Prevention Guidelines for Women 40–49

A screening test is done to find possible health problems or diseases in people who don't have any symptoms. The goal is to find a disease early so lifestyle changes can be made and you can be watched more closely to lower the risk of disease, or to find it early enough to treat it most effectively. Screening tests are not diagnostic. But they are used to find out if more testing is needed. Health counseling is vital, too. This plan does not include recommendations for pregnancy. You and your healthcare provider may decide that a different schedule is best for you. But this plan can guide your discussion.

Screening	Who needs it	How often
Type 2 diabetes or prediabetes	All adults starting at age 45 and adults with no symptoms at any age who are overweight or obese and have 1 or more additional risk factors for diabetes	At least every 3 years
Alcohol misuse	All adults	At routine exams
Blood pressure	All adults	Yearly checkup if your blood pressure is normal. Normal blood pressure is less than 120/80 mmHg.1 If your blood pressure reading is higher than normal, follow the advice of your healthcare provider.
Breast cancer	All women2	Screening with a mammogram every year is an option starting at age 40. Talk to your healthcare provider regarding your recommended frequency depending on your risk factors.
Cervical cancer	All women, except those who had a hysterectomy (with removal of the cervix) for reasons not related to cervical cancer and no history of cervical cancer or serious precancer	Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called "co-testing") every 5 years. This is the preferred approach. But it is also acceptable to continue to have Pap tests alone every 3 years.
Colorectal cancer	Women of average risk ages 45 years and older	Several tests are available and used at different times. Tests include: Flexible sigmoidoscopy every 5 years, or CT colonography (virtual colonoscopy) every 5 years^,or Colonoscopy every 10 years, or Yearly fecal occult blood test, or Yearly fecal immunochemical test every year, or Stool DNA test, every 3 years You will need a follow-up colonoscopy if you choose any test other than a colonoscopy and you have an abnormal result. Screening recommendations vary among expert groups. Talk with your doctor about which test is best for you. Some people should be screened using a different schedule because of their personal or family history. Talk with your doctor about your health history and what colorectal cancer screening schedule is best for you.
Chlamydia	Women at a higher risk for infection	At routine exams if at risk
Depression	All adults in clinical practices that have staff and systems in place to assure accurate diagnosis, effective treatment, and follow-up	At routine exams
Gonorrhea	Sexually active women at a higher risk for infection	At routine exams if at risk
Hepatitis C	Adults at a higher risk; 1 time for those born between 1945 and 1965	At routine exams if at risk
HIV	All women	At routine exams
Lipid disorders	All women age 45 and older at a higher risk for coronary artery disease For women ages 19 to 44, screening should be based on risk factors; talk with your healthcare provider	At least every 5 years
Obesity	All adults	At routine checkups
Syphilis	Women at a higher risk for infection	At routine exams if at risk
Tuberculosis	Adults at a higher risk for infection	Check with your healthcare provider.
Vision	All adults3	Baseline comprehensive exam at age 40; if you have a chronic disease, check with your healthcare provider for exam frequency.
Counseling	Who needs it	How often
Breast cancer, chemoprevention	Women at high risk	When risk is identified
BRCA mutation testing for breast and ovarian cancer susceptibility	Women with a higher risk	When risk is identified
Diet and exercise	Adults who are overweight or obese	When diagnosed and at routine exams
Domestic violence	Women of child-bearing age and older women with a higher risk	At routine exams
Sexually transmitted disease prevention	Adults at a higher risk for infection	At routine exams
Tobacco use and tobacco-related disease	All adults	Every exam
Immunization	Who needs it	How often
Tetanus/diphtheria/pertussis (Td/Tdap) booster	All adults	Td: every 10 years Tdap: substitute a one-time dose of Tdap for a Td booster after age 18, then boost with Td every 10 years
Chickenpox (varicella)	All adults in this age group who have no record of previous infection or vaccinations	2 doses; the second dose should be given at least 4 weeks after the first dose
Measles, mumps, rubella (MMR)	All adults in this age group who have no record of previous infection or vaccinations	1 or 2 doses
Flu vaccine (seasonal)	All adults	Yearly, when the vaccine becomes available in the community
Hepatitis A vaccine	People at risk4	2 doses given 6 months apart
Hepatitis B vaccine	People at risk5	3 doses; the second dose should be given 1 month after the first dose; the third dose should be given at least 2 months after the second dose (and at least 4 months after the first dose).
Haemophilus influenzae type B (HIB)	People at risk	1 to 3 doses
Meningococcal	People at risk**	1 or 2 doses
Pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23)	People at risk6	1 or 2 doses