Disease: Disease Prevention in Women

    Disease prevention in women overview

    Screening tests are a basic part of prevention medicine. All screening tests are commonly available through your general doctor. Some specialized tests may be available elsewhere. Take an active role and discuss screening tests with your doctor early in life. The following charts are beneficial (generally simple and safe) screening tests that can help detect diseases and conditions 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.

    Screening tests

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

    DEXA bone density scanning can:

    • detect osteoporosis before fractures occur
    • predict the risk of future bone fractures
    • Although still controversial, some doctors use bone density to monitor effects of osteoporosis treatments
    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 menopause or surgical absence of ovaries;
    • family members with osteoporosis and related bone fractures;
    • cigarette smoking and/or heavy alcohol use;
    • over-active thyroid gland (hyperthyroidism), previous or current anorexia nervosa or bulimia;
    • thin stature, light skin;
    • Asian or Northern European descent;
    • any condition 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.

    Learn more about: Deltasone | Dilantin

    Benefits of early detection

    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.

    Prevention measures include:
    • quitting smoking and curtailing alcohol intake;
    • performing regular weight-bearing exercises, including walking, dancing, gardening and other physical activities, and (supervised) muscle strengthening exercises;
    • getting adequate calcium and vitamin D intake;
    • medications may be taken to prevent osteoporosis. The most effective medications for osteoporosis 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, HT is recommended for women for the treatment of menopausal symptoms only at the lowest effective dose for the short-term.

    Learn more about: Fosamax | Actonel | Evista | Boniva | Reclast

    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

    Breast self-examination/breast awareness:

    • breast examination by a doctor, 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, stating a lack of benefit for a monthly self-exam. 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 so state that a woman should be aware of any changes in her breasts.
    • Breast examination by a doctor.
    • 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, sometimes a baseline mammogram at 35 years of age is recommended. This recommendation is somewhat controversial, and there are other viewpoints.
    High-risk factors include:
    • previous breast cancer; and
    • close 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 ovary 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. 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 by breast examinations, and there is extensive evidence that early detection by mammograms has improved survival in women with this disease.

    However, some 10% to15% of breast cancers is not detected by 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.

    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 cause arterial disease (atherosclerosis) that can lead to heart attack, congestive heart failure, stroke, and kidney failure.

    Screening tests 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.
    Who to test and how often
    • How often blood pressure should be checked depends on how severely elevated the blood pressure is. It also depends on the presence of other risk factors for heart attack and stroke.
    • Adults with most recent normal blood pressure of systolic < 130 and diastolic < 85 should be checked at least every other year.
    Benefits of early detection

    High blood pressure can cause diseases without any early warning symptoms.

    There is good evidence that treatment of high blood pressure can reduce the risk of heart diseases, stroke, and kidney failure.

    Actually there is good evidence that adults with all degrees of high blood pressure can benefit from blood pressure lowering, thus it is important to discuss with your doctor about weight management, exercise, and stress management.

    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 most often 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 can transform into cervix cancer over a number of years. After turning cancerous, these cancer cells can invade or spread to other parts of the body.

    Screening tests

    Pap test also known as Pap smear.

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

    Who to test and how often

    Women should have Pap tests as part of an annual pelvic examination beginning at age 21. 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. High-risk factors for cancer of the cervix include:

    • cigarette smoking;
    • previous genital warts or other genital infection with the human papilloma virus (HPV);
    • multiple sexual partners or a partner who has multiple sexual partners; and
    • onset of sexual activity at a young age.

    In 2009, the American College of Obstetricians and Gynecologists (ACOG) revised its recommendations regarding Pap screening. Instead of beginning at age 18 as previously recommended, the new recommendations advise beginning Pap smears at age 21. Further changes to the ACOG guidelines are:

    • Women younger than 30 years of age should have a Pap test every 2 years.
    • Women aged 30 years of age and older should have a Pap test every 2 years. After three normal Pap test results in a row, a woman in this age group may have Pap tests every 3 years if:
      • she does not have a history of moderate or severe dysplasia;
      • she is not infected with human immunodeficiency virus (HIV);
      • her immune system is not weakened (for example, if she has had an organ transplant); and
      • she was not exposed to diethylstilbestrol (DES) before birth.

