August 16, 2012

Women’s Screening Tests: What, Why And How Often?

The following recommendations are general guidelines on screening procedures for healthy women. Your doctor may recommend a different screening schedule based on a variety of factors, particularly your personal health history, age and family medical history.

 Blood Pressure Reading

What is it?

An inflatable cuff, wrapped around your upper arm, measures the amount of pressure your heart generates when pumping blood out through your arteries (systolic pressure) and measures the amount of pressure in your arteries when your heart is at rest between beats (diastolic pressure).

Why?
For early detection of high blood pressure (hypertension). Blood pressure is determined by the amount of blood your heart pumps and the resistance to blood flow in your arteries. Narrowed arteries limit this blood flow. In general, the more blood your heart pumps and the narrower your arteries, the harder your heart must work to pump the same amount of blood. The longer high blood pressure goes undetected and untreated, the higher your risk of heart attack, stroke, heart failure and kidney damage.

How often?
Initial test at age 21, then at least every 2 years.

Cholesterol Test

What is it?

A simple blood test that measures total cholesterol, low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol), high-density lipoprotein (HDL) cholesterol (the “good” cholesterol) and triglycerides.

Cholesterol is a form of fat carried in your blood by lipoproteins. LDL deposits cholesterol in your artery walls, and HDL carries cholesterol away from your arteries and to your liver for disposal.

Problems occur when your LDL deposits too much cholesterol in your artery walls or when your HDL doesn’t take enough away. This can lead to a buildup of cholesterol-containing fatty deposits (plaques) in your arteries (atherosclerosis).

Why?
To evaluate the level of cholesterol in your blood. Undesirable levels of cholesterol raise your risk of heart attack and stroke.

How often?
If you’re 20 years of age or older, have your cholesterol measured every 5 years. Your doctor may recommend more frequent measurements if your levels are abnormal.

What do the numbers mean?
Results from a blood fat test show a set of numbers in milligrams per deciliter (mg/dL) indicating the levels of total, LDL and HDL cholesterol as well as triglyceride levels. The National Cholesterol Education Program, a branch of the National Institutes of Health, has developed a set of guidelines to help determine which numbers are acceptable and which ones carry increased risk.

Clinical Breast Exam

What is it?

A physical examination of your breasts and armpits. Your doctor looks for color changes, skin irregularities and changes in your nipples. He or she also feels your breasts and armpits for lumps and enlarged lymph nodes.

Why?
To detect suspicious changes and to exclude breast cancer.

How often?
The American Cancer Society recommends an initial clinical breast exam at age 20, with subsequent exams every 3 years. At age 40, you should begin annual clinical breast exams.

Mammogram

What is it?

A radiology technician compresses your breasts between plastic plates while he or she takes X-rays of your breast tissue.

Why?
To detect breast lumps or suspicious changes or calcifications when they’re too small to be detected by physical examination. These small lumps can be the first finding of early-stage breast cancer.

How often?
Every 1 to 2 years after age 40, depending on your risk. Annually after age 50.

Pap Test

What is it?

Your doctor inserts a speculum into your vagina. Then using a small wooden spatula and a brush or cotton swab, your doctor gently removes cells from your cervix. The procedure generally takes only a few minutes. Your doctor places the cells on a glass slide and sends them to a laboratory for microscopic examination.

Why?
To detect cancer and precancerous changes of your cervix. You’re at increased risk if you have a history of sexually transmitted disease — particularly human papillomavirus (HPV) — multiple sex partners, a history of cervical, vaginal or vulvar cancer, or are a smoker.

How often?
The American Cancer Society recommends that you have your first Pap test about 3 years after first having sexual relations or at age 21 if you haven’t been sexually active. After age 21, the guidelines are as follows:

Age Frequency
21 to 29 Once a year using the regular Pap test or every 2 years using the liquid-based Pap test.
30 to 69 Every 2 to 3 years if you’ve had three normal Pap tests in a row.
70 and older You may stop having Pap tests if you’ve had three normal Pap tests in a row and you’ve had normal Pap tests in the last 10 years.

Regardless of your age, if you have certain risk factors — such as a weakened immune system — you need to be screened annually. In addition, you may need more frequent Pap tests if you’re at high risk of cervical cancer. Discuss your risks of cervical cancer with your doctor to help determine the optimal frequency of your Pap test.

