What women need to know about USNWR’s “16 Health Screenings All Women Need”

When I see a headline such as “16 Health Screenings All Women Need,” I steel myself for what comes next. “All women need“?

What came next in the US News & World Report column was a list of recommendations that included imbalance, incompleteness, and more controversy than the column suggests.

For example:

On clinical breast exams and breast self-examination, the USNWR column says:

Clinical breast exams should begin at age 20 and be repeated every one to three years for women ages 20 to 39, and yearly beginning at age 40. Self-checks, meanwhile, are easy to do at home — and you ought to check for lumps every month or so.

The US Preventive Services Task Force:

  • concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40, and
  • recommends against teaching breast self-examination.

On mammography, the USNWR column says:

“beginning at age 40, women should undergo yearly mammograms.”

The US Preventive Services Task Force states:

“The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.”

Note: USNWR is pushing annual mammograms with a statement of “should.” The USPSTF promotes shared decision-making – not the lecturing verb “should” – but fully informed assessment of tradeoffs.  And this is with biennial mammograms, not the annual tests that USNWR promotes.

On diabetes screening, the USNWR column says:

“Beginning at age 45, women should be screened for diabetes every three years”

The US Preventive Services Task Force statement on diabetes screening is much more nuanced, yet just as easy to understand.  It’s a far cry from saying all women should (there’s that verb again) start being screened at age 45:

  • The USPSTF recommends screening for type 2 diabetes in asymptomatic adults with sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg.
  • The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for type 2 diabetes in asymptomatic adults with blood pressure of 135/80 mm Hg or lower.

On lipid profile assessment, the USNWR column says:

“Routine screening, repeated every five years, starts at age 45.”

Hmmm.  That’s news to a lot of evidence-based doctors.

The USPSTF makes no recommendation for or against routine screening for lipid disorders in women age 20 years and older who are not at increased risk for coronary heart disease.

On thyroid-stimulating hormone testing for thyroid problems, the USNWR column says:

“It should begin as recommended between ages 19 to 49 in high-risk women — such as those with an autoimmune disease or family history — and every five years starting at age 50.”

The USPSTF states:

“Although the yield of screening is greater in certain high-risk groups (e.g., postpartum women, people with Down syndrome, and the elderly), the USPSTF found poor evidence that screening these groups leads to clinically important benefits. There is the potential for harm caused by false positive screening tests; however, the magnitude of harm is not known. There is good evidence that over-treatment with levothyroxine occurs in a substantial proportion of patients, but the long-term harmful effects of over-treatment are not known. As a result, the USPSTF could not determine the balance of benefits and harms of screening asymptomatic adults for thyroid disease.”

On skin cancer, the USNWR column says:

 “Visit a dermatologist for a thorough skin exam every other year, (a NY internist) says — or sooner if you notice any suspicious spots. “Once a month, check for any new or unusual spots.”

The US Preventive Services Task Force states:

” the current evidence is insufficient to assess the balance of benefits and harms of using a whole-body skin examination by a primary care clinician or patient skin self-examination for the early detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer in the adult general population.”

Scorecard:  on about half of the “16 health screenings all women need,” according to US News & World Report, there are many in medicine who disagree.

I have often suggested that there is a pattern of journalistic bias – promoting screening outside the boundaries of evidence.  In this case, I would emphasize:

  • The evidence behind US Preventive Services Task Force recommendations is posted online for anyone to review.
  • No evidence is given for most of the US News & World Report recommendations.
  • Instead, most of the recommendations are opinions of the physicians US News chose to interview.
  • Why US News chose to interview the people they did is not explained.

I often suggest to readers that whenever they hear claims about a “simple test,” they should run for the hills because there’s no such thing.  Screening and testing decisions should be some of the most informed, complex decisions we make.

I would also suggest to readers that whenever they hear or read about lists of tests everyone should have, run for the hills.  There’s usually harm in them thar recommendations.  And a fully informed consumer would be wise to look further for evidence about the tradeoffs involved in the screening decision.

Finally, a column like this is click rate bait.  It’s presented on the US News & World Report website in a series of 18 pages that you have to click through to see the entire content.  That means 18 clicks instead of one.  And that means the news organization can promote its higher click rate.

I wish they’d practice evidence-based reporting – and then promote that if they wish.


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