The path to early cancer detection used to be clear: You got your first annual Pap after you starting having sex, and your inaugural yearly mammogram at age 40 — all the while performing regular breast self-exams. But recently, the American College of Obstetricians and Gynecologists (ACOG) and the U.S. Preventive Services Task Force (USPSTF) published new testing recommendations, which include putting off initial tests and waiting longer between screenings, setting off a firestorm of controversy.
Why the sudden shift? Both groups changed their positions after studying evidence that less frequent screenings can be just as effective at diagnosing cancers, plus they would cost less and negate unnecessary follow-ups. Most doctors, however, disagree with a one-size-fits-all exam schedule and stress that it's critical for women to always have frank conversations with their gynecologists. (That fling you had last year in Vegas? Your "social smoking" habit? Spill it.) Your M.D. will help you craft a personalized timetable, but you should start by following these guidelines.
The American Cancer Society has long held that women should have their first annual mammogram at age 40, but the USPSTF now says most don't need them until they turn 50. The reasoning? Younger, denser breasts are more likely to produce benign cysts, and aggressive testing on innocent lumps is expensive and unnecessary. But some doctors are sticking with earlier screenings until studies prove that fewer exams won't equal higher fatalities, says Carolyn Runowicz, M.D., director of the Carole and Ray Neag Comprehensive Cancer Center at the University of Connecticut. "Everyone agrees that mammography reduces mortality in women over 40," she explains. Still, she adds, "It's key to understand that mammograms are effective, but they're not perfect." They can miss cancers or "overread" some benign changes.
The bottom line: Get tested annually starting at age 40, or earlier if you have a family history of breast cancer. Start screenings 10 years earlier than the age of your relative at the time of her diagnosis (so if your mom was diagnosed at age 42, for example, you should have your first mammogram at 32).
These are fast and free, and the USPSTF's recommendation against teaching them has caused a big-time brouhaha. The group argues that self-exams have not been proved to reduce cancer-related deaths, though no conclusive study has been done in the United States. Most doctors say not to quit altogether. "Women often discover their own cancers," says Runowicz . "So if you're not going to panic about every lump — and if you're young and menstruating, there will be lumps — there's little downside to doing self-exams."
Most lumps in younger women are caused by benign cysts, but there are no absolutes. "I've evaluated women as young as 22 who were diagnosed with breast cancer and found the abnormality while doing a breast self-exam," says Sandhya Pruthi, M.D., director of the breast clinic at the Mayo Clinic Cancer Center. "If we'd told them 'Don't touch your breasts,' a lump that was cancerous may have been detected at a much later stage."
The bottom line: Become familiar with the normal changes of your breasts by examining them monthly, in the days just after your period. For instructions, visit cancer.org.
ACOG now says that women should get their first Pap smear, a screener for cervical cancer, at age 21, with follow-up tests every other year until they turn 30; women over 30 who have had three consecutive "normal" results can then wait three years between tests. The group points to studies showing that only 0.1 percent of cervical cancer cases occur in women under 21, but that does little to ease big fears that the killer disease could grow undetected between spaced-out exams.
The bottom line: "It's all about risk," says Celeste Robb-Nicholson, M.D., associate chief of general medicine at Massachusetts General Hospital. "A healthy woman who is HPV negative and is either not sexually active or has just one partner can be screened every three years. Women who have risk factors — such as smoking and having multiple partners — should be screened annually."
For adults 20 and older, a total cholesterol exam in the form of a simple blood test can assess your risk of heart disease.
Do it: Annually if your LDL, or "bad," cholesterol measures more than 130. If it's lower, get tested every five years.