    It is rare to find pre-cancer or cancer of the cervix in women over age 65 who have repeatedly had normal Pap smears, so many doctors stop screening in women over age 65 who have had consistently normal Pap smears. Other doctors decrease the frequency of Pap screening under these circumstances.

    Women who have had a hysterectomy (surgery to remove the uterus, including the cervix) may need Pap smears less often, but they should continue with manual pelvic and rectal examinations by their doctors as a part of their periodic medical evaluations for reasons other than cancer of the cervix.

    Benefits of early detection

    There has been a 70% decrease in the deaths from cancer of the cervix by regular use of the Pap test. Benefits of the Pap test include:

    1. Pap tests can prevent cancer of the cervix by identifying and allowing treatment of abnormal cells before they become cancerous.
    2. Pap tests can identify cancer of the cervix at an early curable stage, before cancer cells spread (metastasize) to other parts of the body.
    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 HPV-16/18 vaccine is safe and induces a high degree of protection against HPV-16/18 infection. 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 newer vaccine (Cervarix) was approved by the FDA in October, 2009, for use in girls and young women ages 10-25 to help prevent cervical cancer. Cervarix targets two HPV strains, HPV 16 and HPV 18, A comparison of the two vaccines has not been carried out.

    Learn more about: Cervarix

    Human immunodeficiency virus (HIV)

    HIV is the virus that causes AIDS (Acquired immune deficiency syndrome). 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.

    Screening tests
    • Screening blood test for antibodies to HIV is called an ELISA test. Confirmatory test for antibodies to HIV is 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. HIV testing can be performed by a physician or at a testing center.
    Who should be tested

    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; and
    • individuals with active tuberculosis, unexplained fevers, low white blood cell counts, or who have been diagnosed with a sexually transmitted infection.

    Most infected individuals will develop a positive HIV blood test within three months of being exposed to HIV. If the HIV test at three months is negative and there are risk factors for infection, the test should be repeated in another three months.

    Benefits of early detection

    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.

    The virus is present in the blood, 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. Sexual transmission of HIV has been described from men to men, men to women, women to men, and women to women through vaginal, anal, and oral sex.

    Prevention of 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 condoms 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 very substantially reduce HIV infection in the newborn.
    • Avoid sharing of needles, razor blades, and toothbrushes.
    • Health care workers who experience aneedle 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.

    Hyperlipidemia is a common and treatable cause of atherosclerosis. Atherosclerosis is the most common cause of death in both men and women in developed countries. The goal is to diagnose and retard or reverse atherosclerosis while it is still in a silent early state

    Screening tests

    Blood lipid panel that includes:

    • total cholesterol;
    • LDL cholesterol, "bad" cholesterol;
    • HDL cholesterol, "good" cholesterol; and
    • triglycerides
    Who to test and how often
    • LDL is the part of the cholesterol panel that is most significant when deciding patient 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.
    Benefits of early detection

    There is good evidence that lowering elevated LDL cholesterol and increasing low HDL is beneficial in heart attack prevention and in some cases stroke prevention in subjects with or without known atherosclerosis.

    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.

    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. Over ten million Americans have been diagnosed with diabetes; and at least half as many more are thought to have undiagnosed diabetes. Many more people have a condition that precedes diabetes, referred to as prediabetes, characterized by sluggish metabolism of sugar (glucose) to a lesser degree than is present in those with diabetes.

    Diabetes is the leading cause of new cases of blindness in adults aged 20-74 years, the leading cause of chronic kidney failure, and the leading cause of lower extremity amputations not related to injury. Individuals with diabetes are 2-4 times as likely to have a heart attack or stroke as are those without diabetes.

    Screening tests

    Tests for diabetes mellitus include:

    • 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; and
    • two hour postprandial blood sugar (blood sugar test two hours after a meal), normal level less than 140mg/dl.
    Who to test and how often

    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.

    Risk factors of diabetes include:

    • excessive weight;
    • first-degree blood relative with adult onset diabetes;
    • certain ethnic groups such as African-Americans, Hispanics, certain Native American groups, and some Asians;
    • delivery of a baby weighing more than 9 lbs or a history of diabetes during pregnancy ("gestational diabetes");
    • impaired glucose tolerance, currently or previously; and
    • low HDL cholesterol (35 mg/dl or less) or elevated triglyceride level (over 250 mg/dl).
    Benefits of early detection

    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 to normal in those with impaired glucose tolerance.

