Women’s Health Screening Guide: Screening Tests Checklist for Women at Every Age

'Health screenings can detect disease when it’s most treatable, and, in many cases, prevent serious health problems that can develop if a medical condition is left unchecked.'

- Dr. Michael Chor, Obstetrics & Gynaecology, OT&P Healthcare

Amidst women's steady rise in life expectancy, ensuring health span has become an imperative focus. A study by the McKinsey Health Instituteⁱ   underscores how an increasing portion of people's lives are afflicted with health issues. Therefore, it is important for women to be aware of potential illnesses that can be detected early with routine full body checkup. From cancer checks and sexually transmitted infection (STI) tests to bone density scans for osteoporosis, each health screening test plays a pivotal role in early disease detection and prevention of more serious health issues. By making informed decisions about when and how to participate in these potentially lifesaving health screening tests, women can be empowered to manage their health proactively. By taking steps to achieve a longer and more active life, women can increase their years spent in good health and extend their health span. 

Women's Health Screenings: Why They Matter

Globally, cervical cancer has an incidence rate of approximately 13.2 per 100,000 women, with higher rates in regions like Sub-Saharan Africa and Southeast Asiaⁱⁱ,  while breast cancer's incidence rate is around 47.8 per 100,000 women, with the highest rates in North America and Western Europe.ⁱⁱⁱ

In Singapore, the incidence rates for cervical cancer is 6.9^iv and 74.0^v per 100,000 women respectively, highlighting regional differences in cancer prevalence.

Screening for cancer of the cervix uteri demonstrates the importance of early detection, which increases the effectiveness of treatment when potentially cancerous cells are identified at an early stage. In the Asia-Pacific region, if every woman participated in regular screenings^vi, this could potentially prevent up to 83% of cervical cancer deaths.^vii This not only highlights the effectiveness of cervical cancer screenings but also the critical need for regular tests to maximize their life-saving potential.

Similarly, the impact of mammography screenings on breast cancer—a disease that accounts for 45.4% of all new cases^viii being diagnosed in Asia —is profound. Research indicates that women who undergo regular mammogram screenings experience a 41% reduction^ix in the risk of dying from breast cancer within ten years. This underscores the importance of consistent screenings and early action.

These examples demonstrate that routine medical checkup is an effective tool in maintaining women’s health. They are not merely appointments to be scheduled but are crucial decisions that empower women to take control of their health. Regular screenings are vital checks on our well-being, giving us the means to lead healthier, longer lives.

Women Health Screenings: From 20s and 30s

During their 20s and 30s, women undergo significant biological and physiological changes, making this a critical period for undergoing regular medical checkup. This phase sets the foundation for long-term health, particularly concerning reproductive and sexual wellness. Early detection through specific screenings can vastly influence women’s quality of life and overall health outcomes.

1. Blood Pressure Screening

Blood pressure screening involves measuring the pressure in the arteries as the heart pumps. This should start in women’s early 20s or sooner if there are risk factors such as obesity or family history. This screening can be conducted at least every two years if initial readings are normal. Detecting hypertension early is critical because high blood pressure is a risk factor for heart disease and stroke.

2. Human Papillomavirus (HPV) Test

This screening checks for the presence of HPV, the virus that can lead to cervical cancer. Doctors recommend this test for women aged 30 and older, although women in their late 20s who have had abnormal Pap results should also take this test. The HPV test is often conducted alongside a Pap smear every three to five years. This test is important because of its ability to identify high-risk strains of HPV that are known to cause cervical cancer, allowing for early intervention.

3. Pap Smear Test

The Pap smear test involves collecting cells from the cervix to check for abnormalities that may indicate cervical cancer or precancerous conditions. Doctors recommend that women begin receiving pap smear tests at the age of 21 and continue testing every three to five years, provided that initial results are normal. This screening is crucial, as it detects cervical abnormalities early, significantly increasing the effectiveness of treatment and preventing the development of cervical cancer.

4. Pelvic Exam

A pelvic exam involves an examination of the reproductive organs, including the vagina, cervix, fallopian tubes, ovaries, and uterus, to check for abnormalities. Doctors recommend women to start these exams in their 20s. The exams should be conducted annually, although the frequency can be adjusted based on medical advice. This exam is important as it helps detect irregularities such as fibroids, ovarian cysts, and other conditions affecting a woman’s reproductive and general health.

5. Sexually Transmitted Infections (STI) Tests

Tests for STIs, such as chlamydia, gonorrhea, and HIV, should be undertaken as soon as a woman is sexually active. Doctors advise women to take these tests annually or more frequently, depending on individual risk factors and lifestyles. Early detection and treatment of STIs can prevent serious reproductive health problems, including infertility and complications that can affect overall health.

