DISEASE PREVENTION IN WOMEN OVERVIEW

Screening tests are a basic part of preventative medicine. All screening tests are commonly available through your primary care physician. Some specialized tests may be available only through specialists. Take an active role and discuss screening tests with your doctor early in life. The following examinations represent beneficial (generally simple and safe) screening tests that can help detect diseases and conditions before they become well-established and harmful.

OSTEOPOROSIS

Osteoporosis is a condition characterized by 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 more common among postmenopausal women.

Screening tests

Measurement of bone density using dual energy X-ray absorptiometry (DEXA) scan

DEXA bone density scanning can:

detect osteopoross before fractures occur

predict the risk of future bone fractures

be used to monitor the efficacy of treatment regimens to combat osteoporosis.

Who to test and how often

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.

High risk factors for osteoporosis include:

early spontaneous menopause or surgical menopause secondary to removal of the ovaries;

family members with osteoporosis and related bone fractures;

cigarette smoking and/or heavy alcohol abuse;

over-active thyroid gland (hyperthyroidism);

previous or current anorexia nervosa or bulimia;

thin body habitus;

light skin;

Asian or Northern European descent;

conditions associated with poor absorption of calcium or vitamin D;

chronic use of oral corticosteroids (such ascortisone and prednisone [Deltasone, Liquid Prep]), excessive thyroid hormone replacement, and phenytoin (Dilantin) or other anti-seizure medications; and

problems with missed menstrual periods.

Benefits of early detection

Osteoporosis produces no symptoms until a bone fracture occurs. Bone fracture secondary to osteoporosis can occur with only a minor fall, blow, or even just a twist of the body that normally would not cause an injury.

Prevention and treatment of osteoporosis can decrease the risk of bone fractures.

Preventative measures include:

quitting smoking;

curtailing alcohol intake;

performing regular weight-bearing exercises, including walking, dancing, gardening, and other physical activities;

supervised muscle strengthening exercises;

getting adequate calcium and vitamin D intake;

using medications to prevent osteoporosis. The most effective medications for osteoporosis prevention that are approved by the FDA are anti-resorptive agents, which prevent bone breakdown. Examples include alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin (Calcimar), and zoledronate (Reclast); and

While hormone therapy containing estrogen has been shown to prevent bone loss, increase bone density, and decrease the risk of fractures, HT has also been associated with health risks. Currently, hormone therapy is recommended for women for the treatment of menopausal symptoms. The lowest effective dosage of hormone therapy should be used, and it should only be continued until symptoms have resolved.

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.

Screening tests for breast cancer

The most important screening methods to detect breast cancer include:

breast examination by a trained professional, and

mammography

Who to test and how often

Breast awareness

In November 2009, the U.S. Preventive Services Task Force recommended against teaching breast self-examination, citing a lack of benefit for a monthly self-examination. Groups such as the American Cancer Society agree with this conclusion and do not offer guidance on exactly how often a woman should check her breasts, but do state that a woman should be aware of any changes in her breasts.

Breast examination by a professional trained in breast examination.

Mammography: In their revised recommendations issued in November 2009, the U.S. Preventive Services Task Force states that women age 40 to 49 do not require routine mammograms. They recommend biannual screening mammograms for women aged 49-74, and further state that: “The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.”

However, The American Cancer Society (ACS) disagrees and recommends a baseline mammogram for all women by age 40 and annual mammograms for women 40 and older for as long as they are in good health.

In women with “lumpy breasts” or breast symptoms, and also in women with a high risk of developing breast cancer, a baseline mammogram at 35 years of age is sometimes recommended. This recommendation is somewhat controversial, and there are other viewpoints.

High-risk factors for breast cancer include:

a history of breast cancer;

first-degree relatives (mother, sister, or daughter) with breast cancer. The risk is especially higher if both the mother and sister have had breast cancers, if a relative developed her cancer before age 50, if the relative had breast cancer in both breasts, if there is both ovarian and breast cancers in the family, or if a male family member has been diagnosed with breast cancer

Benefits of early detection

Early detection of breast cancer is important to every woman, regardless of risk factors, because the earlier a cancer is found, the smaller it is likely to be. 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.

Mammograms can detect many small breast cancers long before they may be felt during breast examinations. There is extensive evidence that early detection by mammography has improved survival in women with this disease.

Some 10% to 15% of breast cancers are not detected through mammograms but are detected by breast examinations. Therefore a normal mammogram does not completely exclude the possibility of breast cancer, and breast self-examinations and breast examinations by a doctor remain important.