    There is good evidence that in patients with diabetes, controlling hyperglycemia with medications, diet, weight control, and regular exercise can slow the development of all the complications of diabetes.

    There is good evidence that even those with impaired glucose tolerance can significantly improve their otherwise increased risk for atherosclerotic disease (including heart attacks and stroke) with appropriate changes in diet, physical activity, and weight.

    Cancer of colon and rectum / polyps of colon and rectum

    Colorectal cancer is the second most common cause of death from cancer overall, and ranks third in both women (after lung and breast cancer) and men (after lung and prostate cancer).

    Scientists believe that majority of the 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. Colon cancer is curable if resected before the cancer spreads.

    Screening tests
    • Stool occult blood test: Stool occult blood test is 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: Flexible sigmoidoscopy is 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: 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 for screening. Although screening colonoscopies may have a slightly higher risk of complications than flexible sigmoidoscopies, both screening tests are very safe when performed by trained professionals.
    Who to test and how often

    All healthy subjects should have stool occult blood tests and flexible sigmoidoscopy at age 50, followed by stool occult blood 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.

    Higher risk subjects (individuals with family history of colon polyps and cancer, long standing ulcerative colitis, or prior personal history of colon polyps or cancer) need colonoscopy earlier and at shorter intervals.

    Benefits of early detection

    Stool occult blood test, flexible sigmoidoscopy, and colonoscopy have been documented to reduce colon cancer mortality by:

    1. Preventing colon cancer by identifying and removing polyps before they become cancerous.
    2. Increasing cancer cure rate by identifying early cancer at a treatable stage before the cancer has spread (metastasized).

    Bladder cancer

    Screening tests
    • 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.
    • Bladder cancer can cause either gross hematuria (visible blood in the urine) or microscopic hematuria (blood in the urine only visible with a microscope).

    (Note that bladder cancer is only one of many causes of blood in the urine.)

    Who to test and how often

    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.

    Benefits of early detection

    Early bladder cancer may produce no symptoms and no visible bleeding in the urine, and blood in the urine is most commonly microscopically apparent and not seen by the naked eye.

    Treatment can be effective if the cancer is detected early, and survival is strongly associated with stage of disease at time of treatment.

    Cessation of cigarette smoking is always advisable.

    Glaucoma

    Glaucoma is a condition with abnormally elevated intra-ocular pressures (pressure within the eyes).

    Screening tests
    • Measurement of intra-ocular pressure should be a standard component of a comprehensive eye examination.
    • Note that a check up for vision does not measure intra-ocular pressure.
    • Intra-ocular pressure should be measured by eye care specialists.
    Who to test and how often

    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.

    Benefits of early detection

    Glaucoma causes extensive damage to the retina and irreversible loss of vision without warning symptoms and before the individual becomes aware of loss of vision.

    There is good evidence that treatment of elevated eye pressure in glaucoma can prevent blindness.

    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

    Breast self-examination/breast awareness:

    • breast examination by a doctor, 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, stating a lack of benefit for a monthly self-exam. 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 so state that a woman should be aware of any changes in her breasts.
    • Breast examination by a doctor.
    • 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, sometimes a baseline mammogram at 35 years of age is recommended. This recommendation is somewhat controversial, and there are other viewpoints.
    High-risk factors include:
    • previous breast cancer; and
    • close 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 ovary 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. 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 by breast examinations, and there is extensive evidence that early detection by mammograms has improved survival in women with this disease.

    However, some 10% to15% of breast cancers is not detected by 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.

    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 cause arterial disease (atherosclerosis) that can lead to heart attack, congestive heart failure, stroke, and kidney failure.

    Screening tests 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.
    Who to test and how often
    • How often blood pressure should be checked depends on how severely elevated the blood pressure is. It also depends on the presence of other risk factors for heart attack and stroke.
    • Adults with most recent normal blood pressure of systolic < 130 and diastolic < 85 should be checked at least every other year.
    Benefits of early detection

    High blood pressure can cause diseases without any early warning symptoms.

    There is good evidence that treatment of high blood pressure can reduce the risk of heart diseases, stroke, and kidney failure.

    Actually there is good evidence that adults with all degrees of high blood pressure can benefit from blood pressure lowering, thus it is important to discuss with your doctor about weight management, exercise, and stress management.

