Tests and Immunizations for High-Risk Women

If you have certain risk factors, you may need additional exams or tests other than those recommended for your age group. To find out if you need additional exams or tests, answer the following questions:


Are you a postmenopausal woman younger than 65 years and have one of the following:

  • Have a personal history of fracture as an adult
  • Have a family history of osteoporosis
  • Are Caucasian
  • Have dementia
  • Eat a poor diet or are not physically active
  • Smoke cigarettes
  • Have alcoholism
  • Low weight and body mass index
  • Have low levels of estrogen caused by early menopause (younger than 45 years), removal of both ovaries, or absence of menstrual periods for more than 1 year
  • Low lifelong calcium intake
  • Impaired eyesight (despite adequate correction)
  • History of falls

Do you have certain diseases or medical conditions or take certain drugs that increase the risk of osteoporosis?

If you answer yes to any of these questions, bone mineral density screening is recommended.


Have you had a positive test result for BRCA1 or BRCA2 mutations?

Has your mother, sister, or daughter had a positive test result for BRCA1 or BRCA2 mutations, but you have had a negative test result or you have not been tested?

Is your lifetime risk of breast cancer estimated to be 20% or greater based on various questionnaires designed to calculate breast cancer risk?

Do you have a history of breast biopsy results that are associated with a high risk of breast cancer?

Did you receive thoracic irradiation (typically as a treatment for lymphoma) between the ages 10 years and 30 years?

If you answer yes to any of these questions, enhanced breast cancer screening is recommended. Enhanced breast cancer screening may include more frequent clinical breast exams, yearly magnetic resonance imaging tests, and instruction in how to do a breast self-exam.


Do you have a first-degree relative (parent, sibling, or child) younger than 60 years or two or more first-degree relatives of any age who have had colorectal cancer or adenomatous polyps?

Do you have a family history of familial adenomatous polyposis or hereditary nonpolyposis colon cancer?

Do you have a personal history of colorectal cancer, adenomatous polyps, inflammatory bowel disease, chronic ulcerative colitis, or Crohn disease?

If you answer yes to any of these questions, colorectal cancer screening is recommended. 


Do you have or will have close contact with an infant aged less than 12 months?

Are you are a health care provider?

If you answer yes to any of these questions, diphtheria and reduced tetanus toxoids and acellular pertussis vaccine (tdap) is recommended.


Are you overweight (BMI equal to or greater than 25) or are not physically active?

Do you have a first-degree relative with diabetes mellitus?

Are you a member of a high-risk race or ethnic group for diabetes (African American, Latin American, Native American, Asian American, or Pacific Islander)?

Have you given birth to a newborn weighing more than 9 pounds or do you have a history of gestational diabetes mellitus?

Do you have high blood pressure?

Do you have a high-density lipoprotein cholesterol level of 35 mg/dL or less or a triglyceride level greater than 250 mg/dL?

Do you have a history of impaired glucose tolerance or impaired fasting glucose?

Do you have polycystic ovary syndrome?

Do you have a history of vascular disease?

Do you have other clinical conditions associated with insulin resistance?

If you answer yes to any of these questions, diabetes testing is recommended.


Are you considering pregnancy? If yes, do any of the following statements apply to you?

You, your partner, or a family member has a history of a genetic disorder or birth defect.

You have been exposed to a substance known to cause genetic defects.

You are of African, Cajun, Caucasian, European, Easter European Jewish, French Canadian, Mediterranean, or Southeast Asian ancestry.

If you answer yes to any of these questions, genetic testing and counseling is recommended.


Are you of Caribbean, Latin American, Asian, Mediterranean, or African ancestry?

Do you have a history of heavy menstrual periods?

If you answer yes to answer of these questions, hemoglobin level assessment is recommended. 


Do you have chronic liver disease?

Do you have a clotting factor disorder and receive clotting factor concentrates?

Do you use illegal drugs?

Do you work with hepatitis A virus or nonhuman primates in a research setting?

Are you traveling to a country where hepatitis A is common?

Do you anticipate having close personal contact with an adopted child from a country where hepatitis A is common?

If you answer yes to any of these questions, hepatitis A vaccine is recommended.


Have you had more than one sex partner in the past 6 months?

Are you being evaluated or treated for a sexually transmitted disease?

Have you recently or do you currently inject illegal drugs?

Do you have a job that exposes you to human blood or other body fluids?

Do you have a sexual partner who is infected with hepatitis B virus?

Do you live with someone infected with hepatitis B?

Do you live or work in an institution or do you attend daycare for the developmentally disabled?

Do you have end-stage renal disease?

Are you on dialysis? Do you attend a chronic hemodialysis program?

Do you have chronic (long-term) liver disease?

Are you traveling to a country where hepatitis B is common?

Are you infected with human immunodeficiency virus (HIV)?

Are you younger than 60 years and have diabetes?

Do you attend an STD treatment facility, HIV testing or treatment facility, or drug-abuse treatment or prevention facility?

Do you live in a correctional facility?

If you answer yes to any of these questions, hepatitis B vaccine is recommended.


Are you infected with human immunodeficiency virus (HIV)?

Do you have a history of injecting illegal drugs?

Did you received clotting factors before 1987?

