Routine, easy exams and tests can prevent serious problems
Most of us know the obstetrician/gynecologist as the person who deals with reproductive health issues and promotes optimal wellness for women. The American Congress of Obstetricians and Gynecologists is the nonprofit organization of women’s health-care physicians that advocates for the highest standards of practice and sets forth the rules that govern the field.
ACOG’s goal is to catch problems early through screening tests like Pap smears. “(Patients) are getting screened for high-risk viruses, which helps define a population of people who may be at high risk for developing problems as time goes on,” says Dr. Stephen Champlin, obstetrician/gynecologist at East Jefferson General Hospital in Metairie.
These are the patients who need more screening or observation, including those with signs of osteoporosis. “We have good technology and machines to pick up bone density and osteoporosis years in advance of it actually turning into osteoporosis,” says Champlin, “so those women can get started on medication so their bones get stronger, and [will] never have to deal with an osteoporotic fracture or deformed posture.”
The quick, non-invasive DEXA scan measures bone mineral density and is analogous to getting an X–ray. “Women lie on their backs, put their calves up on a foam block, and it is a combination of ultrasound technology and X–ray radiation, which in low dose looks at the hips, back and tells where the weak areas may be,” Champlin says. Unless a woman has a family history of osteoporosis, ACOG now recommends DEXA scans begin around the age of menopause. Follow-up exams are based on the initial results.
ACOG has also changed its recommendation for Pap smears. “Previously, it had been [at] 18 years old or three years after the first sexual encounter, but we now start at [age] 21,” says Dr. Veronica Gillispie, obstetrician/gynecologist at Ochsner Health System in New Orleans. The frequency recommendation has changed as well. “Patients with normal Pap smears can go every two years,” says Gillispie.
For some patients, it is easier to do the Pap smear annually because it can be hard to remember. “The American Congress of Obstetricians and Gynecologists and the American Cancer Society say that you can stop at [ages] 65 to70, but if patients are coming in and still have a cervix, I screen them into their mid-70s,” says Gillispie.
Patients have a better understanding of the purpose of the test. “The goal of the Pap smear is to diagnose pre-cancerous changes of the cervix such that we can treat it in both an aggressive yet conservative manner, in order to salvage reproductive capacity,” says Dr. William von Almen, obstetrician/gynecologist at Touro Infirmary Hospital in New Orleans. When something is caught in an early—versus later—stage, it may mean the difference between freezing or lasering, and a hysterectomy.
If you have a daughter who is sexually active, do not ask for a Pap smear to be done earlier. “Cervical cancer is caused by the human papillomavirus or HPV, which is such that they can suppress the virus so if a patient is under 21 and we do a Pap smear that is abnormal, it could result in them having to go into a surgical procedure that could remove their cervix and cause issues for the future with pregnancy,” says Gillispie. The virus sometimes disappears naturally in young girls, sparing them from potentially complicating surgeries.
The Gardasil vaccine is recommended for young girls to prevent HPV-related cancers. “The guidelines used to say it was for ages 9 to 26, but now it is approved for up to age 52,” says Dr. Rachel Reitan, obstetrician/gynecologist at Tulane Medical Center in New Orleans. Reitan believes, and research confirms, that the Gardasil vaccine is 100 percent effective.
The pelvic exam should be done annually. “It is to look inside the vagina, make sure the vaginal tissue or vaginal canal and cervix are normal, that no lesions are massive, external genitalia is normal and to palpate and make sure the uterus is regularly shaped and normal size and that the anexa or ovaries are not enlarged,” says Gillispie.
For breast health, health experts recommend women do monthly self exams starting at age 21. “Do it about a week after your period so the breasts are not as lumpy, bumpy and responsive to hormones, and do it in the shower or while lying in bed,” says Gillispie. The gynecologist will do a palpation to make sure there are no masses, lumps, bumps or nipple discharge.
Recommendations on how often to get a mammogram are controversial. “The Institute of Medicine did a study last year that showed that you would have to do 1,900 mammograms in women between ages 40 and 50 to find one woman with breast cancer, so from a cost effectiveness standpoint they made the recommendation that screening should start at 50,” says Gillispie, who doesn’t agree with the Institute’s finding.
“The American Cancer Society and the American Congress of Obstetricians and Gynecologists still recommend starting at [age] 40,” says Gillispie.
Colon cancer screening should begin at age 50. “Previously, the fecal occult blood test was recommended, but now it is recommended to do a colonoscopy,” says Gillispie. Those with a family history are advised to start 10 years before the family member was diagnosed.
The recommendation for the first visit to the gynecologist is in puberty. “The gynecologist can talk to you about what is going on in your body and let young girls know what is normal and abnormal, talk about good sexual health—and hopefully increase the rate of abstinence—but also talk about the menstrual cycle, safe sex and sexually transmitted diseases,” says Gillispie.
Pre-conception counseling is recommended as well. The goal is to get patients on board with prenatal vitamins and folic acid to reduce the risk of neural tube defects when pregnancy occurs and minimize any health problems like chronic hypertension or diabetes. This is also a good time to identify any genetic abnormality, like cystic fibrosis, or an infectious disease like rubella, which could cross the placenta and cause a range of birth defects. If a woman is not immunized, that is addressed.
During pregnancy, many screenings are recommended, including the initial screening for blood type. “In the past, we had traditionally screened for Down syndrome in the second trimester, between 15 and 22 weeks … but now we are able to screen in the first trimester,” says Gillispie. An ultrasound is used that measures nuchal translucency and blood work. It is also recommended to screen for gestational diabetes between 24 and 28 weeks. Between 35 and 37 weeks, cultures are done for group B beta strep, Gillispie says.
Postmenopausal women still need screenings. “We do urinalysis in women over 60 to look for asymptomatic urinary tract infections or bladder cancers,” says Reitan with Tulane Medical Center. Thyroid hormone screening is also done, which is one of the few blood tests run. “Sometimes we do a fasting glucose test, along with cholesterol,” says Reitan.
Reitan says it is important that women do not skip their annual exam. “Women should come every year, because one of the first and easiest ways to diagnose ovarian cancer is with yearly pelvic exams,” Reitan says.
Take the time to understand the recommendations and comply. Dr. von Almen with Touro says, “There is an exam because most of the time if you had the symptoms, it would be way too late. So screening is important.”