Risk Assessments

Prevention Guidelines for Women 40–49

Here are the screening tests and immunizations that most women ages 40 to 49 need. This plan does not include recommendations for pregnancy. Although you and your health care provider may decide that a different schedule is best for you, this plan can guide your discussion.

Screening	Who needs it	How often
Alcohol misuse	All adults	At routine exams
Blood pressure	All adults	Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends the following screening schedules: Every 2 years if blood pressure reading < 120/80 mm Hg, or Yearly if systolic blood pressure reading of 120 to 139 mm Hg or diastolic blood pressure reading of 80 to 89 mm Hg
Breast cancer	All women*	Yearly mammogram and clinical breast exam*
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.
Chlamydia	Women at increased 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
Diabetes mellitus, type 2	Adults who have no symptoms and have sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg	At least every 3 years
Gonorrhea	Sexually active women at increased risk for infection	At routine exams if at risk
HIV	Anyone at increased risk for infection	At routine checkups
Lipid disorders	All women age 45 and older at increased risk for coronary artery disease For women ages 19 to 44, screening should be based on risk factors¹; discuss with your health care provider	At least every 5 years
Obesity	All adults	At routine checkups
Syphilis	Women at increased risk for infection	At routine exams if at risk
Tuberculosis	Anyone at increased risk for infection	Check with your health care provider
Vision	All adults²	Baseline comprehensive exam at age 40; if you have a chronic disease, check with your health care 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 increased risk	When risk is identified
Diet, behavioral counseling	Adults with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease	When diagnosed
Tobacco use and tobacco-related disease	All adults	Every visit
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 ages 19 to 49 who have no documentation of previous infection or vaccinations	Two doses; the second dose should be given at least 4 weeks after the first dose
Measles, mumps, rubella (MMR)	All adults ages 19 to 49 who have no documentation of previous infection or vaccinations	One or two doses
Flu vaccine (seasonal)	All adults	Yearly
Hepatitis A vaccine	People at risk³	Two doses given 6 months apart
Hepatitis B vaccine	People at risk⁴	Three 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)
Meningococcal	People at risk**	One or more doses
Pneumococcal (polysaccharide)	People at risk⁵	One or two doses

*Recommendation from the American Cancer Society (ACS). The ACS recommends yearly screening for all women ages 40 and older. Women should talk with their doctors about their personal risk factors before making a decision about when to start getting mammograms or how often they should get them. The ACS also recommends annual clinical breast exams (CBEs) for women ages 40 and older. Women should talk with their doctors about their personal risk factors and make a decision about whether they should have a CBE.

**Exceptions may exist, please discuss with your health care provider

¹Recommendation from the American Congress of Obstetricians and Gynecologists

²Recommendation from the American Academy of Ophthalmology

³For complete list, see the CDC website

⁴For complete list, see the CDC website

⁵For complete list, see the CDC website

Immunization schedule from the CDC