Prevention of HPV infection holds the hope of true prevention for cervical cancer.
This month, I’d like to highlight the aspects of health maintenance that pertain particularly to women.
Let’s start at the beginning: Women—and what they do before and during pregnancy—set an important foundation for their children’s health. As mothers, women ensure their children develop good habits, eat well, exercise, receive necessary immunizations, health screenings and care.
Vaccination for HPV (human papilloma virus) has particularly important implications for women. While HPV does have a role in penile and anal cancer in men, its overwhelming importance is its almost exclusive cause of cervical cancer in women. Prevention of HPV infection holds the hope of true prevention for cervical cancer. Recent studies have shown that the HPV vaccine is extremely effective in preventing acquisition of the disease. The vaccine is recommended for both girls and boys between the ages of nine and 12, when the best immunologic response occurs, but it can be given into the late 20s. However, waiting until after the start of sexual activity is just missing an important preventive opportunity.
Parents, and mothers in particular, play a crucial role in helping girls through puberty. Helping them cope with physical changes is just one aspect of support for this challenging time in girls’ lives. Providing emotional support is the other aspect of the parents’ role, as suicide is one of the greatest risks for young women. And let’s not forget critical conversations about sexual activity and providing counsel or access to birth control to prevent unwanted pregnancies. After the start of sexual activity, girls should have yearly screenings for chlamydia infection.
The first particularly female intervention in adulthood is that of the first PAP smear, our best current strategy for early detection of cervical cancer. This should be done starting at age 21. PAP smears are currently recommended every three years until age 65 as long as there’s no history of abnormal results or an actual cancer diagnosis. After age 30, that interval can be lengthened to five years with “co-testing” (PAP screening and HPV testing) done with the same sample. This method isn’t recommended during a woman’s 20s, however, since HPV can remain undetected even if it is present. This lengthening of the cervical cancer screening interval (from yearly) is one of the biggest changes we’ve seen in women’s health recommendations during the last decade. It’s supported by very strong science and widely accepted by professional organizations.
There’s significant controversy about the need for routine pelvic exam separate from cancer screening. The American College of Obstetricians and Gynecologists (ACOG) still recommends a yearly pelvic exam while acknowledging there’s no medical evidence supporting that recommendation. Other physician organizations along with the U.S. Preventive Health Services Task Force don’t support routine pelvic exams separate from cervical cancer screening. It’s an issue women should discuss with their health care provider.
Breast cancer screening is another important issue in women’s health. Current recommendations from the U.S. Preventive Health Services Task Force call for starting mammography at age 50 and continuing every other year until age 74. Prior to age 50, the evidence is less clear regarding the benefit of screening and mammography, because that age group is accompanied with higher risk of both false negative and false positive results. After age 75, the science is unclear about the benefits and risks. While the science that supports these guidelines is quite solid, the issue is complicated, so again, discuss the matter with your health care provider.
Screening for osteoporosis with bone density testing is recommended at age 65 but not on any routinely recurring schedule. Earlier testing and repeat testing may be appropriate if there are factors that indicate increased risk (such as family history, treatment for cancer or treatment with steroids).
As women approach menopause, it’s important to have a good working relationship with a health care provider. Some women sail through this phase of their life with few issues or problems, but for others, finding solutions to the many symptoms that can arise can make the difference between misery and normal life.
It’s also important to keep track of all the general health maintenance and screening issues that are necessary for all of us, female or male: regular general check-ups, good diet, exercise, blood pressure control and other cancer screening. Care for your health. It’s precious.
Dr. Steven Levenberg, a member of Sutter Medical Group of the Redwoods, is board certified in the specialty of family medicine. He’s been in practice for 30 years, in Cotati and Rohnert Park, since 1989, and is a native of Santa Rosa.
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