6. Skin Checks

Skin checks involve examining the skin for new moles or changes to existing moles, which can indicate skin cancer. These checks should begin in one’s 20s, especially for those with a personal or family history of skin cancer. The recommended frequency is annually or as advised by a dermatologist. Early detection of skin cancer, including melanoma, improves treatment success and can be life-saving.

7. Thyroid Function Test

The Thyroid Function Test is a blood test that measures thyroid hormone levels to assess thyroid function. It is recommended for women experiencing symptoms of thyroid dysfunction, such as unexpected weight changes, fatigue, or menstrual irregularities. The test should be conducted as needed, based on symptoms and medical advice. Proper thyroid function affects metabolism, energy levels, and overall hormonal health. Early detection of imbalances is key to preventing more serious health issues.

Family History and Informed Screening Decisions

Women in their 20s and 30s need to consider their family history, particularly regarding conditions like cancer, hypertension, high cholesterol, and diabetes, as this information can significantly influence the recommended starting age for various screenings. Women should have a thorough discussion with their healthcare provider about their personal and family medical history to determine the most appropriate age to start routine medical checkups and specific health screenings, ensuring they can take timely preventive measures based on their individual risk factors. By prioritizing these screenings, women can take proactive steps towards maintaining their health, starting a healthy pattern that will benefit them throughout life. Regular consultations with healthcare providers also enable a dynamic approach to health management, as screening requirements and technologies may change over time.

When meeting with your healthcare provider, you should be prepared to discuss your personal health history and any known health issues that run in your family. This information can significantly influence the type and frequency of screenings recommended. For instance, if there's a history of breast cancer or cardiovascular disease in your family, you might need to start certain screenings earlier than generally recommended.

Women Health Screenings: 40s and Beyond

As women enter their 40s and beyond, they should shift the focus of their health screenings towards preventing and managing age-related conditions, particularly cancers and osteoporosis. It is crucial to monitor changes that could impact long-term health and vitality.

1. Bone Density Scan (DEXA)

The DEXA measures bone mineral density to assess the risk of osteoporosis. It is especially important for post-menopausal women or those with risk factors for bone loss. The scan is generally recommended from the age of 50 and above, although it may be advised earlier for those at higher risk. Regular scanning helps in the early detection of bone weakening, allowing for interventions that can prevent fractures and other complications associated with osteoporosis.

2. Cholesterol Screening

Cholesterol screening involves testing blood to evaluate levels of various types of cholesterol and triglycerides. It's recommended that these screenings start routinely at age 40 and continue every four to six years, or more frequently if risk factors like obesity are present. Managing cholesterol levels is crucial, as high cholesterol is a significant risk factor for heart disease.

3. Colonoscopy

A colonoscopy is a procedure that allows doctors to inspect the inner lining of the large intestine for abnormalities like polyps or cancer. It is recommended to start at age 45 or earlier, depending on personal risk factors such as family history. Subsequent screenings are advised every ten years if no risks are detected or more frequently depending on findings. This screening is vital as it can detect colorectal cancer early, which is highly treatable when found early.

4. Diabetes Screening

Diabetes screening tests measure blood sugar levels to identify diabetes or prediabetes. Starting in one's 40s, this test is advised every three years or more often if one has risk factors such as obesity or a family history of diabetes. Early detection of diabetes is important for managing and preventing complications, including heart disease, vision loss, and kidney disease.

5. Eye Exams and Hearing Tests

Regular vision and hearing tests are advised as sensory functions can decline with age. Starting these exams in the 40s, typically every two years, helps maintain quality of life and independence by addressing and managing declines in these critical senses early.

6. Lung Cancer Screening

Regular lung cancer screenings, particularly using low-dose computed tomography (LDCT), are recommended for individuals at high risk, especially those with a history of heavy smoking. Starting these screenings around age 50, or earlier for those with significant smoking histories, can greatly improve the chances of detecting lung cancer in its early stages when treatment is most effective. These screenings play a vital role in preserving health and well-being by identifying potential lung abnormalities before symptoms manifest, enhancing the likelihood of successful treatment outcomes.

7. Mammogram Screening or Breast Ultrasound

A mammogram is an X-ray of the breast used to detect breast cancer. Women should start getting mammograms at age 40, with the frequency every one to two years. This can vary based on personal risk factors, such as family history, in which case screening might begin earlier. Mammograms are crucial as they can detect breast cancer early, when it is most treatable, significantly improving survival rates. A breast ultrasound can be used alongside mammograms, especially for women with dense breast tissue, as it provides a clearer image and can help detect abnormalities that mammograms might miss.

8. Skin Cancer Screening

Full-body exams for skin cancer are recommended, especially for those with a personal or family history of skin conditions. Starting in one's 40s, these should be conducted annually. Early detection of skin cancer can lead to more effective treatment and a better prognosis.

Women Health Screenings: Special Considerations for Maternity

During pregnancy, regular screenings and check-ups are vital not only for the health of the expectant mother but also for the developing baby. These screenings help identify conditions that could impact the pregnancy or the baby's health.

