 40. Cervical screening keys to your age, never to when you first had sex. Lung cancer, hepatitis, diabetes and mental health screening were missing entirely.

You came here for ages and tests. A bare list hides what decides your care: who issued the number, in what year, and whether anyone else agrees. Often they do not. Adult immunization is its own subject and is not covered here.

Cervical screening changed its trigger, then changed its test

The old version said to start three years after becoming sexually active. Delete that. Screening keys to age: 21 per USPSTF (1) and ACOG (2), 25 per the American Cancer Society since December 2025 (3).

Cytology every three years from 21 to 29 (1)(2). From 30 to 65, USPSTF treats cytology every three years, hrHPV every five and cotesting every five as equivalent Grade A options (1). ACOG’s 2026 statement prefers clinician-collected primary hrHPV every five years and demotes cytology alone (2). Above 65, after adequate screening, stop.

Self-collection is the new part. ACOG says offer patient-collected hrHPV to women 30 to 65 where results can be tracked, at three years rather than five (2). Three self-collected, five clinician-collected. Those get transposed constantly. The USPSTF statement dates to 2018 and has not been revisited (1). USPSTF is what your plan pays on; ACOG is more current.

My own answer: I do not order patient-collected kits. ACOG conditions that offer on a practice being able to track and follow up the result, and result tracking is what my practice does not have. The limit sits in the workflow, not in the test.

Breast

Cut the “with or without clinical breast examination” half of the old line. ACS recommends no clinical breast exam at any age in average-risk women (5).

USPSTF now says mammography every other year, 40 through 74, Grade B, with insufficient evidence at 75 and older (4). ACS says optional annual from 40, annual from 45 through 54, then biennial or annual by preference, with no upper cutoff (5). Start age, interval, when to stop. They differ on all three.

Since September 10, 2024, every mammogram report and patient letter must state your density in FDA-written wording (6). That letter is not a recommendation to image. USPSTF graded supplemental ultrasound and MRI insufficient either way (4).

I follow USPSTF here. Mammography every other year, 40 through 74. ACS recommends annual screening from 45 through 54, so for a woman in that band the two guidelines disagree about the same calendar year, and both positions stay on this page.

Colon at 45, lung by pack-years, and one test to decline

Colorectal screening starts at 45. Not 50. USPSTF grades 45 to 49 a B, 50 to 75 an A, individualizes 76 to 85, stops after 85 (7). ACS also starts at 45 (8). The old post’s most dangerous line.

Options are unranked on purpose: annual FIT, stool DNA every one to three years, colonoscopy every ten (7). The test you finish beats the better one you postpone.

Lung screening is new. Annual low-dose CT, ages 50 to 80, at least 20 pack-years, currently smoking or quit within 15 years, Grade B (9). ACS keeps the ages and pack-years but deleted the quit window (10). I think ACS has the better argument, though coverage follows USPSTF.

One test to decline. If you are at average risk with no symptoms and someone offers a CA-125 or a transvaginal ultrasound to screen for ovarian cancer, the answer is no. USPSTF grades that a D (11), meaning the harms outweigh the benefits. Being offered a test is not a reason to take it.

Blood pressure, sugar, lipids, bones, and the aspirin question

Blood pressure from age 18, Grade A: every three to five years through 39, annually from 40 (12). Confirm with home readings before treatment. The 2025 AHA/ACC guideline sets stage 1 at 130 to 139 over 80 to 89, target under 130/80 (13). Any hypertensive pregnancy earns an annual check afterward (13).

Cholesterol at 45 is gone. The statin decision runs 40 to 75 with a risk factor: Grade B at ten-year risk of 10% or more, Grade C from 7.5% to 10% (14). That threshold assumed the pooled cohort equations; the 2025 guideline uses PREVENT, which returns lower estimates (13)(14). Two calculators, two answers.

The 2012-era advice pushed a daily aspirin. It now runs the other way. USPSTF makes starting low-dose aspirin at 40 to 59 an individual decision, and only when ten-year CVD risk is 10% or higher, Grade C. At 60 and older it recommends against starting at all, Grade D (15). Low dose means 81 mg. All of that is primary prevention. Aspirin after a heart attack, stroke or stent is secondary prevention, a different question entirely. Stop nothing on your own. Raise it at a visit.

Diabetes is the widest gap. USPSTF screens adults 35 to 70 with overweight or obesity, every three years (16). ADA’s 2026 Standards screen every adult from 35 regardless of BMI, and earlier at a BMI of 25 or more (23 for Asian ancestry) with a risk factor (17).

On diabetes I follow ADA. Every adult screened from 35, whatever the BMI. The USPSTF version would skip anyone in that age band who is not carrying overweight or obesity. USPSTF on breast, ADA on diabetes: I do not follow one organization down the line, which is the whole reason to ask which one a number came from.

Bone density was 65, or 60 with risk. That 60 is gone. USPSTF, January 2025: screen at 65 and older, and screen postmenopausal women under 65 with risk factors like low body weight or a parent’s hip fracture, using FRAX or similar, then DXA (18). No rescreening interval is specified, so “every two years” is not coming from the evidence.

Infections worth testing for once

Screen everyone 15 to 65 for HIV, Grade A (19). Hepatitis C is a one-time test for every adult from 18 to 79, Grade B (20).

Hepatitis B is an open disagreement, and I would rather show it than paper over it. USPSTF screens by risk, Grade B (21). CDC in 2023 recommended one-time triple-panel screening of every adult (22). No-cost coverage keys to USPSTF grades, so the broader approach can arrive with a bill.

Mood, anxiety, and what is happening at home

Depression screening for every adult, including pregnancy, postpartum and past 65, Grade B (23). Anxiety screening is Grade B through 64 and insufficient evidence at 65 and older, a gap rather than reassurance (24). Partner violence screening for women of reproductive age became Grade B in June 2025 (25).

A questionnaire with nothing behind it is theater.

If you are the patient reading this

Bring your last mammogram date, whether it called your tissue dense, your pack-years, and the date and type of your last cervical test.

Then ask what almost nobody asks: which organization does that number come from? I work entirely by telemedicine, so one caveat. Ordering is not performing. The mammogram, the DXA and the colonoscopy still happen in a building.

For the clinicians

Two for the card. Name the risk factor when you order DXA under 65; no rescreening interval exists. And read the dates before you quote a grade: cervical is 2018, colorectal and lung 2021.

The Bottom Line

Four numbers carry most of the change. Colon at 45. Mammography from 40. Cervical by age, HPV testing first. Diabetes at 35. Plus one reversal, aspirin. If your screening plan predates 2020, it is out of date. One appointment fixes that.