    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 most often 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 can transform into cervix cancer over a number of years. After turning cancerous, these cancer cells can invade or spread to other parts of the body.

    Screening tests

    Pap test also known as Pap smear.

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

    Who to test and how often

    Women should have Pap tests as part of an annual pelvic examination beginning at age 21. 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. High-risk factors for cancer of the cervix include:

    • cigarette smoking;
    • previous genital warts or other genital infection with the human papilloma virus (HPV);
    • multiple sexual partners or a partner who has multiple sexual partners; and
    • onset of sexual activity at a young age.

    In 2009, the American College of Obstetricians and Gynecologists (ACOG) revised its recommendations regarding Pap screening. Instead of beginning at age 18 as previously recommended, the new recommendations advise beginning Pap smears at age 21. Further changes to the ACOG guidelines are:

    • Women younger than 30 years of age should have a Pap test every 2 years.
    • Women aged 30 years of age and older should have a Pap test every 2 years. After three normal Pap test results in a row, a woman in this age group may have Pap tests every 3 years if:
      • she does not have a history of moderate or severe dysplasia;
      • she is not infected with human immunodeficiency virus (HIV);
      • her immune system is not weakened (for example, if she has had an organ transplant); and
      • she was not exposed to diethylstilbestrol (DES) before birth.

    It is rare to find pre-cancer or cancer of the cervix in women over age 65 who have repeatedly had normal Pap smears, so many doctors stop screening in women over age 65 who have had consistently normal Pap smears. Other doctors decrease the frequency of Pap screening under these circumstances.

    Women who have had a hysterectomy (surgery to remove the uterus, including the cervix) may need Pap smears less often, but they should continue with manual pelvic and rectal examinations by their doctors as a part of their periodic medical evaluations for reasons other than cancer of the cervix.

    Benefits of early detection

    There has been a 70% decrease in the deaths from cancer of the cervix by regular use of the Pap test. Benefits of the Pap test include:

    1. Pap tests can prevent cancer of the cervix by identifying and allowing treatment of abnormal cells before they become cancerous.
    2. Pap tests can identify cancer of the cervix at an early curable stage, before cancer cells spread (metastasize) to other parts of the body.
    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 HPV-16/18 vaccine is safe and induces a high degree of protection against HPV-16/18 infection. 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 newer vaccine (Cervarix) was approved by the FDA in October, 2009, for use in girls and young women ages 10-25 to help prevent cervical cancer. Cervarix targets two HPV strains, HPV 16 and HPV 18, A comparison of the two vaccines has not been carried out.

    Learn more about: Cervarix

    Human immunodeficiency virus (HIV)

    HIV is the virus that causes AIDS (Acquired immune deficiency syndrome). 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.

    Screening tests
    • Screening blood test for antibodies to HIV is called an ELISA test. Confirmatory test for antibodies to HIV is 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. HIV testing can be performed by a physician or at a testing center.
    Who should be tested

    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; and
    • individuals with active tuberculosis, unexplained fevers, low white blood cell counts, or who have been diagnosed with a sexually transmitted infection.

    Most infected individuals will develop a positive HIV blood test within three months of being exposed to HIV. If the HIV test at three months is negative and there are risk factors for infection, the test should be repeated in another three months.

    Benefits of early detection

    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.

    The virus is present in the blood, 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. Sexual transmission of HIV has been described from men to men, men to women, women to men, and women to women through vaginal, anal, and oral sex.

    Prevention of 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 condoms 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 very substantially reduce HIV infection in the newborn.
    • Avoid sharing of needles, razor blades, and toothbrushes.
    • Health care workers who experience aneedle 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.

    Hyperlipidemia is a common and treatable cause of atherosclerosis. Atherosclerosis is the most common cause of death in both men and women in developed countries. The goal is to diagnose and retard or reverse atherosclerosis while it is still in a silent early state

    Screening tests

    Blood lipid panel that includes:

    • total cholesterol;
    • LDL cholesterol, "bad" cholesterol;
    • HDL cholesterol, "good" cholesterol; and
    • triglycerides
    Who to test and how often
    • LDL is the part of the cholesterol panel that is most significant when deciding patient 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.
    Benefits of early detection

    There is good evidence that lowering elevated LDL cholesterol and increasing low HDL is beneficial in heart attack prevention and in some cases stroke prevention in subjects with or without known atherosclerosis.

