Top 10 things women should know about their health screens in 2018
Are you getting tested too much? Not often enough? For the wrong things? More testing is better, right? This will catch you up to "Medical Screening, 2018", based on recommendations from the National Institute of Health. Things have changed some in the last few years. Let’s see if you are up to date (and in no specific order):
Screening for hypertension should begin at age 18 and if there are no other risk factors, checked every 3 years until age 40 then yearly. You can do it yourself. There is now good data from recent large studies that show benefits to pushing blood pressure lower than we used to. The newer goal in older women with higher risks of heart attack and stroke is 120/70. This lower goal is a fairly recent change from a huge trial published in the New England Journal of Medicine.
2--Abnormal Cholesterol (Lipids) To Prevent Heart Disease
Screening for high cholesterol should start about age 45 and if normal, every 5 years is reasonable. These tests are frequently done on women too early and too often. Studies show that low-risk women DO NOT BENEFIT from taking cholesterol lowering medications unless their 10 year risk of a heart attack or stroke is over 7.5%.
Screening for diabetes at 40 is recommended, then every 3 years if there are risk factors. There there are no significant risk factors, 5 year intervals are reasonable. You do not need to be tested every year.
Screening for colon cancer with colonoscopy every 10 years starting at age 50 is highly recommended. Colonoscopy decreases mortality from colon cancer by over 75%. It is quick, safe, and a very effective screening tool. Appointments can usually be made by calling a gastroenterologist directly for routine screening.
Screening for cervical cancer (Paps) should not start before age 21 and if it is normal, every 3 years. Screening is slowly moving away from Pap smears and towards screening for high-risk HPV (human papilloma virus) instead. Cervical cancers are caused by the HPV virus. An effective HPV vaccine is available now and screening decreases mortality by over 75%. Paps are usually discontinued at age 65.
Screening for ovarian cancer is not recommended in average-risk women. Hopefully that will change in the new future, but presently there are no effective screening methods for a low-risk population.
Screening for lung cancer is recommended yearly for moderate to heavy smokers over 55 with low dose CT scanning. Screening though only reduces death from lung cancer by 20%. Lung cancer is the #1 cause of cancer death in women. And the number one cause of lung cancer is, of course, smoking. Women who smoke are 13 times more likely to develop lung cancer.
Screening for breast cancer with mammography is recommended to start at about age 40-50 (there is no consensus). Mammograms unfortunately show only a very small decrease in breast cancer mortality, and self-exams are no longer encouraged because of lack of evidence. Click the link below to my blog on the pro's and con's of mammography.
Depending on your risks, it is recommended to have a skin exam every 1-3 years if you have risk factors for melanoma as recommended by your dermatologist. If you are at low risk, your primary doctor (FP, OBGYN) should be able to screen you for skin cancers. Of the 3 main types of skin cancers, (basal cell, squamous cell, and melanoma), only melanomas are potentially fatal. They can be ANYWHERE, even in places the sun doesn't shine...
Screening for osteoporosis in normal risk women should start at 65 by having a DEXA scan (like an X-ray). If your bone density is normal, current recommendations are that you do not need to be tested again for 10-15 YEARS. If your DEXA/fracture risk shows some thinning of bone (osteopenia), you should be tested no sooner than every 3 years. Data shows that more frequent or earlier testing is not effective.
Finally, a word of general advice: all other screening lab work and testing should be based on specific concerns or risks. Many people get thyroid tests, blood counts, liver function testing and renal testing just as routine. These are not recommended screening tests for the general population. Such testing is unnecessarily expensive, adding to the already expensive health care costs, and above all is it not beneficial to you. Knowledge is power. You have every right to decide how you want to be screened and treated for disease. The more you know, the better you can be involved with your own health care.