• www.ColumbusClinic.org
Health Maintenance
for Women
L. Jill Moore, MD, CCD
US Women’s Health Stats
•
•
•
•
•
Approximately 155 million women (all ages)
17% of women age >18 currently smoke
36% of women age >20 are obese
33% of women age >20 have hypertension
68% of women age >40 had a mammogram in
the past 2 years
• 75% of women age >18 had Pap smear in past
3 years
Leading Causes of Death
• Heart Disease
• Cancer
• Stroke
10 Leading Causes of Death, 2007
US Women
1
Diseases of the Heart
306,246
25.1%
2
Malignant Neoplasms
270,018
22.1%
3
Cerebrovascular Diseases (stroke)
81,841
6.7%
4
Chronic Lower Respiratory Diseases (COPD)
66,689
5.5%
5
Alzheimer’s Disease
52,832
4.3%
6
Accidents/Unintentional Injuries
43,879
3.6%
7
Diabetes Mellitus
35,904
2.9%
8
Influenza and Pneumonia
28,646
2.3%
9
Kidney Disease/Kidney Failure
23,832
2.0%
10
Septicemia
18,989
1.6%
How Do I Stay Healthy?
Staying Healthy
•
•
•
•
•
•
•
Proper Diet
Appropriate Exercise
Good Sleep Habits
Manage Stress
Immunizations
Screening Exams
Spiritual Health
DISCLAIMER
• Screening and immunization
recommendations may vary depending on the
source (CDC, WHO, NIH, AMA, American
Cancer Society, your insurance carrier, or local
church group bible study)
• Specific disease states or conditions may
warrant earlier or more frequent testing than
discussed here today
IMMUNIZATIONS
Immunizations
• Yearly influenza vaccine – all ages (yes, everyone)
• HPV vaccine – age 9 up to age 26
• Meningococcal vaccine – for college students and
military recruits
• Tetanus-diphtheria-pertussis booster every 10
years – all ages
• Pneumococcal vaccine – once at age 65, sooner if
risk factors such as asthma, COPD, diabetes
• Herpes Zoster (Shingles) vaccine – once > age 60
SCREENING EXAMS
Blood Pressure
• Will be checked at annual wellness visit
• Average blood pressure 120/80, need to treat
if >140/90 on 2 different days
Height and Weight
• Will be checked at annual wellness visit
• Calculation of BMI
• Recommendations can be given regarding
appropriate weight for height
Cholesterol Test
•
•
•
•
Total cholesterol goal < 200
Triglycerides goal < 150
HDL (good cholesterol) >50
LDL (bad cholesterol) <130
– If diabetic then < 100
– If history of stroke or heart attack, then < 70
Frequency of testing to be determined by provider
based on risk factors
Glucose Test/Diabetes Screening
• Elevated blood sugar is often asymptomatic
• Check at least every 3 years starting in 40’s
• More frequent and earlier testing would be
appropriate for those at higher risk such as
those with family history, overweight status,
or specific symptoms
Thyroid Function Test
• Proper thyroid function is critical for most
body systems
• Malfunctioning thyroid may not initially cause
symptoms
• Based on overall health and risk factors,
doctor can determine frequency of screening
Pap Test Cervical Cancer Screening
Pap Test
•
•
•
•
•
•
•
20’s – start age 21, every 2 years
30’s – every 3 years
40’s – every 3 years
50’s – every 3 years
60’s – discuss with doctor about when to stop
70’s – may not be necessary, but optional
Pelvic exam every year beginning at age 21
STD Testing
• Annual chlamydia test until age 25 if sexually
active, repeat if new or multiple partners (all
ages); the same specimen collected may also
test for gonorrhea.
• Both partners should be tested for HIV,
syphilis, hepatitis. (all ages)
• Always request additional testing for any
suspicious symptoms.
Mammogram
Digital Mammogram vs. Traditional X-ray Mammogram
Digital Mammogram vs. MRI
Mammogram Frequency
• Starting age 40
• Every 1-2 years, discuss with your physician
regarding individual risk factors
• May need to start sooner depending on family
history
• Still need annual breast manual exam by
healthcare provider, between 10-15% of
breast lumps are not visible on standard
mammogram
Clinical Breast Exam
• 20’s and 30’s at least every 3 years
• 40’s and over, every year
Breast Self-Exam
• Previous recommendation was monthly selfexam after proper instruction
• Research no longer supports this
recommendation, but be sure to share
concerns with your doctor
Risk Factors for Breast Cancer
• Family History of Breast or Ovarian Cancer
• Genetics and Ethnicity, Blacks or Ashkenazi Jewish are
higher risk
• Cigarette Smoking
• Obesity
• Excess Alcohol Use, 2 servings per day
• Advanced Age
• Early Onset of Menses < age 12
• BPA exposure/plastics
• ? Excess Soy, plant estrogens
• ? Estrogen HRT +/- Progesterone, WHI study revisited
BRACAnalysis Test
• A test for hereditary breast and ovarian cancer
syndrome
• The test does not tell you if you have cancer
currently, but detects genetic mutations in
BRCA 1 and BRCA 2 genes.
