Diseases

Disease Prevention in Women Information

Benefits of early detection

mellitus commonly causes asymptomatic organ damage until the disease is far advanced.There is good evidence that curtailing total caloric intake (especially intake of processed starches, sugar and sweets), regular exercise, and the loss of excess weight can help prevent the development of diabetes mellitus. Weight control will usually lead to improved metabolism of glucose, often to levels in those with impaired glucose tolerance.There is good evidence that in patients with diabetes, controlling hyperglycemia with medications, diet, weight control, and regular exercise can slow the development of diabetic complications.There is also strong evidence that even those with impaired glucose tolerance can significantly improve their otherwise increased risk for atherosclerotic disease (including heart attacks and stroke) with appropriate changes in diet, physical activity, and weight.

Bladder cancer

Screening tests

• Initial screening for bladder cancer is carried out by determining if there is blood in the urine (hematuria). This may be done using a dipstick that is placed in the urine. If positive, the urine is examined under the microscope.
• Alternatively, the urine may be visualized microscopically without the dipstick being used.
• Bladder cancer can cause gross hematuria (a large amount of blood in the urine), or microscopic hematuria (the blood can only be seen with the aid of a microscope).
• Bladder cancers is only on of many causes of hematuria.

Breast cancer

Breast cancer is the most common cancer among women in the United States. Approximately one in nine women who live to age 65 will develop breast cancer, although many will not do so until after age 65.Screening tests for breast cancerThe most important screening methods to detect breast cancer include:

• breast examination by a trained professional, and
• mammography

• In November, 2009, the U.S. Preventive Services Task Force recommended against teaching breast self-examination, citing a lack of benefit for a monthly self-examination. Groups such as the American Cancer Society agree with this conclusion and do not offer guidance on exactly how often a woman should check her breasts, but so state that a woman should be aware of any changes in her breasts.
• Breast examination by a professional trained in breast examination.
• Mammography: In their revised recommendations issued in November, 2009, the U.S. Preventive Services Task Force states that women age 40 to 49 do not require routine mammograms. They recommend biannual screening mammograms for women aged 49-74, and further state that: "The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms."
• However, The American Cancer Society (ACS) disagrees and recommends a baseline mammogram for all women by age 40 and annual mammograms for women 40 and older for as long as they are in good health.
• In women with "lumpy breasts" or breast symptoms, and also in women with a high risk for developing breast cancer, sometimes a baseline mammogram at 35 years of age is recommended. This recommendation is somewhat controversial, and there are other viewpoints.

• a history of previous breast cancer; and
• First-degree relatives (mother, sister, or daughter) with breast cancer. The risk is especially higher if both the mother and sister have had breast cancers, if a relative developed her cancer before age 50, if the relative had breast cancer in both breasts, if there is both ovarian and breast cancers in the family, or if a male family member has been diagnosed with breast cancer

Cancer of colon and rectum / polyps of colon and rectum

Colorectal cancer is the second most common cause of death from cancer overall, and ranks third in both women (after lung and breast cancer) and men (after lung and prostate cancer).Scientists believe that majority of the colon cancers develop from colonic polyps (precancerous growths on the inner surface of the colon). These tumors may become malignant, with the cells invading locally or spreading (metastasizing) to other parts of the body.Colon cancer is preventable by removing colon polyps before they evolve into a cancer. Colon cancer is curable if removed before spread occurs.Screening tests

• Stool occult blood test: Stool occult blood test is a chemical test to detect trace amounts of blood in the stool. It is inexpensive and easily performed, though not always accurate. Some cancers are not detected by the test, and many positive tests are caused by other problems beside cancer.
• Flexible sigmoidoscopy: Flexible sigmoidoscopy is a relatively quick and easy office procedure which allows direct visualization and biopsy of suspicious lesions from the distal portion of the colon. The procedure is uncomfortable, and it is less accurate than a full colonoscopy.
• Colonoscopy: Colonoscopy allows visualization of the entire colon and is the most complete and thorough test. It requires intravenous sedation, is much more expensive, and is not covered by some insurance plans as a screening procedure. Although screening colonoscopies may have a slightly higher risk of complications than flexible sigmoidoscopies, both screening tests are very safe when performed by trained professionals.

1. Preventing colon cancer by identifying and removing polyps before they become cancerous.
2. Increasing cancer cure rate by identifying early cancer at a treatable stage before the cancer has spread (metastasized).

