The 5 cancer screenings women need

When you think of cancer screenings, uncomfortable is probably the first word that comes to mind. Whether it’s a Pap smear, mammogram, or just stripping down for a skin inspection at the dermatologist—none of the cancer screening tests for females are particularly pleasant. But they are crucial for protecting your health and may give you peace of mind, especially as you get older.

“Cancer screenings are important because they can detect cancer before you notice symptoms,” says Rebecca Berens, MD, a family physician and owner of Vida Family Medicine in Houston, Texas. “The earlier cancer is detected, the less chance of the cancer growing and spreading (metastasizing). Larger cancers and cancers that have metastasized are more difficult to treat and achieve a cure, and are more likely to have long-term complications or lead to death.”

RELATED: Why a well-woman exam is so important

Who needs cancer screening?

“All women should be screened for breast cancer, cervical cancer, and colon cancer,” says Anjali Malik, MD, a board-certified radiologist in Washington, D.C. “If they are high risk, for example, smokers or people with a family history, women should also be screened for lung cancer. And women with genetic syndrome, taking certain medications, or with family history should be screened for uterine and pancreatic cancer as well.” 

Screening tests are based on age, gender, and risk factors. For example, we do not screen males with mammograms or 90-year-olds with Pap smears. The medical community uses research to help determine which screening tests are needed for specific populations.

But what if you are otherwise healthy and you have no cancer risk factors?

“Even people who are in great physical health can develop cancers due to a variety of factors,” says Jeff Fortner, Pharm.D., associate professor at Pacific University School of Pharmacy in Hillsboro, Oregon, and a member of the SingleCare Medical Review Board. “Some of these are outside of their control, such as family history, exposure to cancer causing substances, and aging. While other factors are controllable such as diet, alcohol, and tobacco consumption.” Meaning, healthy individuals are at risk of cancer despite having no symptoms nor risk factors.

When should women get screened for cancer?

Each type of cancer comes with its own age-related risk factors. Use this guide to cancer screening tests for females by age and cancer type.

Cervical cancer

Cervical cancer screening age: “Cervical cancer screening should begin at age 21 regardless of age of onset of sexual activity,” says Dr. Berens. According to the CDC, as long as pap smear results are normal, screens should take place every three years from age 21 to 29. From age 30 to 65, screens may be done every five years if your Pap and high-risk HPV test results are negative. (The pap and high-risk HPV testing is done on the same pap specimen.)

Risk factors: Almost all cervical cancers are caused by the human papilloma virus (HPV), which is a very common sexually transmitted infection. According to the U.S. Centers for Disease Control and Prevention (CDC), HPV is so common that almost everyone will get it at some point in their lives. But not all strains cause cervical cancer and if HPV is contracted as a teenager, often the body “clears” it. Some HPV strains cause genital or skin warts, and others have no symptoms.

How to reduce your risk: There is a safe and effective vaccine available for HPV called Gardasil 9. It is recommended for boys and girls at age 11 or 12, but it can be given as young as age 9 or as old as age 45. Those receiving the vaccine before age 15 need two doses of Gardasil, six months apart. If your child receives their first dose of Gardasil after he or she turns 15, guidelines state they should receive three doses over the course of six months. 

Screening test: Your family physician or OB-GYN will screen for abnormal cervical cells using a pap smear. This is done with a brush inserted in your vagina and swabbed across your cervix.

RELATED: Why you should get the HPV vaccine—even in your 30s or 40s

Breast cancer

Breast cancer screening age: You should discuss your screening schedule with your healthcare provider starting at age 40 to determine if you are high risk and require early screening. CDC guidelines recommend that average risk women have a mammogram once every two years from age 50 to 74.

Risk factors: According to the CDC, many of the factors that increase a woman’s risk for developing breast cancer are beyond her control. Genetics, aging, starting your period before age 12 or menopause after age 55, having dense breasts, and a family history of breast cancer all contribute to increased risk. 

How to reduce your risk: There are some risk factors that are controllable, however. Women can reduce their risk of breast cancer by staying physically active, maintaining a healthy weight with a BMI less than 25, and avoiding hormonal birth control, alcohol, and cigarettes. Hormonal contraception may increase the risk of breast cancer while on the pills, but then reduces to routine risk two to five years after stopping the pill. Research also shows that having a first pregnancy before age 30 and breastfeeding reduces breast cancer risk.

Screening test: Providers use a mammogram, which is like an X-ray with compression of the breast, to screen for breast cancer.

Colon (or colorectal) cancer

Colon cancer screening age: “For colon cancer, women should begin screenings at 50, or earlier if they are at increased risk due to colon issues or family history,” says Dr. Fortner. Patients should receive the fecal test every year, but a normal colonoscopy only needs to be repeated once every 10 years, or upon receiving abnormal results from the fecal test. The CDC recommends screening starting at 50, with frequency based on healthcare provider recommendations The U.S. Preventive Services Task Force (USPSTF) suggests initiating screening at age 45 years in adults at average risk. 

Risk factors: “Colon cancer risk is increased with age, genetics, and a personal history of inflammatory bowel disease such as Crohn’s disease and ulcerative colitis,” says Dr. Berens. She notes that, as with other cancers, a poor diet and limited physical activity can also contribute to colon cancer risk. Tobacco use and alcohol consumption also increase risk of colon cancer.

