Smart Testing: Health Screenings for Women

Yes, yes. You know you’re overdue for your annual physical. And when was the last time you visited your dentist? Most women know that routine tests can be essential to maintaining good health, but our packed schedules and overflowing to-do lists often shove suggested medical screenings to the side. Still, a short talk with your doctor to learn which tests make sense for you can mean the difference between life and death.

“The goal of medical screening tests is to find diseases early, while they are easier to treat,” says Dr. Cheryl Rucker-Whitaker, assistant professor of preventive medicine at Rush University Medical Center.

Knowing which tests are recommended for your age and understanding the relative risk levels are first steps, says Dr. Rachel Oosterbaan, doctor of internal medicine at Northwestern Memorial Hospital.

“So many patients think that they should be screened for everything at any age,” Dr. Oosterbaan says. “But if you screen a woman for breast cancer at age 30, the risk of receiving a false-positive result from the mammogram is higher than her risk of breast cancer.”

A good screening test, she explains, is sensitive (it detects the disease in most cases and also in its early stages) and specific (meaning that the test picks up very few false positives).  “The reason these certain tests are chosen is that the diseases they screen for are prevalent in this age group, and they are treatable,” Dr. Oosterbaan says.

The following guide, based on recommendations from several Chicago physicians and the U.S. Preventive Services Task Force, outlines the recommended screening tests for women in a range of age groups. The list is by no means exhaustive, and screening needs often vary, based on a woman’s family history, health habits and medical history.

20s – 30s

Pap smear. This test screens for cervical cancer by swabbing cells from the cervix and then testing the cells for abnormalities. The Pap has decreased the death rate from cervical cancer by more than 74 percent over the last 50 years, according to the American Cancer Society. “I recommend that women ask their doctors for a liquid-based Pap smear, because it’s more sensitive than testing on a slide, and you can do reflex testing for human papillomavirus (HPV), the virus that causes most cervical cancers,” Dr. Oosterbaan says. Frequency: First Pap smear, three years after first sexual intercourse or at age 21. Thereafter, annually until age 30. After age 30, assuming the woman has one sexual partner and has had three consecutive normal Pap smears, every two to three years.

Clinical and self-exams of the breast. These tests can be lifesavers in detecting breast cancer early, while the lump may still be small and easily treated. Women should get clinical breast exams at their yearly gynecological physical, Dr. Rucker-Whitaker says, but she also recommends a monthly breast self-exam. “Your doctor will, of course, have a higher level of expertise in detecting abnormalities,” she explains. “But women also know their own bodies well, so you can point out things for your doctor to check.” Visit komen.org for a visual tutorial on how to perform a breast self-exam. Frequency: Clinical breast exams at least every three years; self-exams monthly, roughly a week after the start of your period.

 

STD testing. Testing for sexually transmitted diseases is important for women 25 and younger who are sexually active, according to the U.S. Preventive Services Task Force. A doctor will perform a DNA probe (similar to a cervical swab for a Pap smear) to check for gonorrhea and chlamydia and run blood tests to screen for syphilis, hepatitis and HIV. “Several STDs, such as chlamydia, can have virtually no symptoms,” says Dr. Maura Quinlan, an ob/gyn at MacNeal Physicians Group. “If such an infection is left untreated, it can cause problems later in life, like infertility.” Frequency: Annually, or every three to six months if you have a new sexual partner. Women in monogamous relationships should discuss their need for testing with their doctors.

BMI (Body Mass Index). Women should strive to maintain their ideal body weight to manage their risk for diabetes, high blood pressure, cardiovascular disease and cancer later in life, Dr. Rucker-Whitaker says. Calculate your Body Mass Index, a measure of body fat based on height and weight, by visiting The National Heart, Lung and Blood Institute’s website at nhlbisupport.com/bmi and using its BMI calculator tool. Frequency: Regularly.

Blood pressure screening. The American Heart Association estimates that nearly one in three Americans has high blood pressure and doesn’t know it. Uncontrolled high blood pressure can lead to stroke, heart attack, heart failure or kidney failure. Luckily, this simple test can be performed at any doctor’s office. Frequency: Every two years, or more frequently, depending on family history. If your blood pressure is higher than 130/85, get tested annually.

