Recommendations for healthcare screening
The United States Preventative Services task force (USPSTF) develops the recommendations for screening in the United States. Generally, insurance companies use these guidelines to decide which screening services they will pay for. Click the name of the screening you want to learn more about:
Mammograms are officially recommended by the USPSTF every other year from ages 40-65. Despite this every other year recommendation, insurance companies will pay for yearly mammograms if you are older than 40. There is no upper limit of age for which insurance will pay for a mammogram, but insurance will likely not pay the whole cost if you are less than 40.
If you are at high risk for breast cancer and over 35, you can take a medicine like tamoxifen for 5 years to decrease your future breast cancer risk. This calculator can tell you your risk level: https://bcrisktool.cancer.gov/ and if your risk is more than 3% in 5 years, you should consider taking a medicine.
Pap smear
Pap smears recommendations have changed dramatically in the last 10 years because we now have testing for HPV, which is thought to be the cause of most cases of cervical cancer. If you are greater than 30 and your Pap and HPV test are both negative, you only need a pap smear every 5 years. Make sure you confirm at your appointment that your doctor is sending the HPV testing with the Pap smear (if they don’t send it, then you’ll have to come back at the 3 year mark). If you are 21-29 years old, you should get a Pap smear (with no HPV testing) every 3 years. Pap smears for women under 21 are no longer recommended, because their risk of cancer is very low.
Colon cancer screening
Colonoscopy is the most common test for colon cancer screening. The starting age for colonoscopy has gone down in the last few years. Now, colonoscopies start at age 45 and go through age 75. If your colonoscopy is normal, you will get a colonoscopy every 10 years. If it is abnormal, your repeat will be on an interval of every 1-7 years, depending on what they found during your colonoscopy.
If you have a family history (first degree relative - mom, dad, sister, brother, child) then you should start colonoscopies at 10 years younger than the age of diagnosis of your family member, and from then on you will get colonoscopies at least every 5 years.
Stool testing through Cologuard (every 3 years) and stool blood testing (every 1 year) are also available if you don’t want to get a colonoscopy. If these tests are positive, it doesn’t mean that you necessarily have cancer, but it does mean that you need to get a colonoscopy. Insurance companies generally pay for a regular colonoscopy better than a colonoscopy done because you have a problem (and a positive Cologuard is classified as a problem). Consider this before choosing whether to do a colonoscopy or a stool test.
Abdominal aortic aneurysm (AAA)
An AAA is a widening of the aorta in your lower abdomen. This usually has no symptoms, but if the aneurysm gets large enough it could burst. Older men who have smoked are at higher risk of this, so the USPSTF recommends that all men over 65 who have ever smoked (100 total cigarettes in your lifetime) be screened with an ultrasound of the stomach.
Lab tests
The USPSTF recommends some screening lab tests for every patient:
Hepatitis C testing once for everyone 18-80 years old
HIV screening - at least once for everyone 15-65 years old
Lung cancer screening
If you are between 50 and 80 years old and have smoked more than a pack a day for 20 years, they recommend a CT of the chest every year to look for lung cancer. If you quit smoking, you should continue getting this scan until you have been quit for 15 years.
Bone density screening
If you are above 65 and a woman, DEXA screening for osteoporosis is recommended every few years (insurance will not pay for this more often than every 2 years). If you are younger than 65 and postmenopausal, you might also qualify for bone density if you are high risk - talk to your doctor about your personal risk.
The United States Preventative Services task force (USPSTF) develops the recommendations for screening in the United States. Generally, insurance companies use these guidelines to decide which screening services they will pay for. Click the name of the screening you want to learn more about:
