Slideshow: Disease Prevention in Women - Know What to Screen For

Disease Prevention in Women Overview

Screening tests are a basic part of prevention medicine. All screening tests are commonly available through your primary health care practitioner. Some specialized tests may be available elsewhere. The following slides discuss beneficial (generally simple and safe) screening tests that can help detect diseases and conditions, often before they become harmful.

Osteoporosis

Osteoporosis is a condition with progressive loss of bone density leading to bone fractures. Estrogen is important in maintaining bone density. When estrogen levels drop after menopause, bone loss accelerates. Thus osteoporosis is most common among postmenopausal women.

Osteoporosis produces no symptoms until a bone fracture occurs. Bone fracture in osteoporosis can occur with only a minor fall, blow, or even just a twist of the body that ordinarily would not cause an injury. Prevention and treatment of osteoporosis can decrease the risk of bone fractures.

A senior couple with osteoporosis goes for a walk.

Osteoporosis Screening Tests

Dual Energy X-ray Absorptiometry (DEXA) scan:

measures bone density
detect osteoporosis before fractures occur
can help predict the risk of future bone fractures
Although still controversial, some doctors use bone density to monitor effects of osteoporosis treatments

The National Osteoporosis Foundation guidelines state that all postmenopausal women below age 65 who have risk factors for osteoporosis or medical conditions associated with osteoporosis and all women aged 65 and older should consider bone density testing.

A doctor discusses osteoporosis with a senior woman and her daughter.

Breast Cancer

Breast cancer is the most common cancer among women in the United States. Approximately one in nine women who live to age 65 will develop breast cancer, although many will not do so until after age 65.

Early detection of breast cancer is important, regardless of risk factors, because the earlier a cancer is found, the smaller it is. Studies have clearly shown that the smaller the size of the breast cancer when detected, the better the chance of a surgical cure and long-term survival. Smaller breast cancers are also less likely to have already spread to lymph nodes and to other organs such as the lungs, liver, bones, and brain.

Front and back views of a human skeleton.

High Blood Pressure (Hypertension)

About one-sixth of all Americans have high blood pressure, and the incidence of this disease increases with age. Consequently, the proportion among adults is higher, and it is even higher among seniors. African-Americans are more likely than others to have high blood pressure.

High blood pressure can have severe complications without any early warning symptoms. There is good evidence that treatment of high blood pressure can reduce the risk of heart disease, stroke, and kidney failure. Actually there is good evidence that adults with all degrees of high blood pressure can benefit from blood pressure lowering practices, thus it is important to discuss with your doctor lifestyle modifications such as weight management, exercise, and stress management.

$X-ray of a forearm fracture.$

High Blood Pressure Screening Tests

How often blood pressure should be checked depends the severity of the elevated blood pressure, if present. It also depends on the presence of other risk factors for heart attack and stroke. Adults with most recent normal blood pressure measurement of systolic ∨130 and diastolic ∨85 should be checked at least every other year. Blood pressure measurements:

High-normal blood pressure is 130-139/85-89.
Stage 1 hypertension is 140-159/90-99.
• Stages 2 and 3 blood pressure are ∧160 / ∧100.

Cancer of the Cervix

Cancer of the cervix (the portion of the uterus that extends into the vaginal cavity) is the third most common gynecologic cancer. Cancer of the cervix is caused by infection with the human papillomavirus (HPV). Cervical cancer typically develops over the long term from abnormal precancerous (before-cancer) cells on the surface of the cervix. These abnormal cells transform into cervical cancer over a number of years. After turning cancerous, these cancer cells can invade or spread to other parts of the body.

A nurse helps a senior woman with osteoporosis stand up.

Cancer of the Cervix Screening Tests

A Pap test (Pap smear) is a simple, quick office test in which a sample of cells from a woman's cervix is collected by aspiration or swabbing and spread (smeared) on a microscope slide. The cells are examined under a microscope in order to look for precancerous (before-cancer) or cancer cells.

Women should have yearly Pap tests as part of a routine pelvic examination beginning at age 18. Because the risk of cervical cancer increases sharply in the first few years after sexual activity begins, some physicians begin screening women as soon as they become sexually active, but not before. There has been a 70% decrease in the death rate from cancer of the cervix by regular use of the Pap test.

This illustration shows gradual progression of bone density deterioration after the age of 35.

Cancer of the Cervix Prevention

A vaccine (Gardasil) has received U.S. FDA approval for use in women between 9 and 26 years of age and confers immunity against HPV types 6, 11, 16, and 18. Initial trials with the vaccine have shown that the vaccine is safe and induces a high degree of protection against infection with the 4 HPV types in the vaccine. Gardasil is given in three shots over six months. The U.S. Centers for Disease Control and Prevention (CDC) recommends that girls 11-12 years of age receive the vaccine. It is also recommended for girls and women age 13 through 26 who have not yet been vaccinated or completed the vaccine series.

A senior woman with osteoporosis is examined by her doctor.

Human Immunodeficiency Virus (HIV)

HIV is the virus that causes AIDS (acquired immune deficiency syndrome). The virus is present in the blood and genital and other body secretions of virtually all infected individuals, regardless of whether or not they have symptoms. The HIV virus is spread from one person to another when these secretions come in contact with the vagina, anal area, mouth, or eyes, or with a break in the skin, such as from a cut, bruise, sore, or puncture by a needle.

While modern anti-HIV medications have significantly improved long-term survival and quality of life of HIV-infected individuals, there is still no cure or vaccine. HIV infection is still eventually lethal in everyone who is infected. Therefore, preventing the spread of HIV is the most important step in preventing illness and death due to HIV infection. Theoretically, early treatment with anti-HIV medications may help the body's immune system fight the virus. So far, early treatment cannot cure or eradicate the virus. Therefore, early detection is most important to prevent the spread of the virus.

HIV Screening Tests

The screening blood test for antibodies to HIV is called an ELISA test. This is followed by a confirmatory test for antibodies to HIV called a Western blot. HIV-infected individuals can remain free of symptoms for many years. They will know if they are infected ONLY if a blood test for HIV is done.

The following individuals should be routinely offered HIV testing:

Pregnant women
Individuals with occupational exposure to HIV (health care workers and researchers working with HIV)
Individuals with high-risk sexual behavior (multiple sexual partners, unprotected intercourse), or who practice needle-sharing
Anyone requesting HIV testing
Individuals with active tuberculosis, unexplained fevers, low white blood cell counts, or who have been diagnosed with a sexually-transmitted infection.

A doctor discusses osteoporosis treatment options with a patient.

Preventing the Spread of HIV

Abstinence from sex until both partners are certain that they are not infected (for example both partners test negative for HIV antibody after the last potential exposure). While most newly infected individuals test positive by two months after infection, up to 5% are still negative after six months with routine testing. If abstinence is not possible, use latex barriers such as a condom and a dental dam (piece of latex that prevents vaginal secretions from coming in direct contact with the mouth).
For pregnant women infected with HIV, proper prenatal counseling, treatment with anti-HIV drugs after the first trimester, proper handling of the delivery process, and short-term treatment of the newborn child can substantially reduce HIV infection in the newborn.
Avoid sharing of needles, razor blades, and toothbrushes.
Health care workers who experience a needle stick or exposure of the eyes, mouth, or injured skin from an infected person must take anti-HIV medication in order to reduce the risk of developing infection.

Hypercholesterolemia (Hyperlipidemia, Dyslipidemia)

Elevated LDL cholesterol or low HDL cholesterol increases the risk of developing atherosclerosis ("hardening of the arteries"). Atherosclerosis can begin to develop in adolescence and progress without any symptoms for many years. It leads to heart attack and stroke later in life.

Treatment of elevated LDL cholesterol is multi-dimensional. Patients should discuss their total caloric intake, total fat, saturated fat, and cholesterol intake as well as weight reduction and regular exercise with their doctor. Cholesterol-lowering medications are also an important part of treatment for many people with elevated blood lipid levels.

A doctor performs a DXA bone density scan on a female patient.

Hypercholesterolemia Screening Tests

Blood lipid panel that includes:

Total cholesterol
LDL cholesterol, "bad" cholesterol
HDL cholesterol, "good" cholesterol
Triglycerides

LDL is the part of the cholesterol panel that is most significant when deciding about treatment, as well as determining how often lipid panels are checked. All adults over 20 should have a lipid panel every five years, and more frequently as medically indicated.

Type II Diabetes Mellitus

Diabetes mellitus is a condition characterized by elevated blood sugar levels ("hyperglycemia") due to impaired utilization of insulin, decreased production of insulin, or both. Diabetes is the seventh leading cause of death in the United States. An estimated 18% of all Americans over 65 have diabetes.

Diabetes mellitus commonly causes organ damage without symptoms until extensive damage is present. There is good evidence that curtailing total calorie intake (especially intake of processed starches, sugar and sweets), regular exercise, and losing excess weight can help prevent the development of diabetes mellitus. Control of excessive weight usually leads to improved metabolism of sugar, often returning to normal in those with impaired glucose tolerance.

Type II Diabetes Mellitus Screening Tests

Fasting blood sugar (blood sugar test after at least eight hours without calories), normal level less than 100 mg/dl
Pre-diabetes is characterized by a fasting blood sugar level of 100-125 mg/dl.
Diabetes is characterized by a fasting glucose level greater than 126 mg/dl.
2 hour postprandial blood sugar (blood sugar test two hours after a meal), normal level less than 140mg/dl

Healthy subjects over 45 years of age should have fasting blood glucose level checked every three years; however, adults at a higher than normal risk of developing diabetes mellitus should be checked more frequently than every three years.

Colorectal Cancer

Colorectal cancer is the second most common cause of death from cancer overall, and ranks third for both women (after lung and breast cancer) and men (after lung and prostate cancer). Scientists believe that majority of colon cancers develop from colon polyps (precancerous growths on the inner surface of the colon). After turning cancerous, the cells can then invade or spread (metastasize) to other parts of the body. Colon cancer is preventable by removing colon polyps before they turn cancerous.

A nurse instructs a senior woman on how to exercise.

Colorectal Cancer Screening Tests

All healthy subjects should have stool occult blood tests and flexible sigmoidoscopy at age 50, followed by stool occult blood tests annually and flexible sigmoidoscopy every five years. Alternatively, instead of flexible sigmoidoscopy, all healthy subjects can undergo screening colonoscopy at age 50 and then every 10 years if tests remain normal and there is no prior history of polyps or cancer.

Stool occult blood test: A chemical test to detect trace amounts of blood in stool. It is inexpensive and easy, though not always accurate. Some cancers are not detected by the test, and many positive tests are not caused by cancer.
Flexible sigmoidoscopy: A relatively quick and easy office procedure that allows direct visualization and biopsy of suspicious lesions from the distal portion of the colon, but causes some discomfort, and is not as thorough as colonoscopy.
Colonoscopy: Allows visualization of the entire colon and is the most complete and thorough test, but often requires intravenous sedation, is much more expensive, and is not covered by some insurance policies as a screening tool.

Bladder Cancer

Cancer of the urinary bladder develops in over 61,000 Americans each year, leading to over 13,000 deaths. Men are about three times more likely than women to develop bladder cancer, and up to 90% of those affected are over the age of 55. This form of cancer begins in the lining of the bladder as a superficial tumor (carcinoma in situ). The most common warning sign is blood in the urine. If there is enough blood to color the urine it may range from slightly rusty to deep red. Other symptoms may be pain during urination, frequent urination, or feeling the need to urinate without results. Anyone experiencing the signs or symptoms of bladder cancer should be checked by an urologist, who can perform tests to diagnose bladder cancer even in its early stages.

Recommended calcium intake by the National Institutes of Health Consensus Conference on Osteoporosis.

Bladder Cancer Screening Tests

Screening consists of a urine examination for blood cells (urinalysis). This may be done by dipstick with confirmation by microscopic examination of the urine, or by initial microscopic examination. Early bladder cancer may produce no symptoms and no visible bleeding in the urine. Blood in the urine is most commonly microscopically apparent and not seen by the naked eye.

All people who are current or former cigarette smokers or who have a history of occupational exposure to certain chemicals often used in the dye, leather, tire, and rubber industries should have a urine examination for blood periodically after the age of 60 years.

Daily calcium intake examples include milk, yogurt, cottage cheese, cheddar cheese, vanilla ice cream, and orange juice.

Glaucoma

Glaucoma is a condition with abnormally elevated intra-ocular pressures (pressure within the eyes). The term is applied to a group of eye diseases that gradually result in loss of vision by permanently damaging the optic nerve, the nerve that transmits visual images to the brain. The leading cause of irreversible blindness, glaucoma often produces no symptoms until it is too late and vision loss has begun. There is good evidence that treatment of elevated eye pressure in glaucoma can prevent blindness.

Good sources of vitamin D include natural sunlight, fortified milk, cheese, butter/margarine, cereal, and fish.

Glaucoma Screening Tests

The American Academy of Ophthalmology's recommended intervals for eye exams, including glaucoma screening, are:

Age 20-29: Individuals of African descent or with a family history of glaucoma should have an eye examination every three to five years. Others should have an eye exam at least once during this period.
Age 30-39: Individuals of African descent or with a family history of glaucoma should have an eye examination every two to four years. Others should have an eye exam at least twice during this period.
Age 40-64: Every two to four years.
Age 65 or older: Every one to two years.

Although there is no formal screening recommendation for healthy subjects with normal risk, everybody over 60 years of age should have intra-ocular pressure measurements periodically, perhaps yearly.

A woman takes her hormone replacement therapy pill.

Melanoma

The most dangerous form of skin cancer, melanoma is a malignancy of the melanocyte, the cell that produces pigment in the skin. The tendency toward melanoma may be inherited, and the risk increases with overexposure to the sun and sunburn.

Skin cancer is the most common cancer. Even though the benefit of skin cancer screening is uncertain, early treatment of skin cancer can be effective. Melanomas may be detected at a thinner stage with regular skin exams. Thinner melanomas are more successfully treated than are thick ones that have grown downward into the deeper portions of the skin.

A pharmacist holds a bottle of medication.

Melanoma Screening Tests

Total body skin examination. The American Cancer Society recommends a skin check every three years between the ages of 20 and 40, and a skin check annually over age 40. See a doctor if you notice a mole with the following characteristics:

diameter more than 6mm
asymmetric, meaning an uneven shape
irregular border
variable color pattern, meaning many colors or unusual colors, like blue or black

Importance of Health Screening

Take an active role and discuss screening tests with your doctor early in life. New tests and investigations are always being developed. If you have any questions about exactly which tests are right for you, please discuss these concerns with your doctor. However, it is important to be aware that just because doctors can identify someone at increased risk for a condition, it may not necessarily be preventable. It may simply mean that you will need to work with your doctor to closely monitor your health to ensure that the condition is detected as early as possible and adequately treated.

A senior woman with osteoporosis signs documents for a nurse.