Random Thoughts on Women’s health

I’m dividing this post into two parts. The first is on the recommendations for screening in females. The other part is some general thoughts on women’s health in general (and are somewhat generalizable to anyone’s health, male or female). The recommendations are taken from USPSTF related sites.

If you’ve read any or all of my earlier posts, you know I’m into screening and catching diseases early, especially if there is treatment for the particular disease.

Women should get pap smears every 3-5 years with HPV testing. The frequency depends on a woman’s age, whether the pap smear is negative and the results of HPV testing. It is important that the HPV testing be done via one of the five tests that are FDA approved: the unapproved tests from what I understand are more prone to error. Ask your doctor if he or she knows whether the lab he or she uses is FDA approved.

Screening for STIs (sexually transmitted infections) is suggested. This includes syphilis and HIV in high risk individuals.

Breast cancer screening (mammography) is done every 1-2 years starting at 50 (the old recommendations were every two years starting at 40, then yearly after age 50). BRAC testing should only be done if there is a family history of breast, ovarian, peritoneal cancer.

Bone density should be done at least once after age 64. However one can consider doing bone densitometry at an earlier age.

As much time and energy that people put into screening for breast cancer, cervical cancer, etc I think there a tendency forget about screening for heart disease and colorectal cancer, things I think people tend to see as “a man’s disease”.   However in 2010, 23.5% of deaths in women were due to heart disease,  and 22.1% were due to cancer deaths (this includes all cancer deaths, not just breast cancer).  Lung cancer killed 70,000 women whereas breast cancer killed 40,000 women that same year. These are  for the most part “lifestyle diseases” in as much as most lung cancer is caused by smoking; diet, lack of exercise, obesity contribute to heart disease. These are all things that are modifiable to a  great extent.

The Prevention Prescription, part 3

In my previous two posts I’ve written about different kinds of prevention (eg, primary, secondary, etc as well as vaccination which is a form of primary prevention). In this post I am going to talk about a couple of different things relating to prevention.

The first is that there are preventative measures which sometimes fall into more than one category. By this I mean that if we counsel someone to change their diet and exercise more because they’ve had a heart attack, give them aspirin, a statin, etc. that we’re engaging in tertiary prevention. However if they are on their way to becoming diabetic but because of the change in diet and increase the amount of exercise they do, and therefore lower their risk of Diabetes Mellitus, then one could argue that’s primary prevention (or secondary if they have metabolic syndrome…).

I’m a firm believer in using medication to lower cholesterol, blood pressure, etc when and if appropriate. However, I think we give short shrift to diet, exercise and sleeping enough as preventative measures to prevent or delay multiple medical problems.  Even if someone needs to be on medication, lifestyle changes are important to keep up. Exercise and diet do not become less important just because someone’s started medication. One recent study published in the New England Journal of Medicine comparing intensive lifestyle changes+usual care as compared to usual care did not reduce death. However there was evidence for a better quality of life and less need for medication, at least early on. There is a lot of evidence that enough exercise and good dietary practices can prevent and delay Diabetes. And for those that are cost conscious, a half an hour a day of walking is a lot cheaper than most medications!

There is a push by some physicians to actually prescribe exercise the same way we prescribe medications. Books have even been published on the matter!!

The Prevention Prescription, Part 2

In my last post I talked about vaccination, which is a form of primary prevention: it is the prevention of disease. There is also the concept of secondary prevention. In the case of secondary prevention, one has already has a disorder and doesn’t know it. Secondary prevention prevents the disease from getting to the point where it causes symptoms or complications (this is paraphrasing the definition on the CDC website). The example the CDC website uses is excising/taking a biopsy of a suspicious skin lesion before it becomes cancerous. Colonoscopy could also be put in the category of secondary prevention if pre cancerous polyps are found and removed before they become cancerous.

Sometimes it can be difficult to convince people to do some secondary prevention. Colonoscopy is one such item it is sometimes challenging to convince people to do. It is inconvenient as one needs to take a day off from work (if one is of working age and is working), has to have someone who’s willing to drive them home and requires taking things to clean their colon out so the colonoscopy can be done. When someone has a problem that can only be diagnosed by colonoscopy (eg: weight loss, fevers, and blood in the stool which could be a sign of inflammatory bowel disease, for example) people are worried enough about their health to get it.

Tertiary prevention is when one is trying to prevent complications or side effects of a disease which is already present. Examples of this are anticoagulation in people with atrial fibrillation, use of ACE inhibitors to prevent or slow kidney disease in diabetics.

In my next post I’ll take more about prevention and why it’s important.

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