Annual Examination Components for a 20-Year-Old Female

Core Components

A complete medical history focusing on family history of cancer, particularly breast cancer, should be taken to identify patients who may benefit from genetic counseling 1
Clinical breast examination (CBE) should be performed every 3 years for women in their 20s as part of periodic health examination 3, 4
A comprehensive physical examination with particular attention to blood pressure measurement, heart, lungs, abdomen, and reflexes should be performed 2

Cervical cancer screening with Pap test should begin approximately 3 years after a woman begins having vaginal intercourse, but no later than age 21 3, 4
Screening should be done every year with conventional Pap tests or every 2 years using liquid-based Pap tests 4
Discussion about breast self-examination (BSE) benefits and limitations should be conducted, emphasizing prompt reporting of any new breast symptoms 3, 1
No mammography is recommended at this age (begins at age 40) 3, 4

Health counseling about tobacco use, sun exposure, diet and nutrition, risk factors, sexual practices, and environmental/occupational exposures should be provided 5, 1
Education about risk factors for various cancers and preventive measures should be provided 1
The importance of recognizing breast cancer symptoms and developing awareness about breast changes should be discussed 2

Examination for cancers of the thyroid, ovaries, lymph nodes, oral cavity, and skin should be performed as part of the cancer-related checkup 5, 1
This comprehensive cancer-related checkup should be performed every 3 years from ages 20 to 39 5

If the patient chooses to perform BSE, instruction and technique review should be provided 3, 4
The American Cancer Society no longer recommends monthly BSE beginning at age 20, but emphasizes the importance of prompt reporting of any new breast symptoms 3
Women who choose to do BSE should receive instruction and have their technique reviewed during the periodic health examination 4

Ordering unnecessary screening tests not recommended for this age group (e.g., mammography, colorectal cancer screening) should be avoided 1, 2
Performing annual Pap tests when guidelines recommend less frequent screening based on risk factors should be avoided 1, 2
Failing to provide adequate education about the importance of recognizing and reporting new symptoms should be avoided 1, 2
Overlooking family history that might indicate need for earlier or more intensive screening should be avoided 2