Vital medical tests for women

Must have medical tests for women to take and when to take them with Dr. Kymm Feldman.

MUST HAVE MEDICAL TESTS FOR WOMEN:

Which tests to  take and when to take them

Pap Test: 

-Paps check for early changes of cervical cancer (the cervix is the opening to the uterus)

-Cervical changes that can lead to cancer are mostly caused by HPV (human papilloma virus) HPV also causes genital warts. The strains that cause genital warts DO NOT cause cancer.

-The pap smear does not check for infection with other sexually transmitted infections

-The changes from HPV will not necessarily become cancer but if you’ve had an abnormal pap it is important to follow up with your doctor because they could.

For screening there are varying practices throughout the country but the national guidelines say: Start: age 18 or within 3 years of first sex (whatever comes first), regardless of gender of partner, every year until 2 normals then every 2-3 years depending on whether a recall system is in place. End age 70 if history of 3 normals in past ten years and no abnormals in that time.

Screening increases for those with risk factors like HIV or decreased immune systems.

Prevention:

Use condoms
Don’t smoke
Consider the HPV Vaccine (Gardasil) routine for all grade 8 girls.

Breast:

 -Mammograms beginning at age 50 every two years. -Controversial between 40 and 50

-Could be earlier/more often if family history (usually start screening 10 years prior to mother or sister with cancer)

Why is it controversial between 40-50?

-May be some small benefit of mammograms for women in their 40’s but lower risk of cancer in the first place and high risk of false positives because breast tissue in the 40’s is more dense…so harder to see anything on the mammogram.

-Also if a woman gets a breast cancer in her 40’s it may be more likely to be aggressive so may be missed in the yearly and may not change the outcome anyway.

It’s a decision that must be discussed individually with each dr. and patient and individual risk factors considered.

Minimize alcohol intake: Even one drink a day can increase the risk of breast cancer…but we are told that in women up to 9 drinks a week is okay and may even be helpful for the heart…a conundrum!

Increase vegetables and fruit: Anti-oxidant: (Esp. broccoli, bok choy, Brussels sprouts, cabbage, cauliflower and kale are especially protective from breast cancer, particularly when eaten raw or lightly cooked.) Cut fat and Control body weight b/c fat cells can turn into estrogen peripherally.

Add daily exercise: Moderate exercise has been shown to improve breast cancer survival. (i.e. in one study, walking 30 minutes six days a week, regular exercise lowers levels of circulating estrogen)

Colon Cancer Screening:

Beginning at age 50, average risk (no significant family history): Stool sample to check for microscopic blood (Fecal occult blood testing) every two years

Sigmoidoscopy every 5 yrs

Double Contrast Barium Enema every 5 yrs

Colonoscopy every 10 years

Risks for colon cancer:

Age
Past medical history of crohn’s or colitis
Family history

 Prevention:

Eat a balanced diet.
Maintain a healthy weight.
Maintain an active lifestyle
Don't smoke

 Bone Mineral Density Testing:

Now begin at age 65 unless there are risk factors.

Consider Bone Density Testing at 50 if:

Low trauma fracture after age 40
Prolonged steroid or other high-risk medication use
Parental hip fracture
High alcohol intake (>3 drinks/day or current smoking)
Low body weight (< 60 kg) or major weight
loss (>10% of weight at age 25)

Consider Bone Density Testing younger than 50 if:

High-risk medication use, other problems like malabsorption syndrome etc.

Prevention:

Weight bearing exercises (running, weight lifting)
Calcium 1200 mg/day
Vitamin D 800-2000 I.U./day of > age 50 (400-1000 I.U./day if < age 50)

 Blood Work: Blood Sugar: Check every 3 years beginning at age 40 (more often if risk factors like high blood pressure, obesity etc.)

Cholesterol: Women > 50 years old or post-menopausal

Screen younger if risk factors: obesity, diabetes, high blood pressure, smoker, family history

Probably also reasonable to check a complete blood count (which may be a reflection of iron deficiency or vitamin B12 status), especially in menstruating women.