How to reduce your risk: A fiber-rich diet containing lots of fruits and vegetables and very little processed foods will reduce your risk of colon cancer. You can also exercise more and avoid tobacco and alcohol. 

Screening test: There are a few options for colon cancer screening. The most common are a colonoscopy or fecal test. For the latter option, the doctor collects a stool sample and looks for  blood in your stool. If blood is detected, the doctor will order a colonoscopy. During a colonoscopy, you first perform a bowel preparation in the comfort of your home, then are sedated in the endoscopy suite. The doctor inserts a long, flexible instrument into your rectum roughly the diameter of your thumb and threads it through to the beginning of your large intestine. The scope’s camera transmits an image of the walls of your colon so the doctor can examine it for abnormalities. It doesn’t hurt, but it may cause an uncomfortable, gassy feeling afterward that is resolved after passing gas. Most patient’s say that their endoscopy was “the best nap of their life.” 

Endometrial cancer

Endometrial cancer screening age:  As with other gynecological cancers, early detection is important. Because there is currently no official early screening test for endometrial cancer, the American Cancer Society advises that all menopausal women be informed about the risks of endometrial cancer. The most common symptom of early endometrial cancer is abnormal vaginal bleeding that occurs outside of normal menstruation timing or after menopause. Women should report any unexpected vaginal bleeding to their doctor.

Risk factors: The risk of endometrial cancer increases with age. Obesity, Type 2 diabetes, PCOS, hormonal imbalances, a fatty diet, the drug tamoxifen, never being pregnant, ovarian tumors, and prior pelvic radiation therapy may also increase endometrial cancer risk. Women with Lynch syndrome, or hereditary non-polyposis colon cancer (HNPCC), have a high risk of developing encometrial cancer and should be offered yealy endometrial biopsies starting at age 35. Because there is no effective screening test for endometrial cancer, a biopsy is the only way to rule it out.

How to reduce your risk: There are certain lifestyle factors that can reduce your risk of endometrial cancer. These include limiting your dietary fat intake, getting plenty of exercise, and maintaining a healthy weight. Oral contraceptives, or birth control pills, may reduce your risk, as may prior use of an IUD (Intrauterine device). Women who have had multiple pregnancies are at reduced risk of developing endometrial cancer, but those who have had more menstrual cycles than average may be at an increased risk. If you are on hormone replacement therapy (HRT), it’s best to take the lowest effective dose for the shortest duration possible to lower the risk of endometrial cancer. Women with a uterus who take HRT need to take both progesterone and estrogen. It’s best to work closely with your doctor. 

Screening test: At this time, there is no screening test for endometrial cancer. 

Lung cancer

Lung cancer screening age: The USPSTF recommends annual lung cancer screening for adults between the ages of 50-80 who have smoked a pack a day for the last 20 years and still smoke, or have quit within the last 15 years. Screenings should be conducted annually using low-dose computed topography until 15 years has passed since quitting smoking or the patient develops a health issue that either limits their life expectancy or impedes their ability to survive lung surgery or chemotherapy.

Risk factors: The number one risk factor for lung cancer is smoking cigarettes. According to the CDC, 80-90% of lung cancer deaths are caused by the use of tobacco products. Exposure to secondhand tobacco smoke, radon, silica, asbestos, arsenic, chromium and diesel exhaust also increase your chances of developing lung cancer, as does a family history of the disease or prior radiation therapy to the chest. Smoking combined with a high dietary intake of beta carotene is also linked to an increased risk of lung cancer. 

How to reduce your risk: Avoid smoking or quit if you already smoke. This is the best way to reduce your risk of lung cancer. Staying away from secondhand smoke, radon, and other environmental risk factors is important, too. Eating plenty of fruits and veggies may also lower risk, and regular exercise is important.

Screening test: In those between the ages of 50-80 (as indicated above) a low-dose CT (LDCT) scan is the recommended screening for lung cancer. When conducted annually before symptoms are present, the test can detect early lung cancer, increasing the chance of a long life. 

Other cancers

Most women will only need regular screenings for skin, cervical, breast, and colon cancers. At your annual well visits with your primary care provider ask if you have any risk factors that may require other screening tests, like those for lung, uterine, or ovarian cancer. 

Risk factors for other cancers include:

• Smoking
• Alcohol use
• Family history
• Certain medications
• Genetics
• Obesity
• Poor diet
• Certain genetic diseases

This is not an exhaustive list. Discuss your health needs with your primary care provider.

How much do cancer screenings cost?

Thanks to the Affordable Care Act, most insurance plans cover cancer screenings that are recommended based on your age and other risk factors. But if you don’t have insurance, there are other options for receiving free cancer screenings. 

“Planned Parenthood, federally-qualified health centers [FQHCs], and local health departments offer many women’s preventive health services on a sliding fee scale,” says Dr. Berens. “Direct primary care practices are located throughout the country and provide affordable comprehensive primary care to all patients regardless of insurance status, and they can help connect self-pay patients with affordable resources for screening.”