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September 21, 2017

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Key screening procedures for women

Preventive health screenings are important for everyone, but for women, there is a special set of risks that screenings can help minimize.

Due to changes in hormonal composition pre- and post-menopause, women are more susceptible to certain diseases and cancers. In the United States, 1 in 8 women is diagnosed with breast cancer. Women also face risks of cervical cancer, ovarian cancer and other diseases. Because of these risks, maintaining a diligent and ongoing screening routine is critical, said Dr. Margaret Terhar, MD, FACS at Comprehensive Cancer Centers of Nevada and Sunrise Hospital and Medical Center.

Annual appointment with a general care physician

All ages

Men and women should see a physician once a year for a check-up. Even for people who feel perfectly healthy, an annual checkup might help catch subtle abnormalities that could lead to larger problems. Annual check-ups can include blood pressure checks, cholesterol tests and blood glucose checks.

HPV Vaccine

For ages 11 to 26, a series of three shots

The HPV vaccine is a series of three shots given over a six-month period to protect against HPV. Although the vaccines do not protect against all HPV strains — which is why Pap smears still are necessary for all women — the series does address the most damaging strains commonly linked to cervical cancer. Ideally, all pre-teen girls and boys, ages 11 to 13, would get the vaccination before becoming sexually active. If not, it is recommended that people ages 13 to 26 get the vaccination regardless of their sexual experience.

Breast Self-Exam

Starting at age 18, once a month thereafter

“Many women are intimidated by this, especially because normal breast tissue tends to be somewhat lumpy, which can lead to unnecessary concern. The goal for self-exams is just to get women familiar with their breast tissue so that they’d be able to notice if there was a change,” Terhar said.

Tips for self-exams

Breast tissue begins at the collarbone, extends to the middle part of the ribcage and goes across the middle of the breastbone into the arm from the armpit. “Women need to examine all the breast tissue, and it’s often preferred to start in the middle of the breast and work your way out and across in circles,” Terhar said. She also notes that for many women, it’s more comfortable to do this in the shower so skin is slippery. Premenopausal women should examine seven to 10 days after their period starts because hormones can affect the consistency of breast tissue, making it harder to decipher a change. Postmenopausal women also should examine themselves monthly, but they don’t need to do it on the same day each month.

Skin examinations

Age 18, regularly thereafter

All people should examine their skin for unusual growths, which could include cancerous moles. Skin examinations also should be a part of all routine physicals.

Pap smear

By age 21 and ongoing, frequency depends on age and results

A Pap smear is an integral screening for detecting cervical cancer. Based on risk factors or past Pap smear results, some women will need to get checked more regularly than every two or three years. Women also should get tested for human papillomavirus during alternating years. After 30 years old, if there haven’t been abnormal results, most women should get Pap smears and HPV tests every five years.

Pelvic exams

Age 21, annually thereafter

During a pelvic exam, a physician will check for any abnormalities or signs of illness in the uterus, cervix, fallopian tubes, ovaries and bladder. Getting an annual pelvic exam also can help ensure a patient stays up-to-date with other sexual health screenings, including Pap smears and STD testing.

Mammogram

Age 40, every one to two years thereafter

“There’s some controversy around how often the majority of women should be getting mammograms,” Terhar said. “Some think it’s best to do it once a year, whereas others think every other year is sufficient. Women should consult with their physicians and make a plan considering their individual risk factors.” Some women’s risk factors might require them to get their first mammogram before age 40.

Menopause

Age 45 to 55

Menopause occurs in three phases: premenopause, menopause and postmenopause. Postmenopause usually begins when a woman is in her early- to mid-50s. It lasts the rest of her life. Postmenopausal women are more prone to heart disease because of hormonal shifts, so it’s important that women be especially diligent about getting their blood pressure and cholesterol checked postmenopause.

Colonoscopy

Age 50 and ongoing, frequency depends on results

At age 50, all women should get a colonoscopy to screen for colon polyps and colon cancer. If nothing appears irregular, the patient should get a colonoscopy every eight to 10 years thereafter.

Bone-density screening

Age 65 and ongoing, frequency depends on results

Women who are 65 or who have broken a bone postmenopause should have a bone density screening to test for osteoporosis. Depending on the results, the physician will decide if, and how often, the woman needs to be rescreened.

Genetic testing can aid cancer prevention

Women who test positive for the BRCA mutation in either the BRCA1 or BRCA2 genes have an increased risk for breast or ovarian cancer by as much as 85 percent.

“For women who are BRCA positive, it’s best to find out early because they’ll need to speak to their physician about ongoing care options,” Terhar said.

Such gene mutations are fairly rare in the general population, but being able to identify them for women who are at risk can mean more prevention and better treatment.

“Genetics are the biggest indicator for breast and ovarian cancer, but the majority of breast cancers — 80 percent or more — are sporadic,” Terhar said. “They just happen. Women who have genetic ties to breast cancer have higher risks individually, but all women are susceptible.”

Who should consider genetic testing for the BRCA gene mutation?

• Women who have multiple family members who have had breast or ovarian cancer, especially family members who have had cancer in both breasts, have had breast cancer multiple times, have had both breast and ovarian cancer or had either cancer before menopause

• Women who have male family members who have had breast cancer

• Ashkenazi (European) Jewish women

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