• Insurance coverage for this blood test makes it
affordable for most.
Who Should Consider BRACAnalysis
testing?
Patients with any of the following in their personal or family
history may be candidates for BRACAnalysis® testing:
•
•
•
•
•
•
•
Breast cancer diagnosed < age 50
Ovarian cancer at any age
Two primary breast cancers
Male breast cancer
Triple negative breast cancer
Pancreas cancer with additional HBOC cancer
Ashkenazi Jew descent with additional HBOC
cancer
• A previously identified BRCA gene mutation in the
family
Abnormal BRCA gene increases risk of
Breast and Ovarian Cancer
Risks can be Reduced with Proven
Medical Management
Medical Management Options
•
Increased Surveillance for Breast Cancer in Mutation Carriers
•
•
•
•
Monthly breast self-exams starting at age 1812
Annual or semiannual clinical breast exams starting at age 2513
Yearly mammography starting at age 2512,13
Yearly magnetic resonance imaging (MRI) starting at age 25 or individualized based on earliest case in the family 12,14
•
Increased Surveillance for Ovarian Cancer in Mutation Carriers
•
•
•
Annual or semiannual transvaginal ultrasound12,13
Annual of semiannual blood test for CA125 beginning at age 2512,13
Annual pelvic exams
•
Risk Reducing Medications for Mutation Carriers
•
•
•
Tamoxifen use has been associated with a reduction of 53% in the risk of a second primary breast cancer in contralateral cancers 15
Oral contraceptives, when taken for 6 or more years, have been associated with a reduction of up to 60% in the risk of ovarian cancer16
Prophylactic Surgery in Mutation Carriers
•
•
•
•
Prophylactic mastectomy reduces breast cancer risk by at least 90%17
Prophylactic oophorectomy reduces ovarian cancer risk by up to 96% and breast cancer risk by up to 68% 18,19
*Any discussion of medical management options is for general informational purposes only and does not constitute a recommendation. While
genetic testing and medical society guidelines provide important and useful information, medical management decisions should be made based on
consultation between each patient and his or her healthcare provider.
DXA Scan Osteoporosis Screening
Vertebral Fracture Analysis
DXA Scan
• Generally start at age 50 or at onset of
menopause, whichever is first
• It measures calcium content of bones of lower
spine and hip (and sometimes wrist)
• Diagnosis of osteoporosis is not made by finger or
heel scan
• Higher calcium content usually means increased
bone strength
• Frequency of testing depends on results and
other risk factors
Vertebral Fracture Analysis
• Special “from the side” X-ray of the spine from
upper shoulders to pelvis
• Degree of compression of individual vertebrae
can be measured
• This test is recommended for women over age
65, especially with low bone density,
significant loss of height (3/4 inch), or other
concerning risks
Vertebral Fracture
Analysis
Fragility Fractures
• Any broken bone from standing height (excluding
fingers/toes/face/nose) or any low trauma fracture
• Any fragility fracture = diagnosis of osteoporosis and it
should be treated as such even if the DXA result is
normal
• Common sites of fragility fractures : hip, spine, wrist
• Approximately 25% of patients who have a fragility
fracture of the hip will die within 1 year
• Only 25% of those with hip fracture will ever regain
previous level of function
Colorectal Cancer Screening
Colorectal Cancer Screening
• Begins at age 50
• Colonoscopy every 10 years until late 70’s
• Alternative study – Flexible Sigmoidoscopy
every 5 years with annual fecal blood test
• Annual fecal blood test alone
References
•
•
•
•
•
•
Centers for Disease Control and Prevention
Magee-Women’s Hospital of UPMC
www.BeBrightPink.org
www.BreastCancer.org
Discover Magazine
U.S. Department of Health and Human Services, Office
of Women’s Health
• National Cancer Institute at the National Institutes of
Health
• www.myriadtests.com
• www.iofbonehealth.org