Proactive Screenings for Women’s Health

The past four decades have birthed a virtual transformation within the field of women’s healthcare. Traditionally, diagnostic exams or screenings for many life-threatening diseases were performed only after symptoms developed. Unfortunately for many women, the first sign of trouble often showed up as a catastrophic health event such as a stroke or heart attack. Healthcare providers are well aware that early detection is the most effective way to fight debilitating and chronic disease, but the key to early diagnosis and the detection of risk factors begins with raising patient awareness about the need for specific screenings.

“The U.S. Preventive Task Force has come out with new guidelines for certain screening tests,” says Sue Romanick, MD, board certified in internal medicine and rheumatology, with a practice in Bellevue,Wash. “I tell women it’s a good idea to work with your doctor to find out which annual screenings you need while also making the right lifestyle choices, including a healthy diet, regular exercise and stress modification. All of these decisions can help tip the balance in your favor when it comes to staying disease-free.”

The Weaker Sex?

While women may not literally be the “weaker sex,” the fact remains that women experience life-altering conditions like diabetes and heart disease differently than their male counterparts. Women also tend to suffer from certain diseases at a higher rate than men, including osteoarthritis, obesity, depression and fibromyalgia. Statistically, women are more prone to autoimmune conditions like Sjogren’s syndrome, lupus and hypothyroidism as well. Understanding these gender differences can help clinicians develop studies and screenings that address the unique needs of the female population.¹

Greater awareness of women’s health concerns has led to increased attention on female-focused research. The National Institutes of Health now requires women and minorities to be included in the research it supports, and the U.S. Food and Drug Administration (FDA) encourages that women be included in drug and device testing. To support this effort, regional women’s health coordinators have been appointed to focus on inclusion at state and local levels, and a National Women’s Health Resource Center (NWHRC) has been established to provide easier access to women’s health information by telephone and on the Internet.²

Gaps in knowledge regarding women’s health concerns are increasingly being filled through more targeted research; to date, 18 National Centers of Excellence in Women’s Health have been established around the country to foster research, clinical services and education on women’s health issues, as well as to enhance the career development of women in academic medicine.³ New recommendations for medical education curricula are also being developed to help ensure that future physicians are sensitive to gender differences in the etiology, treatment and prevention of disease for women of all ages.⁴

Promoting Patient Awareness

In 2012 alone, almost half a million women will die of cardiovascular disease.⁵ To put that in perspective, the number is nearly equivalent to the entire population of the state of Wyoming. Although statistics like this are widely publicized, there is still ample misinformation and lack of awareness among patients and providers; while heart disease is the No. 1 killer of American women, only 13 percent of women in the United States see heart disease as the greatest threat to their health. Even more surprising, less than one in five physicians know that more women than men die of heart disease each year.⁶ “There are far too many women dying of heart disease in their 60s, when no one expects to die because that’s too young in this country,” says Cindy Pearson, executive director of the National Women’s Health Network. “There are (also) women, who, for many years, are really ill with heart disease — being out of breath, not being able to walk up one flight of stairs … because heart disease impairs their ability to get around.”⁷

Thanks to organizations like Susan G. Komen and its ubiquitous pink ribbons, breast cancer awareness is at an all-time high, but misperceptions still abound. Two of the most common false beliefs are that mammograms can detect 100 percent of all breast cancers, and that breast cancer does not afflict young women. Studies show that up to 10 percent of breast cancers do not show up on a mammogram, either because they are located in a part of the breast that is difficult to include in the image, or they are hidden by normal breast tissue.And while only 5 percent of all breast cancer cases occur in women under 40 years old, the disease can strike at any age, depending on a woman’s risk factors. On the bright side, a recent study in the New England Journal of Medicine found that advances in breast cancer screenings contributed significantly to the 20 percent reduction in the U.S. breast cancer death rate between 1975 and 2000. The study also found that when breast cancer is detected early and confined to the breast, the five-year survival rate is nearly 100 percent.⁷

According to the American Cancer Society guidelines, all women should begin cervical cancer screening about three years after they begin having vaginal intercourse, but no later than 21 years of age. Screening should be performed annually with the regular Pap test or every two years using the newer liquid-based Pap test. Older women experiencing menopause are encouraged to be aware of the signs and symptoms of uterine cancer, and if risk factors exist, may opt for a yearly endometrial biopsy. Likewise, colon cancer screenings are recommended yearly after the age of 50, or more often based on the patient’s personal and family history.

When it comes to conditions like cardiovascular disease and cancer, one thing is certain: A woman’s best line of defense is through regular, proactive screenings and examinations as prescribed by her physician; early detection saves lives.

Advanced Diagnostics on the Rise

Breakthroughs in diagnostic technology have given physicians improved tools for detecting disease earlier, making more confident diagnoses and providing more personalized treatment. For example, when it comes to breast cancer, traditional screening mammography has long been considered the gold standard. In recent years, digital mammography has emerged and is allowing radiologists to manipulate images for a more accurate assessment and diagnosis. A recent study sponsored by the National Cancer Institute suggests digital mammography detects up to 28 percent more cancers than traditional mammography for women under the age of 50 or for those with dense breasts.