1. Glucose Screening Test 

The Glucose Screening Test is performed to check for gestational diabetes, a type of diabetes that can develop during pregnancy. This test is typically conducted between the 24th and 28th weeks of pregnancy. It involves drinking a sweet liquid and measuring blood sugar levels after one hour to see how well the body processes sugar. This test is important because managing blood sugar levels during pregnancy can help prevent complications for both the mother and the baby, such as excessive birth weight and preterm birth.

2. Group B Streptococcus (GBS) Screening

GBS screening is designed to detect the presence of Group B strep bacteria, which can be found in a pregnant woman's vagina or rectum. This screening is usually done between 35 and 37 weeks of pregnancy. Women who test positive for GBS are given antibiotics during labor to prevent the bacteria from infecting the baby during delivery, which can lead to serious illnesses in newborns.

3. Iron Deficiency Anemia Screening

Screening for iron deficiency anemia is common during pregnancy due to the increased iron demands of the developing fetus. This test involves checking iron levels, which is important because iron deficiency can lead to premature birth and low birth weight. It can also cause postpartum issues for the mother, such as increased fatigue and reduced quality of breast milk. Regular screening helps ensure that iron levels support both mother and baby's health throughout pregnancy.

4. Prenatal Screening Tests

Prenatal screening tests include a range of blood tests and ultrasounds conducted at various stages of pregnancy to assess the fetus for developmental and genetic conditions. These screenings are crucial for early detection of potential issues affecting the baby's health and development. The specific timing for each test varies and is designed to target different stages of fetal development for optimal assessment accuracy.

Together, these tests form a comprehensive screening regime that supports the health of the mother and baby, highlighting the importance of regular medical check-ups during pregnancy. They empower pregnant women with knowledge and medical support to manage their health proactively during this crucial phase of life.

Female Health Screening and Insurance

It's important to note that while many health screenings are vital for maintaining women's health, some, like low-dose CT scans for lung cancer, can be among the more expensive tests. These costs can serve as a reminder of the necessity for comprehensive health insurance coverage. With robust health insurance coverage, women can prioritize their health without worrying about the financial burden, leading to better health outcomes and a higher quality of life. Investing in comprehensive health insurance is investing in one's own well-being and future.

Disclaimer: This list is not comprehensive, and screenings should be based on individual family history, lifestyle, and risk factors. It's essential to consult with a healthcare provider to determine the most appropriate screenings for your specific health needs.

The importance of regular health screenings cannot be overstated for women at various life stages. For women, each screening is a step towards understanding and managing health proactively. By taking timely actions, scheduling your next screening, and discussing your personal and family health history with a healthcare provider, you are not just taking control of your health; you are empowering yourself to lead a healthier, more fulfilled life.

References

ⁱ Coe, E. et al. (2022a) Adding years to life and life to years, McKinsey & Company. Available at: https://www.mckinsey.com/mhi/our-insights/adding-years-to-life-and-life-to-years (Accessed: 03 May 2024).

ⁱⁱ Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries - PubMed (nih.gov) - https://pubmed.ncbi.nlm.nih.gov/32007142/

ⁱⁱⁱ Globocan 2020, Breast Cancer Fact Sheet, viewed 23 May 2024, 20-breast-fact-sheet.pdf (who.int).

^iv Channel News Asia 2023, Singapore women shouldn’t put off breast cancer screening, viewed 22 July 2024, https://www.channelnewsasia.com/commentary/breast-cancer-free-screening-healthier-sg-mammogram-3407941.

^v ICO/IARC Information Centre on HPV and Cancer, Human Papillomavirus and Related Cancers, Fact Sheet 2023, viewed 22 July 2024, https://hpvcentre.net/statistics/reports/SGP_FS.pdf.

^vi PubMed, Cervical cancer burden, status of implementation and challenges of cervical cancer screening in Association of Southeast Asian Nations (ASEAN) countries, viewed 23 May 2024,  https://pubmed.ncbi.nlm.nih.gov./34728309/

^vii UNFPA Asia-Pacific, Cervical Cancer Elimination in Asia-Pacific: Country Reviews & Roadmaps for Action, viewed 23 May 2024, https://png.unfpa.org/en/publications/cervical-cancer-elimination-country-review-and-roadmap-action

^viii Lim, Y.X. et al. (2022) ‘Breast cancer in Asia: Incidence, mortality, early detection, mammography programs, and risk-based screening initiatives’, Cancers, 14(17), p. 4218. doi:10.3390/cancers14174218.

^ix Duffy, S.W. et al. (2020) ‘Mammography screening reduces rates of advanced and fatal breast cancers: Results in 549,091 women’, Cancer, 126(13), pp. 2971–2979. doi:10.1002/cncr.32859