40s

Mammograms. A mammogram, an X-ray of the breast, screens for cancer. Finding small breast cancers early greatly improves a woman’s chance for successful treatment. In fact, the American Cancer Society reports that when breast cancer is detected at a localized stage (it hasn’t spread to the lymph nodes), the five-year survival rate is 98 percent. Still, it is important that women in their 40s undergo aggressive screening. “The rate of growth of breast cancer in women is actually higher between ages 40 to 50 than at 50 and above,” Dr. Oosterbaan says. “So, it’s essential for women in this age bracket to get annual mammograms and to continue with monthly breast self-exams and yearly clinical breast exams.” Frequency: Annually. Mammograms should be done before age 40 if a woman has a strong family history of breast cancer.

Lipid profile and fasting blood-glucose test. A lipid profile is a simple blood test that screens for high cholesterol, which can increase a woman’s risk for heart disease, stroke and, interestingly, gallbladder disease. Ideally, the test is done after fasting for six to eight hours. Likewise, a blood glucose test measures blood glucose levels after fasting and can determine a patient’s risk for developing diabetes. A more definitive screen for diabetes is a glycohemoglobin blood test. Frequency: Lipid profile, annually, starting at age 45. If you smoke, have diabetes or a family history of heart disease, start having cholesterol checked at age 20. Blood-glucose test frequency varies depending on a patient’s blood pressure, cholesterol and family history.

Eye exam. A complete eye exam should be done, starting at age 40, to catch vision changes and to address eye-health problems. An ophthalmologist will check the pressure in the eye; elevated pressure is a sign of glaucoma (damage to the optic nerve that can result in blindness), which is usually highly treatable if caught early.  An eye exam can also screen for the earliest changes of previously undiagnosed diabetes. Frequency: If you have good vision, every two years from age 40 to 65. After 65, annually.

50s

Heart disease testing. Several tests diagnose possible heart disease including cardiac stress tests and echocardiograms. The choice of which (and how many) tests to perform depends on variables such as a patient’s risk factors, advent of menopause, history of heart problems and current symptoms, as well as the doctor’s interpretation of these factors. Frequency: Depends on age, family history and initial cholesterol levels.

Colonoscopy. During this procedure, a doctor looks inside the large intestine using a colonoscope, an instrument with a tiny video camera, to find issues such as inflamed tissue, abnormal growths and ulcers. “Colon cancer is the third most common cancer in women, so it’s really important that patients take responsibility and get this test as recommended,” Dr. Oosterbaan says. Ask your primary-care physician for a referral to a gastroenterologist, who performs colonoscopies. Frequency: Once at age 50 and then based on your doctor’s recommendation. The procedure may be recommended earlier if you have a family history of colon cancer or another inflammatory bowel disease.

Bone-mineral density test. This test determines whether women are at risk for osteoporosis, a crippling bone weakness that affects nearly 10 million older Americans, 80 percent of whom are women, according to The National Osteoporosis Foundation. The DEXA (dual-energy X-ray) scan is noninvasive and accurate; a patient lies fully clothed on a table while the X-ray machine scans the body. Frequency: Annually, beginning at age 65. Women with a family history of osteoporosis or women at risk (heavy smokers, underweight, heavy caffeine or alcohol intake) should get scanned at an earlier age.

60s+

Abdominal Aortic Aneurysm. According to the U.S. Preventive Services Task Force, if you are between the ages of 65 and 75 and have ever smoked (100 or more cigarettes during your lifetime), you need to be screened once for abdominal aortic aneurysm, which is an abnormally large or swollen blood vessel in your abdomen.­

 

For additional information, consult the U.S. Preventive Services Task Force of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services: ahrq.gov/clinic/uspstfix.htm

For additional information on the list of recommended preventive medical screening tests, the AHRQ provides separate pages for men and women: ahrq.gov/ppip/healthymen.htm; ahrq.gov/ppip/healthywom.htm

(Reprinted from Chicago Health: Top Doctors & Hospitals, November 2010)

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Published in Chicago Health Winter 2010