Other technologies such as magnetic resonance imaging (MRI),ultrasound and the hybrid positron emission tomography/ computed tomography (PET·CT) also are valuable tools for diagnosing breast cancer. MRI, for example, can help physicians better examine abnormalities first detected by mammography, can detect abnormalities in women with breast implants, and can provide accurate assessments of the breast tissue in younger women. Additionally, breast ultrasound technology elastography, in which images are acquired on high-end ultrasound devices equipped with additional software and hardware, is expected to enable physicians to accurately distinguish characteristics of breast lesions, which may reduce reliance on invasive breast biopsy procedures.

A recent Mayo Clinic study of nearly 1,000 women showed that new gamma-ray cameras detected three times as many tiny tumors (as small as two-fifths of an inch in diameter) as standard mammography in women with dense breasts. This development gives high-risk women another early-detection option besides mammograms and more expensive MRIs.⁸

Although the most talked about, breast cancer is not the only cancer impacting women. Other types of female-specific cancers such as ovarian and uterine cancer also can be detected through proactive screenings, although risk factors should often be evaluated first to ensure an accurate assessment.

“Screening for cancer saves lives, yet the numbers of Americans getting screened fall below recommended target levels,” says Dr. Romanick. “There can be controversy surrounding certain screening tests such as the CA-125 for ovarian cancer, a test some women are now asking for during annual exams. As with other cancers, we now know that it’s important to consider risk factors first. For example, if you’ve had a certain cancer before, or if ovarian cancer already runs in your family, or let’s say that you’ve had a condition such as endometriosis, then your provider may opt to do additional screenings.” Romanick says typical screenings would include looking for gene mutations (BRCA 1 and BRCA 2), in addition to having repeated CA-125 testing over time while looking to see how the values are changing rather than looking at one isolated value.

Heart disease, too, can be detected with advanced imaging technologies to help pinpoint the disease in its earliest stages. Scanners such as the CT angiography, in which multiple CT scans are used to produce a three-dimensional image of the heart, can be highly effective, but advised only if specific risk factors are present. Several studies have suggested that expensive tests for biomarkers that are sometimes indicative of heart disease, including C-reactive protein, a sign of systemic inflammation, are not cost-effective in generally healthy patients. More sophisticated tests such as these are often advised only in patients with known heart risks.

Benefits of Blood Panel Testing

Imaging technology is not the only type of screening recommended when assessing a woman’s risk factors for disease. Blood panel tests also can identify a variety of red flags. “In addition to a complete blood panel, which assesses the complete blood count, lipid panel and liver enzymes, I am a big believer in blood testing to assess and then correct the hidden epidemic of diabetes, believed to be an underlying cause of dementia, fatty liver disease, depression, mood disorders, nervous system dysfunction and kidney failure,” says Ann Louise Gittleman, PhD, CNS. “To monitor for this condition, the tests I would absolutely request include an insulin response test, hemoglobin A1c and NMR profile to measure the size and number of low-density lipoprotein, high-density lipoprotein and triglycerides, the latter being a major red flag for heart disease, especially among women.”

Gittleman, a best-selling author and expert on women’s health, asserts that lifestyle changes are still probably the largest contributor to long-term health for women. “The most important lifestyle change I recommend is to cut sugar from the diet. Sugar, including excessive fruit, fruit juices, sweeteners and processed and refined carbohydrates, triggers the production of insulin, the fat-promoting hormone. Curtailing its intake is critical to obtaining and maintaining a healthy weight.”

Women and the Affordable Care Act

The Affordable Care Act, which was passed by Congress and signed into law by President Obama on March 23, 2010, is poised to have a potentially large impact on the future of health screenings for women. Under the Affordable Care Act, women’s preventive healthcare such as mammograms, screenings for cervical cancer, prenatal care and other services are covered with no cost-sharing for new health plans. For women who have traditionally declined screenings due to financial restraints, this is good news.

As of September 2010, new health plans are required to cover the services recommended by the U.S. Preventive Services Task Force (UPSTF), an independent panel of prevention and primary care experts that routinely assesses and makes recommendations for clinical preventive care. Current UPSTF recommendations for preventive screenings for diseases such as breast and cervical cancer, colorectal cancer and chlamydia, as well as bone density tests, testing for high cholesterol and high blood pressure, obesity screening, annual influenza vaccinations, and smoking cessation treatment all are covered under the new guidelines.⁹

Over the last decade, there has been heightened interest and awareness regarding women’s health issues. Stakeholders from medical, government and patient sectors have weighed in to create strategic plans that will improve the health, longevity and quality of life for future generations of women. Critical gaps in medical research are being addressed, and while there is much that still needs to be done, great strides have been made to ensure that proactive screenings for the diseases that impact women are utilized to their full advantage. This increased focus can go a long way toward better equipping 21st-century healthcare providers with the improved diagnostic tools and resources needed to prevent disease and prolong life.