Cervical cancer

Cancer of the cervix (the portion of the uterus that extends downward into the the vagina) is the third leading cause of gynecologic cancer. It is almost always caused by a sexually transmitted organism human papillomavirus (HPV). Cervical cancer typically develops over the long term from abnormal precancerous (before-cancer) cells on the surface of the cervix. Once cancer develops, the cells may spread (i.e. metastasize) to other organs.Screening testsPap test also known as Pap smear.A Pap test is a simple, quick office test in which a sample of cells from a woman's cervix is collected by swabbing the surface of the cervix and spreading the cells on a microscope slide or placed in a special solution. The cells are examined under a microscope in order to look for precancerous (before-cancer) or cancer cells.Who to test and how oftenWomen should have Pap tests as part of an annual pelvic examination beginning at age 21 or three years following the onset of sexual activity. The risk of cervical cancer increases sharply during the first few years following the initiation of sexual activity. Some physicians begin screening women as soon as they become sexually active, but not before. High-risk factors for cervical cancer of the cervix include:

• cigarette smoking;
• a previous genital warts or other genital infection with the human papilloma virus (HPV);
• multiple sexual partners or a partner who has multiple sexual partners; and
• the onset of sexual activity at a young age.

• women younger than 30 years of age should have a Pap test every 2 years.
• women aged 30 years of age and older should have a Pap test every 2 years. After three normal Pap test results in a row, a woman in this age group may have Pap tests every 3 years if:
  • she does not have a history of moderate or severe dysplasia;
  • she is not infected with human immunodeficiency virus (HIV);
  • her immune system is not weakened (for example, if she has had an organ transplant); and
  • she was not exposed to diethylstilbestrol (DES) before birth.

1. early identification and treatment of abnormal cells before they become cancerous.
2. identification of cervical cancer at an early stage, thereby allowing optimum treatment before the cancer has metastasized.

Disease prevention in women overview

Screening tests are a basic part of preventitive medicine. All screening tests are commonly available through your primary care physician. Some specialized tests may be available only through specialists. Take an active role and discuss screening tests with your doctor early in life. The following examinations represent beneficial (generally simple and safe) screening tests that can help detect diseases and conditions before they become well-established and harmful.

Glaucoma

Glaucoma is a condition with abnormally elevated intra-ocular pressures (pressure within the eyeball).Screening tests

• Measurement of intra-ocular pressure should be a standard component of a comprehensive eye examination.
• Note that a check up for vision does not always measure intra-ocular pressure.
• Intra-ocular pressure should be measured by eye care specialists.

• Age 20-29: Individuals of African descent or with a family history of glaucoma should have an eye examination every three to five years. Others should have an eye exam at least once during this period.
• Age 30-39: Individuals of African descent or with a family history of glaucoma should have an eye examination every two to four years. Others should have an eye exam at least twice during this period.
• Age 40-64: Every two to four years.
• Age 65 or older: Every one to two years.

High blood pressure (hypertension)

About one-sixth of all Americans have high blood pressure, and the incidence of this disease increases with age. Consequently, the proportion among adults is higher, and it is even higher among seniors. African-Americans are more likely than others to have high blood pressure. High blood pressure can cause arterial disease (atherosclerosis) that can lead to heart attack, congestive heart failure, stroke, and kidney failure. Screening tests Blood pressure measurements

• High-normal blood pressure is 130-139/85-89.
• Stage 1 hypertension is 140-159/90-99.
• Stages 2 and 3 blood pressure are >160 / >100.

• How often blood pressure should be checked depends on how severely elevated the blood pressure is. It also depends on the presence of other risk factors for heart attack and stroke.
• Adults with most recent normal blood pressure of systolic

Human immunodeficiency virus (HIV)

HIV is the virus that causes AIDS (Acquired immune deficiency syndrome). While modern anti-HIV medications have significantly improved long-term survival and quality of life of HIV infected individuals, there is still no cure or vaccine. HIV infection is still eventually lethal in everyone who is infected. Therefore, preventing the spread of HIV is the most important step in preventing illness and death due to HIV infection.Screening tests

• Screening blood test for antibodies to HIV is called an ELISA test. Confirmatory test for antibodies to HIV is called a Western blot.
• HIV infected individuals can remain free of symptoms for many years.
• Patients will know if they are infected ONLY if a blood test for HIV is done.
• HIV testing can be performed by a physician or at a testing center.

• pregnant women;
• individuals with occupational exposure to HIV (health care workers and researchers working with HIV);
• individuals with high-risk sexual behavior (multiple sexual partners, unprotected intercourse),
• drug users who practice needle-sharing;
• anyone requesting HIV testing; and
• individuals with active tuberculosis, unexplained fevers, low white blood cell counts, or who have been diagnosed with a sexually transmitted infection.

• Abstinence from sex until both partners are certain that they are not infected (for example both partners test negative for HIV antibody after the last potential exposure) is paramount in preventing the spread of HIV. While most newly infected individuals test positive by two months after infection, up to 5% are still negative after six months with routine testing. If abstinence is not possible, use latex barriers such as a condoms should be used. A dental dam (i.e. a piece of latex that prevents vaginal secretions from coming in direct contact with the mouth) can also be employed.
• For pregnant women infected with HIV, proper prenatal counseling, treatment with anti-HIV drugs after the first trimester, proper handling of the delivery process, and short-term treatment of the newborn child can very substantially reduce HIV infection in the newborn.
• Avoid sharing of needles, razor blades, and toothbrushes.
• Health care workers who experience a needle stick or exposure of the eyes, mouth, or injured skin to fluids from an infected person should take anti-HIV medication in order to reduce the risk of developing a clinical infection.

