An Ounce of Prevention: Keeping up with Preventive Women’s Health Care
By Louise D. Metz, MD
At the onset of the COVID-19 pandemic, many appropriately delayed their routine medical care. However, as the pandemic has continued, it has become crucial to continue to seek care for chronic medical conditions and preventive wellness during this unique time. Preventive health recommendations change over time as new evidence emerges. Check out these latest guidelines for preventive care in women and make sure that you are up to date!
Cervical Cancer Screening
A pap smear or pap test is the screening test for cervical cancer, which is caused by the HPV virus. The US Preventive Services Task Force (USPSTF) recommends that women between the ages of 21 and 29 have a pap smear every 3 years, and women between the ages of 30 and 65 have a pap smear with HPV testing every 5 years. Five years between tests seems like a long time, but the evidence is clear in support of this guideline. And just in the last few months, the American Cancer Society put out new recommendations to begin cervical cancer screening at age 25 instead of 21. Other medical groups, including the American College of Obstetrics and Gynecology and USPSTF, have not followed suit on this guideline change as of yet, but keep an eye out for changes on this front.
Your Primary Care or Women’s Health Provider can support you in making decisions about these preventive care tests. This essential aspect of women’s health care should not be delayed!
Breast Cancer Screening
Decisions about breast cancer screening involve shared decision-making with your healthcare provider. Mammograms are indicated and are most accurate when performed every 1-2 years between the ages 50 and 74. The option to start breast cancer screening earlier at age 40 is a personal choice that can be made after considering your individual risk and the potential for false positive results in this age range. Women who have a strong family history of breast cancer or ovarian cancer should also discuss whether testing for high risk genetic mutations and earlier screening are indicated. In particular, women with a first degree relative with breast cancer should start screening 10 years prior to the family member’s diagnosis.
Colon Cancer Screening
The major medical societies recommend initiating colon cancer screening at age 50 and continuing at least through age 75. A colonoscopy every 10 years (or more often if abnormal) is still the preferred screening test, but alternatives include a Fecal Immunochemical Test for occult blood once a year, a stool DNA testing every 3 years, or a CT colonography every 5 years. Of note, there is evidence that African Americans benefit from beginning screening earlier at age 45. A family history of colon cancer is another indication to begin screening earlier than 50.
Ovarian Cancer Screening
Unfortunately, there are not currently any effective screening tests for ovarian cancer. Studies looking at routine pelvic exams, pelvic ultrasounds, and blood tests have shown no benefit to performing these tests for screening in average-risk women. However, women with a family history of ovarian or breast cancer, or a known high-risk genetic mutation such as the BRCA mutation may benefit from testing.
Vaccinations
It is particularly important to keep up with routine vaccinations in order to prevent other infections and outbreaks while we are in the midst of the COVID-19 pandemic. Here are the CDC-recommended vaccines for adult women:
- Tetanus/Tdap: Every 10 years. Protects against lockjaw caused by the tetanus bacteria that can be acquired during an injury. Also protects against Whooping cough, and therefore is important for pregnant or postpartum women to receive in order to protect infants from this illness.
- Pneumonia vaccine: Indicated for adults with asthma, heart disease, liver disease, diabetes, alcoholism or cigarette smoking.
- Shingles vaccine: Recommended for people 50 and over to protect against reactivation of the chickenpox virus causing a painful rash.
- Influenza vaccine: Every year for all ages, especially this year when we will have COVID-19 and Influenza circulating!
- HPV vaccine: Three shot series to prevent HPV infection and HPV-associated cancers. Though the HPV vaccine was previously approved through age 26, it is now approved for use up through age 45. If you are within this age range and have not received this vaccine, it is not too late!
- MMR: Typically given in childhood, but some women require a booster if immunity has waned at time of pregnancy or if they did not receive the full series during childhood.
Lab Screening Tests
Lab testing is generally considered an essential part of annual check-up, but the evidence supports only a limited number of screening blood tests:
- Cholesterol screening: Recommended every 5 years for women 45 years and older, or beginning at age 20 if high risk of heart disease (diabetes, hypertension, family history of heart disease).
- Diabetes screening: Recommended every 3 years in women 40 years and older, or beginning at younger ages in women with PCOS, history of gestational diabetes, or a family history of diabetes.
- Thyroid screening: Evidence is limited, but consider screening periodically in women with a family history of thyroid disease, or certainly if symptoms of thyroid disease arise.
Lab testing is generally considered an essential part of annual check-up, but the evidence supports only a limited number of screening blood tests:
- Cholesterol screening: Recommended every 5 years for women 45 years and older, or beginning at age 20 if high risk of heart disease (diabetes, hypertension, family history of heart disease).
- Diabetes screening: Recommended every 3 years in women 40 years and older, or beginning at younger ages in women with PCOS, history of gestational diabetes, or a family history of diabetes.
- Thyroid screening: Evidence is limited, but consider screening periodically in women with a family history of thyroid disease, or certainly if symptoms of thyroid disease arise.
Osteoporosis Screening
A bone density test is an X-ray test of the spine and hips that evaluates for osteopenia or osteoporosis, which is low bone density, and predicts the risk of fractures. Bone density tests are indicated for women who are 65 and older. However, screening should begin at younger ages for women with early menopause, chronic steroid use, overactive thyroid, anorexia nervosa, cigarette smoking, heavy alcohol use, rheumatoid arthritis, personal history of fracture, or parental history of hip fracture.
Your Primary Care or Women’s Health Provider can support you in making decisions about these preventive care tests. This essential aspect of women’s health care should not be delayed!
References:
United States Preventive Service Task Force (USPSTF): https://www.uspreventiveservicestaskforce.org/uspstf/
CDC Vaccination Guidelines: https://www.cdc.gov/vaccines/schedules/
Dr. Louise Metz is an Internal Medicine Physician who has expertise in the medical management of eating disorders and gender-related medical care. She is the owner and founder of Mosaic Comprehensive Care, a medical practice in Chapel Hill that offers weight-inclusive primary care and gynecologic care for adolescents and adults of all genders.
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