• Health Check-Ups for Women

    IMAGE If you're a woman, chances are good that your car gets a tune-up more often than you do. While many doctors send women friendly reminders when it is time for a periodic physical, some of us are on our own to remember when it is time for our next "30,000 mile" tune-up.
    It pays to pay attention. All of the medical procedures described below are proactive rather than reactive. Each is designed to catch a developing health problem in its early, more treatable stages. As such, timing is everything, so it is in every woman's best interest to become an informed healthcare consumer. Keep in mind that the timetable suggested for each test applies to healthy women. If you have specific medical concerns, follow the guidance of your doctor.

    Guarding Against Cancer

    Breast Cancer

    A mammogram is a screening device that is used to identify a cancerous lump in its early stages. There is controversy about when women who are at low risk for developing breast cancer should start to have periodic mammograms, but many organizations suggest that screening or at least discussion about screening should start at age 40. The United States Preventive Services Task Force (USPSTF), American Cancer Society, and the American College of Obstetricians and Gynecologists are some organizations that provide guidelines for breast cancer screening.
    If you are interested in getting a mammogram, you should be able to find a certified facility through your doctor. Insurance usually covers the procedure. The National Cancer Institute's Cancer Information Service (1-800-422-6237) can also provide a list of certified facilities, answer related questions, and make referrals for free or low cost mammograms if you are uninsured or underinsured.

    Colon Cancer

    The risk of developing colon cancer increases with age, so it is important to learn the facts about this disease and tests that can help doctors detect it. It is one of the most common types of cancer in women. As is the case with any type of cancer, early detection is the key to survival.
    While there are many organizations that offer guidelines for colon cancer, the most common recommendations for people aged 50 years and older include:
    • Fecal occult blood test (detects blood in the stool)—every year
    • Sigmoidoscopy—visual exam of the rectum and lower portion of the colon, every five years, or
    • Colonoscopy (visual exam of the rectum and entire colon) every 10 years, or
    • Barium enema (x-rays of the lower intestines using barium)—every 5 years, or
    • Computed tomographic colonography (computer that uses x-rays to make a picture of your intestines) every 5 years.

    Cervical Cancer

    A Pap test is used to identify cervical cancer before symptoms become apparent. As part of the test, cells scraped from the cervix are smeared on a slide and examined under a microscope for any unusual looking cells. Suspect cells identified during this procedure indicate the need for further testing.
    A sexually transmitted virus called the human papilloma virus (HPV) can cause changes in cervical cells. In some cases, these changes can lead to cancer. The HPV test, which can be used along with the Pap test, screens women for the HPV virus. The same cervical sample taken for the Pap test can be tested for HPV.
    If you are a healthy woman, many professional health organizations offer these recommendations for screening:
    • If you are aged 21-29 years—It is recommended that you have the Pap test every 3 years.
    • If you are aged 30-65—It is recommended that you have the Pap test along with the HPV test every five years. (Or, you can continue to have just the Pap test every three years.)
    • If you are aged 65 or older—You may be able to stop having Pap and HPV tests if you have had normal results (eg, three normal results in a row and no abnormal results in the past 10 years).
    Note: You will need to have Pap tests done more often if you have abnormal results or certain conditions, such as:

    Heart Disease Is a Women's Problem Too

    It is actually the most potent health risk for both men and women in the United States. A lipid profile that includes a measurement of total cholesterol, HDL "good" cholesterol, LDL "bad" cholesterol, and triglycerides is an important part of your preventive healthcare. As with other conditions, organizations vary in their screening guidelines. The USPSTF recommends cholesterol testing in women aged 20 years and older if they are at increased risk of coronary heart disease. And since high blood pressure is a risk factor for heart disease, USPSTF also suggests that all women (starting at age 18) get their blood pressure checked as part of routine medical care.

    Other Tests You May Need

    Depending on your age and risk factors, your doctor may also screen you for:
    • Osteoporosis—If you have reached your 65th birthday, the USPSTF recommends that you get screened for osteoporosis. Screening involves a bone mineral density test. This is a noninvasive way to measure bone mass. If you have risk factors for osteoporosis, screening should begin earlier.
    • Type 2 diabetes—According to the USPSTF, you should be screened for diabetes if your blood pressure is above 135/80 mmHg. But, the American Diabetes Association recommends screening in all adults aged 45 years and older. If you are overweight or obese with other risk factors (like a family history of diabetes or high cholesterol), screening is done at any age.
    • Sexually transmitted diseases—If you are aged 25 years or younger, the USPSTF recommends screening for chlamydia and gonorrhea. If you are at high risk (eg, having multiple partners, having a new partner, not using condoms), you should be screened at any age for chlamydia, gonorrhea, syphilis, and HIV.
    • Lung cancer—The American Lung Association and American Cancer Society both suggest that screening for lung cancer with a type of CT scan may be considered if you are a smoker (or former smoker), aged 55-74 years, and have a history of heavy smoking (eg, one pack a day for 30 years).
    You and your doctor can work together to create a screening schedule that is right for you.

    RESOURCES

    United States Department of Health and Human Services http://www.hhs.gov/

    WomensHealth.gov http://www.womenshealth.gov/

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    Women's Health Matters http://www.womenshealthmatters.ca/

    References

    American College of Obstetricians and Gynecologists practice bulletin number 131: Screening for cervical cancer. Obstet Gynecol. 2012;120(5):1222-38.

    American College of Obstetricians and Gynecologists. First cervical cancer screening delayed until age 21 less frequent Pap tests recommended. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/. Published November 20, 2009. Accessed November 23, 2009.

    Cervical cancer screening. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 9, 2012. Accessed June 14, 2012.

    Colorectal cancer screening. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 24, 2012. Accessed June 14, 2012.

    Diabetes mellitus type 2. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 5, 2012. Accessed June 14, 2012.

    Hypercholesterolemia. EBSCO DynaMed website. Available at: http://ebscohost.com/dynamed. Updated May 17, 2012. Accessed June 14, 2012.

    Hypertension. EBSCO DynaMed website. Available at: http://ebscohost.com/dynamed. Updated April 30, 2012. Accessed June 14, 2012.

    Lung cancer (non-small cell). American Cancer Society website. Available at: http://www.cancer.org/Cancer/LungCancer-Non-SmallCell/DetailedGuide/non-small-cell-lung-cancer-detection. Updated February 17, 2012.

    Mammography for breast cancer screening. EBSCO DynaMed website. Available at: http://ebscohost.com/dynamed. Updated April 26, 2012. Accessed June 14, 2012.

    Non-small cell lung cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 7, 2012. Accessed June 14, 2012.

    Osteoporosis. EBSCO DynaMed website. Available at: http://ebscohost.com/dynamed. Updated May 25, 2012. Accessed June 14, 2012.

    Sexually transmitted diseases. EBSCO DynaMed website. Available at: http://ebscohost.com/dynamed. Updated April 10, 2012. Accessed June 14, 2012.

    USPSTF recommendations for STI screening. Am Fam Physician. 2008;77(6):819.

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