Health screening for women



A) Screening for chronic illness from 40 years of age


1. Hypertension

The blood pressure should be measured at least once every 2 years.


2. Obesity

The body mass index should be measured at least once every year.


3. Diabetes Mellitus

Fasting blood test should be done to check for diabetes mellitus at least once every 3 years.


4. High cholesterol level (from age of 40 and age)

Fasting blood test should be done to check for high cholesterol level at least once every 3 years.


B) Immunisation


1. HPV vaccination is recommended for all women between 9 to 45 years old.


C) Screening for cancers


1. Cervical cancer from age of 25 onwards


Human papillomavirus (HPV) test for high risk subtypes is a simple test (obtained from the cervix just like with a Pap smear) for the presence of HPV high risk types in the cervix. This should be done for women who have had sexual intercourse from 30 years old onwards. Recent guidelines have promoted that women should have this test rather than the Pap smear. If tested negative, this needs to be repeated only 5 years later.


Pap smear is a simple test to check for abnormal cell changes in the cervix after you have had sexual intercourse, and are above 25 years old. If the HPV test for the high risk subtypes is positive, a Pap smear to look for pre-cancerous changes in the cervix should be performed as well. For women between 25-29 years old, Pap smear should be done at least once a year for at least 3 years. If there is no HPV test results available, Pap smear should be performed at least every 3 years if the previous results have been normal.


2. Breast cancer from age 40 onwards


Risk factors for developing breast cancer include:

  • overweight or obese

  • use of hormone therapy

  • physical inactivity

  • use of alcohol

  • older age

  • personal or family history of breast cancer

  • inherited genetic mutations e.g. BRCA gene mutations

  • personal history of certain benign or precancerous breast conditions

  • dense breast tissue

  • early menarche, late menopause

  • no previous deliveries of babies


Factors that decrease the risk of breast cancer include"

  • have breastfed for at least 1 year

  • have exercised regularly

  • have healthy body weight


You could use this online calculator to calculate your risk of developing breast cancer (http://www.cancer.gov/bcrisktool).


Breast self-examination (BSE) vs Breast Self Awareness


Monthly breast self-examination does not reduce breast cancer-related mortality, and is associated with an increased rate of benign biopsies.


Instead, it is important for you to be aware of the way your breasts normally appear and feel. If there is any change that occur in your own body, please discuss these changes with the doctor. This would usually be followed by a breast examination by the doctor followed by reassurance or further imaging with ultrasound scan of the breasts or mammogram.


Clinical Breast Examination


Clinical breast examination by the doctor may detect a small proportion of breast cancers not detected by screening mammograms. While there is no clear evidence that clinical breast examination provides a clear net benefit for average risk women, the ACOG still continues to advocate the use of CBE every 1-3 years between ages 20-39; every year from 40 years old onwards.


Mammogram


Asymptomatic women of average risk (< 15% lifetime risk of developing breast cancer)


Its use as a screening tool in women 40 years of age or older has been consistently proven to lower death rate among women. It is able to detect small breast cancers before the onset of symptoms. Mammogram is able to detect 70-90% of breast cancers.


There is a small net benefit of screening mammogram for average risk patients between 40-49 years old. This should be balanced with the potential harms of mammograms, namely overdiagnosis and overtreatment. Therefore the decision to start screening mammogram in women prior to age 50 years old should be an individual one. This can be done every 2 years.


Asymptomatic women of moderate risk (15-20% lifetime risk of developing breast cancer)


This group includes patients with :

  • a personal history of breast cancer

  • a personal history of DCIS or LCIS

  • a personal history of ADH or ALH

  • Extremely dense breasts

  • Life time risk of 15-20% as calculated by a risk model

Annual mammogram and consider annual MRI.


Asymptomatic women of high risk (> 20% lifetime risk of developing breast cancer)


This group includes patients with :

  • a personal BRCA1 or BRCA2 gene mutation

  • a first degree relative with a BRCA1 or BRCA2 gene mutation, with the patient's own genetic status unknown

  • a personal history of a genetic syndrome associated with an increased breast cancer risk (e.g. Li-Fraumeni, Cowden and Bannayan-Riley-Ruvalcba syndromes), or a first degree relative with one of these syndromes

  • a personal history of radiation to the chest wall between ages of 10 and 30 years (i.e. prior treated Hodgkin's lymphoma

  • Life time risk of >20% as calculated by a risk model

Consider mammogram and screening MRI from age 30 years onwards. For example, alternative between MRI and mammography every 6 months.


Symptomatic women


Consider ultrasound if the woman is < 40 years old, and ultrasound and/or mammogram if >= 40 years old.


Those with dense breasts


Combine mammogram and ultrasound breasts


3. Colorectal cancer from age 50 onwards


This could be accomplished by either testing the faeces for occult blood every year or by doing screening colonoscopy every 10 years.

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