“An Apple A Day”
Orcas Family
Health Center
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“Apple A Day Articles”
FDA LICENSES NEWVACCINE FOR PREVENTION OF CERVICAL CANCER
ONE FLU OVER THE CUCKOO’S NEST
AN APPLE A DAY…FOR WOMEN
In continuing our series on medical screening tests, this article will deal with women’s health issues. These recommendations are for SCREENING tests and are only appropriate for asymptomatic patients. The US Preventive Services Task Force (USPSTF) uses a rating system (shown below) which “grades” each test based on evidence and its benefit to the patient.
Most women view mammograms as a standard part of their annual exam. The current recommendation is for a screening mammography every 1-2 years in women ages 40+ (B rating). The best evidence that screening mammography can help diagnose breast cancer and lead to better outcomes is in women ages 50-69. Yearly complete breast exams and teaching self-breast exam have both received I ratings, as no studies exist that do not also combine these “screening” tests with mammography.
Screening for cervical cancer through use of the cervical cytology smear (Pap smear) received an A recommendation. Paps should begin within three years of onset of sexual activity and done at least every three years in sexually active women. Over age 65 and for women who have had total hysterectomies for benign diseases, it has received a D – IF they have had adequate screening and are not considered “high risk” individuals. While Human Papilloma Virus (HPV) is felt to be a major factor in the development of cervical cancer, at this time routine screening for it has received an I rating. Trials are underway to determine whether it will become a routine part of the gynecologic exam. Ovarian cancer has no adequate screening test although patients sometimes request CA 125 blood levels. Use of this test for these purposes has a D rating. Menopause and Hormone Replacement Therapy (HRT) have received a lot of press in the past few years. For women on combined therapy (estrogen/progesterone) it currently has received a D rating for use in
prevention of chronic conditions. Though combined HRT increases bone strength and decreases the risk of colon cancer, it also seems to increase the risk of breast cancer, blood clots, stroke and heart disease. For women on estrogen therapy alone, the rating is currently”/‘, or undetermined if there is either benefit or harm done. These recommendations do not include women who are taking HRT of either form for short- term menopausal symptom relief.
With menopause come concerns about bone demineralization, or osteoporosis. While new medicines exist to treat this, calcium supplementation of 1200-1500 mg daily (B rating) and weight bearing exercise are also felt to be helpful in prevention of bone loss. Women over age 65 are at greatest risk of osteoporosis and should be routinely screened (the gold standard test at this time being a DEXA Scan of the lumbar spine and hip).
Remember, these tests may not be indicated for everyone. Please discuss them with your healthcare provider so they can be utilized appropriately. You can contact our office at 376-7778 for an appointment.
A=Strongly recommended with good evidence for benefit to the patient
B=Recommended with fair evidence for patient benefit
C=No recommendation for or against as the evidence is too close to call
D=Recommended AGAINST providing to patients as risks outweigh benefits
I=Evidence is insufficient to recommend for or against the test.