Time for a medical \'tune-up\'?

by Jean Baker, M.S., R.D.

In addition to ferrying our kids to their activities, we keep running between work, the gym, and the grocery store. And chances are good that your car gets a tune-up more often than you do. While some healthcare providers send a friendly reminder when it's time for a periodic physical, most of us are on our own to remember when it's time for our next '30,000 mile' tune-up.

It pays to pay attention. All of the medical procedures described below are proactive rather than reactive. Each is designed to catch a developing health problem in its early, more treatable stages. As such, timing is everything, so it is in every woman's best interest to become an informed health care consumer. Keep in mind that the timetable suggested for each test applies to healthy women; those with specific medical concerns should follow the guidance of their healthcare providers.

Breast cancer

Most women have heard the breast cancer statistics—more than 43,000 women will die from breast cancer this year. An important part of a woman's defense against this killer disease is a mammogram—an X-ray of the breast that can identify a cancerous lump in its early stages. There is some controversy about when women who are at low risk for developing breast cancer should start to have periodic mammograms. The American Cancer Society, though, advises all women over age forty to have a yearly mammogram.

You should be able to find a certified mammography facility through your healthcare provider, and insurance usually covers the procedure. The National Cancer Institute's Mammography Information Service (1-800-422-6237) can also provide a list of certified facilities, answer related questions and make referrals for free or low-cost mammograms for uninsured or underinsured women.

Colon cancer

Risk of developing colon cancer increases with age, so it is important for women to learn the facts about this disease and know about tests that can reduce their risk of developing it. Although often perceived as a "man's disease," it is the third most common type of cancer in women. As is the case with any type of cancer, early detection is the key to survival.

The initial step in screening for colon cancer is a digital rectal exam, a painless procedure in which a doctor inserts a gloved finger into the rectum to feel for abnormal masses. This test may be done during routine health exams starting at age 40. After age 50, the American Cancer Society recommends a periodic fecal occult blood test, an analysis of a stool sample for the presence of blood. This test is not always definitive because other conditions, such as hemorrhoids, can alter the results, so your doctor may also recommend a sigmoidoscopy. In this procedure a doctor inserts a lighted, flexible tube into the rectum to find and remove any precancerous growths, or polyps, on the wall of the lower colon. In some cases, a longer tube is used to examine the upper portions of the colon as well.

Cervical cancer

While some tests become more important as a woman ages, guarding against cervical cancer is an issue for women of all ages. A periodic Pap test is the best way to identify cervical cancer before symptoms become apparent. In fact, the 74% drop in the incidence of cervical cancer since the 1950s is attributed to the use of this early diagnostic test. As part of a pelvic exam, cells scraped from the cervix are smeared on a slide and examined under a microscope for any unusual-looking cells. Suspect cells identified during this procedure indicate the need for further testing. Every women over age 18, or younger if sexually active, should have a routine Pap test every one to three years on the advice of her healthcare provider.

It is actually the most potent health risk for both men and women in the United States. A lipid profile that includes both a measurement of total cholesterol and HDL cholesterol is an important part of your preventive health care. The National Institutes of Health recommend that all women get a blood cholesterol check every five years starting at age 45, or more frequently on the advice of their healthcare provider. And since high blood pressure is a risk factor for heart disease, they also suggest that all women get their blood pressure checked as part of routine medical care.

There are several other tests that aren't usually included in routine screening exams but deserve a mention here.

Osteoporosis

Women who are at risk for osteoporosis may benefit from a bone mineral density test. This X-ray procedure can diagnose osteoporosis in a woman before she suffers a fracture and can also measure the rate of bone loss.

Diabetes

Although not a part of routine health screening in most facilities, a fasting plasma glucose test is a relatively easy way to screen for type 2 diabetes. The American Diabetes Association estimates that more than five million Americans have undiagnosed type 2 diabetes and are at risk for the long-term heart, kidney or eye complications that can result from uncontrolled blood sugar levels. They recommend that individuals who can identify one or more of the following risk factors be tested for diabetes:

• Family history of diabetes
• Obesity (body mass index greater than 27)
• Race: African-American, Hispanic, Asian, Native American, Pacific Islander
• Older than age 45
• Previous positive test for elevated blood sugar
• High blood pressure (greater than 140/90 )
• HDL cholesterol less than 35 mg/dl and/or triglyceride level greater than 250 mg/dl
• History of gestational diabetes or delivery of a baby over 9 lbs.

STDs

Testing for sexually transmitted diseases (STD) is usually indicated for pregnant women and young women who have had multiple sexual partners. Several of the most common STDs, including chlamydia and human papillomavirus (HPV), often do not produce obvious symptoms and may go unnoticed. Left untreated, though, chlamydial infection can result in pelvic inflammatory disease, a major cause of infertility. An infected woman risks transmitting it to her newborn baby during delivery. Even more ominous, HPV infection greatly increases a woman's risk of cervical cancer. A frank discussion with a healthcare provider can determine your need for STD testing.

	Age
Test	20-39	40-49	50-65	65+
Pap test	Every 1-3 years on advice of health care provider	Every 1-3 years on advice of health care provider	Every 1-3 years on advice of health care provider	Every 1-3 years; may discontinue if prior exams were normal
Mammogram	-	Yearly*	Yearly*	Yearly to age 70, then on advice of healthcare provider
Total cholesterol	On advice of health care provider	Every 5 years starting at age 45; more often as needed	Every 5 years; more often as needed	Every 5 years; more often as needed
Fecal occult blood test	-	-	Yearly	Yearly
Flexible sigmoidoscopy	-	-	Every 5 years*	Every 5 years*
Blood pressure	Every 2 years	Every 2 years	Yearly	Yearly

*recommendation of American Cancer Society

Adapted from: Report of the U.S. Preventative Services Task Force, 2nd Edition, 1996.

Keep your health on track with a:

• Mammogram- yearly after age 40
• Pap test- every 1-3 years after age 18
• Fecal occult blood test- every year after age 50
• Sigmoidoscopy- every 5 years after age 50
• Cholesterol test- every 5 years after age 45
• Blood pressure check- as part of your routine medical care