By Dr. Holly Dickson

For The Courier-Herald

May 13-19 has been designated as National Women’s Health Week to emphasize the importance of women taking steps for longer, healthier and happier lives. The U.S. Department of Health and Human Services, Office on Women’s Health recommends women:

• Have preventive screenings

• Get active

• Eat healthy

• Pay attention to mental health

• Avoid unhealthy behaviors

1. What screening tests do you recommend for your patients?

The U.S. Preventive Services Task Force recommends blood pressure, bone mineral density and Chlamydia tests in addition to breast cancer (mammogram) and cervical cancer (Pap) screenings.

All women should have a general health evaluation annually.  Mammography should be performed every one to two years beginning at age 40 years and yearly beginning at age 50 years.  All women should have an annual clinical breast examination as part of the physical exam.  Despite a lack of definitive data for or against breast self-exam, breast self-exam has the potential to detect palpable breast caner and can be recommended.

Colonoscopy is a good screening test for colorectal cancer and should be performed every 10 years starting at the age of 50.

2. One of the confusing things for women is that age guidelines seem to change and that what we once thought was best practice for Pap tests and mammograms now appear to be called into question.  How do you answer those concerns?

Traditionally it was thought that as soon as a woman becomes sexually active, she should start getting pap smears.  Multiple studies on this studies have show that starting screening before the age of 21 likely adds little or no benefit but leads to more procedures with  potential harms.  Physicians should target sexually active women starting at age 21. Continue pap smears every 2 years from age 21 to 29.  At 30 years old you can decrease pap smears to every 3 years if 3 consecutive pap smears have been normal.  This does not mean, however, that you don’t need to see your doctor every year.  Every woman should still have annual complete physical exams.

Cervical cancer develops very slowly; women older than age 65 years who have had repeated negative Pap smears and are not at increased risk and can stop getting pap smears, if prior pap smears have all been normal.  Mortality from cervical cancer is greatest among women who have not had prior adequate screening.  A majority of women diagnosed with cervical cancer have either never had, or have not received a pap in the past five years.

About one in eight U.S. women (just under 12 percent) will develop invasive breast cancer over the course of her lifetime.  Mammograms should be performed every one to two years from age 40 to 50, then every year after the age of 50.  Women with a strong family history should receive counseling for options which may include genetic testing for BRCA-1 and BRCA-2 and more intensive screening for breast cancer.

3. Are there vaccines and/or boosters that women should be getting?

Recently Washington state has been hit hard by whooping cough. Cases of whooping cough are increasing dramatically in Washington state this year and the trend could bring a spread of the disease not seen since the 1940s, the state’s health secretary said.  As of March 31, officials had already recorded 640 cases, compared with 94 cases reported by this time last year. If the pattern continues, the Health Department expects numbers well into the 2,000s.

Pertussis (whooping cough) is very contagious and can cause serious illness, especially in infants too young to be fully vaccinated. Pertussis vaccines are recommended for children, teens, and adults, including pregnant women.  The vaccine we get as children typically wears off as an adult.   You’re no longer immune, and, if you do get whooping cough, the folks around you are in danger, as well.  The dTap vaccine, a shot that prevents diphtheria, tetanus and pertussis, is readily available to the public.

While people of all ages can come down with whooping cough, even if they’ve been vaccinated, it’s particularly dangerous for newborns’ systems because they don’t have the immunity or vaccine to fight off the infection. Infants cannot receive the vaccination until they are 4 to 6 weeks old, and they are most likely to be infected by close family members who do not know they are sick.  Studies show that about 75 percent of newborns that come down with whooping cough get it from a family member. Of all deaths from pertussis between 2004 and 2008, 83 percent were children less than 3 months old.

Because of the high rate of whooping cough in infants, the Centers for Disease Control and Prevention recently recommended that pregnant mothers get vaccinated with dTap.

4. What advice do you give your patients about decreasing stress or other mental health issues?

It rains a lot in Washington and the sun infrequently shines.  Washington women can have a high propensity to Vitamin D deficiency which may lead to depression.  Vitamin D supplements may be useful.  Ask your doctor to have your Vitamin D levels checked.   Also exercise releases natural endorphins which prevents against depressing and improves longevity.

5. What are the most important recommendations you have for having a healthy diet or staying active?

Women should consume a diet rich in fruits and vegetables; choose whole-grain, high-fiber food; consume fish, especially only fish at least twice a week; limit intake of saturated fat to < less than 10 percent of energy and if possible to less than 7 percent, cholesterol to less than 300 mg/day, alcohol intake to no more than one drink a day and sodium intake to less than 2.3 g/day (approximately 1 tsp salt).  Consumption of trans-fatty acid should be as low as possible.

Women should accumulate a minimum of 30 minutes of moderate-intensity physical activity – walking on most and preferably all days of the week.

Women who need to lose weight or sustain weight loss should accumulate a minimum of 60-90 minutes of moderate-intensity physical activity

Women should maintain or lose weight through an appropriate balance of physical activity and caloric intake to achieve an ideal BMI between 18.5 and 24.9 kg/m and a waist circumference of less than 35 inches

6. As women age, arthritis and other mobility issues may decrease one’s ability to be as active as they should.  Maintaining good balance and eliminating falls are considerations as well.  What suggestions do you have for women in general and in particular for the aging Boomers?

Osteoporosis is a silent disease most frequently found in postmenopausal white women affecting over 8 million women in the United States accounting for 250,000 hip fractions.  Postmenopausal women lose approximately 3 percent cortical(hip) bone and 8 percent of trabecular (spine) bone a year. It is not detected by standard x-rays.  And is detected by a dual energy x-ray absorptiometry or DEXA scan of the spine and hip  Every women 65 and older should be tested.  Younger postmenopausal women with risk factors such as being Caucasian, cigarette smoking, inactive lifestyle should be tested sooner.  Treatment of Osteoporosis exists which may actually reverse bone loss and improve mobility and longevity.

7. The Affordable Health Care Act of 2010 increases vital preventive services, well-woman visits and ensures women can see an OB/GYN physician without a referral.  How will this affect women in general and your practice?

This opens big doors to allowing women to obtain the heath care they need.  This is particularly important for women that suffer from heavy menstrual cycles who previously need a referral to see their Gynecologist.  Prior to seeing me, many women did not realize that there is a simple, safe and effective solution to heave menstrual cycles that takes about 90 seconds.