    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.

    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. Over ten million Americans have been diagnosed with diabetes; and at least half as many more are thought to have undiagnosed diabetes. Many more people have a condition that precedes diabetes, referred to as prediabetes, characterized by sluggish metabolism of sugar (glucose) to a lesser degree than is present in those with diabetes.

    Diabetes is the leading cause of new cases of blindness in adults aged 20-74 years, the leading cause of chronic kidney failure, and the leading cause of lower extremity amputations not related to injury. Individuals with diabetes are 2-4 times as likely to have a heart attack or stroke as are those without diabetes.

    Screening tests

    Tests for diabetes mellitus include:

    • 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; and
    • two hour postprandial blood sugar (blood sugar test two hours after a meal), normal level less than 140mg/dl.
    Who to test and how often

    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.

    Risk factors of diabetes include:

    • excessive weight;
    • first-degree blood relative with adult onset diabetes;
    • certain ethnic groups such as African-Americans, Hispanics, certain Native American groups, and some Asians;
    • delivery of a baby weighing more than 9 lbs or a history of diabetes during pregnancy ("gestational diabetes");
    • impaired glucose tolerance, currently or previously; and
    • low HDL cholesterol (35 mg/dl or less) or elevated triglyceride level (over 250 mg/dl).
    Benefits of early detection

    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 to normal in those with impaired glucose tolerance.

    There is good evidence that in patients with diabetes, controlling hyperglycemia with medications, diet, weight control, and regular exercise can slow the development of all the complications of diabetes.

    There is good evidence that even those with impaired glucose tolerance can significantly improve their otherwise increased risk for atherosclerotic disease (including heart attacks and stroke) with appropriate changes in diet, physical activity, and weight.

    Cancer of colon and rectum / polyps of colon and rectum

    Colorectal cancer is the second most common cause of death from cancer overall, and ranks third in both women (after lung and breast cancer) and men (after lung and prostate cancer).

    Scientists believe that majority of the 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. Colon cancer is curable if resected before the cancer spreads.

    Screening tests
    • Stool occult blood test: Stool occult blood test is 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: Flexible sigmoidoscopy is 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: 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 for screening. Although screening colonoscopies may have a slightly higher risk of complications than flexible sigmoidoscopies, both screening tests are very safe when performed by trained professionals.
    Who to test and how often

    All healthy subjects should have stool occult blood tests and flexible sigmoidoscopy at age 50, followed by stool occult blood 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.

    Higher risk subjects (individuals with family history of colon polyps and cancer, long standing ulcerative colitis, or prior personal history of colon polyps or cancer) need colonoscopy earlier and at shorter intervals.

    Benefits of early detection

    Stool occult blood test, flexible sigmoidoscopy, and colonoscopy have been documented to reduce colon cancer mortality by:

    1. Preventing colon cancer by identifying and removing polyps before they become cancerous.
    2. Increasing cancer cure rate by identifying early cancer at a treatable stage before the cancer has spread (metastasized).

    Bladder cancer

    Screening tests
    • 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.
    • Bladder cancer can cause either gross hematuria (visible blood in the urine) or microscopic hematuria (blood in the urine only visible with a microscope).

    (Note that bladder cancer is only one of many causes of blood in the urine.)

    Who to test and how often

    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.

    Benefits of early detection

    Early bladder cancer may produce no symptoms and no visible bleeding in the urine, and blood in the urine is most commonly microscopically apparent and not seen by the naked eye.

    Treatment can be effective if the cancer is detected early, and survival is strongly associated with stage of disease at time of treatment.

    Cessation of cigarette smoking is always advisable.

    Glaucoma

    Glaucoma is a condition with abnormally elevated intra-ocular pressures (pressure within the eyes).

    Screening tests
    • Measurement of intra-ocular pressure should be a standard component of a comprehensive eye examination.
    • Note that a check up for vision does not measure intra-ocular pressure.
    • Intra-ocular pressure should be measured by eye care specialists.
    Who to test and how often

    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.

    Benefits of early detection

    Glaucoma causes extensive damage to the retina and irreversible loss of vision without warning symptoms and before the individual becomes aware of loss of vision.

    There is good evidence that treatment of elevated eye pressure in glaucoma can prevent blindness.

    Source: http://www.rxlist.com

    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.

    Source: http://www.rxlist.com

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