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