If you’ve had a hysterectomy — surgical removal of the uterus and cervix — ask your doctor if you need to continue having Pap tests. If your hysterectomy was performed for a noncancerous condition, such as fibroids, you may be able to discontinue routine Pap tests, but not pelvic exams. If your hysterectomy was for a precancerous or cancerous condition, your vaginal canal still needs to be checked for abnormal changes.

A Pap test is only one part of the pelvic examination. You may benefit from annual pelvic examinations even if a Pap test isn’t needed.

Pelvic Exam

What is it?

Your doctor examines your external genitals to make sure they look normal and checks for discoloration, swelling or sores, for example. To see the inner walls of your vagina and cervix, your doctor inserts an instrument called a speculum into your vagina to hold the vaginal walls apart.

He or she will then look for sores, lumps, inflammation or signs of abnormal discharge. After removing the speculum, your doctor inserts two gloved fingers inside your vagina.

While simultaneously pressing down on your abdomen, he or she physically examines your uterus and ovaries.

Why?
To detect any abnormalities, such as cysts, tumors, infections or other problems such as muscle weakness that can cause the uterus or bladder to sag. If you have an abnormal discharge, your doctor can obtain a sample to identify the cause.

How often?
The American Cancer Society recommends annual pelvic exams starting at age 18 or with the beginning of sexual activity — whichever comes first. Discuss the frequency of the exam with your doctor.

Colorectal Cancer Screening

What is it?

Your doctor may recommend tests to examine your colon and rectum to detect colon cancer before symptoms occur. The exams are:

  • Fecal occult blood test. This test chemically checks your stool for hidden (occult) blood, which can only be detected through chemical testing. This test may be done in your doctor’s office or you may be given a kit to take the stool sample at home. You usually obtain a stool sample for testing and store it in a supplied container or use an applicator stick to smear it on a chemically treated card. You then return the container or card in person or by mail to a lab or your doctor’s office for analysis. At the lab, a chemical is applied to the specimen. The chemical reacts with the stool sample and appears as a different color if it comes in contact with blood. If blood is found, you will need additional tests to determine the cause.
  • Flexible sigmoidoscopy. Your doctor will examine the lower portion of your colon by inserting a thin, flexible tube called a sigmoidoscope into your rectum. This procedure usually takes about 15 minutes. Sigmoidoscopy may be done in conjunction with a colon X-ray.
  • Colon X-ray (double contrast barium enema). Liquid barium, a solution that looks bright white on X-ray images, is put into your colon by way of a slender tube inserted into your rectum. The barium outlines the inner surface of your colon, allowing the X-ray to detect any irregularities. This test typically takes about 20 minutes and can cause abdominal cramping. It may be done in conjunction with flexible sigmoidoscopy.
  • Colonoscopy. Your doctor will examine the entire length of your colon using a thin, flexible colonoscope inserted into your rectum. The procedure is similar to a flexible sigmoidoscopy, although the instrument is longer so that your doctor can view your entire colon. This procedure takes about a half-hour and can be uncomfortable, so it’s generally done under conscious sedation, a type of sedation that uses pain relievers and sedatives to minimize discomfort.

Why?
To detect cancer and benign growths (polyps) on the inside wall of your colon that may become cancerous. Getting polyps removed may reduce your risk of colorectal cancer.

How often?
Not everyone needs to be tested for precancerous polyps and colorectal cancer. Your need for screening depends on your level of risk. Three major factors put you at higher risk of developing colorectal cancer:

  • Age 50 or older
  • Family or personal history of colorectal cancer or adenomatous polyps
  • Personal history of inflammatory bowel disease

If you’re age 50 or older and at average risk, the American Cancer Society recommends that you follow one of these five recommendations:

  • Fecal occult blood test every year · Flexible sigmoidoscopy every 5 years
  • Fecal occult blood test every year plus flexible sigmoidoscopy every 5 years
  • Double contrast barium enema every 5 years
  • Colonoscopy every 10 years

Talk to your doctor about which screening approach and frequency are best for you based on your particular health issues.

Bone Density Measurement

What is it?