Are you on dialysis?

Do you have abnormal liver enzyme test results?

Did you receive blood or have an organ transplant before 1992?

Have you received blood from someone who later tested positive for hepatitis C?

Are you a health care worker who may have been exposed to hepatitis C-positive blood (for example, you have been stuck with a needle used on a person with hepatitis C)?

If you answer yes to any of these questions, hepatitis C testing is recommended. 


Have you had more than one sexual partner since your most recent HIV test or do you have a sexual partner with more than one sexual partner since his or her most recent HIV test?

Have you had a past or present sex partner who injects drugs or is HIV positive?

Do you have a history of prostitution?

Do you inject illegal drugs?

Are you an adolescent entering a detention facility?

Have you been diagnosed with a sexually transmitted disease in the past year?

Have you lived for a long period or were you born in an area with high prevalence of HIV infection?

Did you receive a blood transfusion between the years 1978 and 1985?

Do you have invasive cervical cancer?

Are you seeking preconception evaluation?

If you answer yes to any of these questions, human immunodeficiency virus testing is recommended.


Do you have a family history of familial hyperlipidemia?

Do you have a female relative with cardiovascular disease before age 60 years or a male relative with heart disease before age 50 years?

Do you have a history of coronary heart disease or noncoronary atherosclerosis (eg, abdominal aortic aneurysm, peripheral artery disease, carotid artery stenosis)?

Are you obese (body mass index greater than 30)?

Do you have a personal or family history of peripheral artery disease?

Do you have diabetes mellitus?

Do you have multiple risk factors for heart disease, such as smoking or hypertension?

If you answer yes to any of these questions, lipid profile assessment is recommended.


Were you born in 1957 or later and have no proof of immunity or documentation of a dose of measles–mumps–rubella (MMR) vaccine given after your first birthday? If yes, you should be offered one dose of measles-mumps-rubella vaccine.


Were you born in 1963–1967? If yes, you should be offered two doses of measles-mumps-rubella vaccine.


Are you a health care worker?

Are you entering college?

Are you traveling internationally?

Did you just have a baby and you are rubella-negative?

If you answer yes to any of these questions, you should be offered a second dose of the measles–mumps–rubella (MMR) vaccine.


Do you have a spleen or immune disorder?

Are you a first-year college student living in a dormitory?

Are you a military recruit?

Are you traveling to an area where bacterial meningitis is common?

Are you a microbiologist who works with the bacteria that causes meningitis?

If you answer yes to any of these questions, the meningococcal vaccine is recommended.


Do you have a chronic illness?

Are you in an environment where pneumococcal outbreaks have occurred?

Do you have a compromised immune system?

Are you an Alaska Native or belong to certain Native American populations?

If you answer yes to any of these questions, the pneumococcal vaccine is recommended. Revaccination after 5 years may be appropriate for certain high-risk groups.


Are you of childbearing age and have no evidence of immunity to rubella? If yes, a rubella titer assessment is recommended.


Have you had more than one sexual partner or do you have a partner who has had more than one sexual partner?

Have you had sexual contact with someone with a sexually transmitted disease?      

Have you had more than one sexually transmitted disease or been treated at a sexually transmitted disease clinic?

If you answer yes to any of these questions, testing for sexually transmitted diseases is recommended.


Are you a sexually active adolescent and do any of the following statements apply to you?

You exchange sex for drugs or money.

You inject illegal drugs.

You are entering a detention facility.

You live in an area with high rates of syphilis.

If you answer yes to any of these questions, syphilis testing is recommended.


Do you work or play often in the sunlight?

Do you have a family or personal history of skin cancer?          

Have you had precancerous lesions?

Do you have fair skin or freckling or light hair?

Are you immunosuppressed?

Do you have xeroderma pigmentosum?

If you answer yes to any of these questions, a skin exam is recommended.


Do you have a strong family history of thyroid disease?

Do you have an autoimmune disorder?

If you answer yes to any of these questions, thyroid-stimulating hormone testing is recommended.

Do you have human immunodeficiency virus (HIV) infection?  

Are you in close contact with persons known or thought to have tuberculosis?

Do you have medical risk factors known to increase the risks associated with tuberculosis if infected?

Were you born in a country with high rates of tuberculosis?    

Do you abuse alcohol or inject illegal drugs?

Do you live in an institutional setting (including a nursing home, prison or jail, or mental health institution)?

Do you work as a health professional in a high-risk health care facility?

Are you medically underserved or low income?

Do you have X-ray evidence of prior healed tuberculosis?

Have you had a positive tuberculosis skin test result showing an increase of 10 millimeters or more in the size of the skin reaction within the previous 2 years?

If you answer yes to any of these questions, tuberculosis skin testing is recommended.


Are you a student (any grade level) or are you attending college or other postsecondary school?

Do you have contact with persons at high risk of serious complications for chicken pox?

Do you live with someone whose immune system is compromised?

Are you a teach, daycare worker, or staff member at a college, prison, military installation, or other institution?

Do you live with children?

Do you travel internationally?

If you answer yes to any of these questions, varicella vaccination is recommended.

Your Annual Health Care Visit Home Page 

Contact:

Caitlin Phelps
Associate Director of Gynecology
cphelps@acog.org