Cancer Screening In Women

By Anne Brown, MD, FACOG

Capital Women's Care

. https://cwcloudoun.com/

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Cancer Screening In Women

There are a number of malignancies that are routinely screened for during a well-woman examination, although the frequency of those screenings depends largely on age, health status, and the type of disease for which the test is screening.

Cervical Cancer Screening

Cervical cancer screening via the Pap smear is the test most people think about when considering gynecologic care. Many improvements in the test have been made in the past 20 years based on a vast amount of research. Cervical cancer is now considered a sexually transmitted disease based on the fact that we know human papilloma virus (HPV) is the source of the cellular mutations that lead to the cancer.

If we screen for the virus (or more importantly prevent the infection with vaccines) we can determine a patient's risk. We have been able to vastly decrease the number of biopsies and unnecessary surgeries done for abnormal Pap smears, and to also decrease the frequency of Pap smears in low risk patients to every third year rather than annually. We also don't begin doing Paps until age 21 and stop after age 65 in patients with a normal history.

Breast Cancer Screening

Breast cancer screening usually begins at 40 years old in the US and is performed every 1-2 years until 50 then annually from 50 until such time as one's other medical problems/life expectancy no longer merit screening for this disease (usually in the 7th or 8th decade of life).

There have been a number of alternatives proposed but so far nothing has surpassed low-dose digital mammography for both sensitivity/specificity and cost-effectiveness. Ultrasounds and MRIs are complementary tests, but not substitutes. Thermography is painless but lacks specificity. Some patients need screening earlier or more intensively based on their family or personal history or their genetic status (if they are carriers of the breast cancer gene, for instance).

Ovarian, Uterine, Tubal, Vaginal or Vulvar Cancers

There are no good screening tests for ovarian, uterine, tubal, vaginal or vulvar cancers, but your gynecologic provider should be aware of what to look for in your history and physical exam to cause them to do further exploration such as biopsies, ultrasounds, diagnostic surgeries, etc. Gynecologists are particularly sensitive to a patient's complaints of abnormally heavy or frequent vaginal bleeding or bleeding of any type after the menopause.

Colon Cancer Screening

Colon cancer screening is recommended every 8-10 years starting at 50, although some higher risk patients require earlier or more frequent evaluations with the gastroenterologist.

Annual visits to your medical provider including manual breast and pelvic examination give the best chance for diseases to be caught and treated early.