A quick, painless scan of your lower back, hip region, wrist or heel. This test measures the density of your bones, indicating your risk of fracture at the most common sites affected.

Several different types of scans are available, including ultrasound, computerized tomography (CT) and dual energy X-ray absorptiometry (DEXA).

Dual energy X-ray absorptiometry scans of the lower spine and hip region are the best standard for deciding when treatment is needed and for assessing the effects of treatment for osteoporosis.

Why?
To detect osteoporosis — a disease characterized by a loss of bone mass, which makes bones more fragile and likely to break, especially affecting the hip, spine and wrist.

How often?
The U.S. Preventive Services Task Force (USPSTF) recommends that women age 65 and older be screened routinely for osteoporosis. The USPSTF also recommends that routine screening begin at age 60 for women at increased risk of osteoporotic fractures. Younger women may need routine screening if they have certain risk factors, such as a history of fractures, steroid use or premature ovarian failure.

Other Screening Tests

These tests may or may not be part of routine medical exams. Your doctor may recommend them based on your symptoms, risk factors, age and health conditions.

Blood chemistry test
This test measures substances such as sodium, potassium, calcium and phosphorus, as well as liver enzymes and creatinine, which tests kidney function. A blood chemistry test can provide information about how well organs such as your liver and kidneys are working.

Chest X-ray
During a chest X-ray, your body is placed between an X-ray camera and an X-ray film. Your doctor will probably request a forward view and a side view.

Chest X-rays reveal the size and shape of your heart and the condition of your lungs, which can help your doctor detect heart or lung disease.

Your doctor may recommend a chest X-ray as part of a health exam if you’re short of breath, have a cough or chest pain, or if your doctor needs to see the size of your heart to monitor conditions such as high blood pressure or a heart disorder.

Complete blood count (CBC) with differential
This test measures:

  • Hemoglobin — amount determines oxygen-carrying capacity of your blood
  • Hematocrit — percentage of blood volume made up of red blood cells
  • White blood cells — number and type
  • Platelets — number

A CBC can help detect the presence of many conditions, including anemia, infections and leukemia.

Electrocardiogram (ECG)
For this test, a technician places electrode patches on your chest, arms and legs to pick up and record electrical impulses from your heart. An ECG can detect abnormalities such as heart damage after a heart attack, an irregular heart rhythm or an enlarged heart. In certain cases, your doctor may recommend it as part of a health exam — for instance, if you’re at increased risk of heart disease.

Fasting blood sugar test
This test measures the level of sugar (glucose) in your blood after an 8-hour fast. High glucose levels can be an indication of diabetes. If you’re 45 years of age or older, the American Diabetes Association recommends that you have your blood glucose level checked every 3 years. If you’re at risk of diabetes, your doctor may test you at a younger age or more frequently. Also get tested if you have signs and symptoms of diabetes, such as excessive thirst, frequent urination, unexplained weight loss, fatigue, or slow-healing cuts or bruises.

Skin examination
To check for skin cancer, your doctor examines your skin from head to toe, looking for moles that are irregularly shaped, have varied colors, are asymmetric, are greater than the size of a pencil eraser, or have grown or changed since your last visit. The American Cancer Society recommends that you have a skin exam every 3 years if you’re between the ages of 20 and 40 and every year if you’re age 40 or older.

Thyroid-stimulating hormone (TSH) test
This is a blood test for levels of TSH, a hormone made by your pituitary gland that stimulates your thyroid to produce the hormone thyroxine. A TSH test can detect whether your thyroid is underactive (hypothyroidism) or overactive (hyperthyroidism). Thyroid disorders are very common among women.

Urinalysis
This test detects substances in your urine that may indicate a medical problem. Excess sugar (glucose), for instance, may suggest diabetes. White blood cells may indicate the presence of an infection. Red blood cells may signal a disorder of the kidneys, ureter or bladder. And elevated bilirubin may suggest liver disease.

Determine What’s Best For You

Controversy still exists concerning the ideal frequency of some examinations and the ages at which to start routine screenings. In addition, how often you need certain screening tests may differ depending on your medical history or your risk factors for certain conditions.

Ask your doctor how these recommendations apply to you so that you can determine the best possible screening schedule.


By Mayo Clinic staff

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