Hypercholesterolemia (hyperlipidemia, dyslipidemia)

Elevated LDL cholesterol or low HDL cholesterol increases the risk of developing atherosclerosis ("hardening of the arteries"). Atherosclerosis can begin to develop in adolescence and progress without any symptoms for many years. It can lead to heart attack and stroke later in life.Hyperlipidemia is a common and treatable cause of atherosclerosis. Atherosclerosis is the most common cause of death in both men and women in developed countries. The goal is to diagnose and retard or reverse atherosclerosis while it is still in a silent early stateScreening testsBlood lipid panel that includes:

• total cholesterol;
• LDL ("bad") cholesterol;
• HDL ("good") cholesterol; and
• triglycerides

• LDL is the part of the cholesterol panel that is most significant when deciding patient treatment, as well as determining how often lipid panels are checked.
• All adults over 20 should have a lipid panel every five years. The panel should be repeated more frequently in high-risk situations.

Melanoma and other skin cancers

Melanoma is the most serious form of skin cancer.

Osteoporosis

Osteoporosis is a condition characterized by progressive loss of bone density leading to bone fractures. Estrogen is important in maintaining bone density. When estrogen levels drop after menopause, bone loss accelerates. Thus, osteoporosis is more common among postmenopausal women.Screening testsMeasurement of bone density using dual energy X-ray absorptiometry (DEXA) scanDEXA bone density scanning can:

• detect osteoporosis before fractures occur
• predict the risk of future bone fractures
• be used to monitor the efficacy of treatment regimens to combat osteoporosis.

• early spontaneous menopause or surgical menopause secondary to removal of the ovaries;
• family members with osteoporosis and related bone fractures;
• cigarette smoking and/or heavy alcohol abuse;
• over-active thyroid gland (hyperthyroidism);
• previous or current anorexia nervosa or bulimia;
• thin body habitus;
• light skin;
• Asian or Northern European descent;
• conditions associated with poor absorption of calcium or vitamin D;
• chronic use of oral corticosteroids (such ascortisone and prednisone [Deltasone, Liquid Prep]), excessive thyroid hormone replacement, and phenytoin (Dilantin) or other anti-seizure medications; and
• problems with missed menstrual periods.

• quitting smoking;
• curtailing alcohol intake;
• performing regular weight-bearing exercises, including walking, dancing, gardening and other physical activities;
• supervised muscle strengthening exercises;
• getting adequate calcium and vitamin D intake;
• medications may be taken to prevent osteoporosis. The most effective medications for osteoporosis that are approved by the FDA are anti-resorptive agents, which prevent bone breakdown. Examples include alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin (Calcimar), and zoledronate (Reclast); and
• while hormone therapy containing estrogen has been shown to prevent bone loss, increase bone density, and decrease the risk of fractures, HT has also been associated with health risks. Currently, hormone therapy is recommended for women for the treatment of menopausal symptoms. The lowest effective doseage of hormone therapy should be used, and it should only be continued until symptoms have resolved.

Screening tests

y skin examinationWho to test and how oftenThe American Cancer Society recommends a skin check every three years between the ages of 20 and 40, and a skin check annually over age 40.Adults with higher than normal risk for melanoma should be particularly vigilant if they have:

• a family history of melanoma;
• are middle-aged adults with frequent sun exposure;
• a history of serious or frequent sunburn. Childhood sunburn is particularly risky;
• more than 50 moles; and
• fair skin.

• a diameter more than 6mm;
• asymmetric, meaning an uneven shape;
• an irregular border; and
• a variable color pattern, usually blue or black.

Type II diabetes mellitus

Diabetes mellitus is a condition characterized by elevated blood sugar levels ("hyperglycemia") due to impaired utilization of insulin, decreased production of insulin, or both.Diabetes is the seventh leading cause of death in the United States. An estimated 18% of all Americans over 65 have diabetes. Over ten million Americans have been diagnosed with diabetes; and at least half as many more are thought to have undiagnosed diabetes. Many more people have a condition that precedes diabetes, referred to as prediabetes, characterized by sluggish metabolism of sugar (glucose) to a lesser degree than is present in those with diabetes.Diabetes is the leading cause of new cases of blindness in adults aged 20-74 years, the leading cause of chronic kidney disease, and the leading cause of lower extremity amputations not related to injury. Individuals with diabetes are 2-4 times as likely to have a heart attack or stroke than are those without diabetes.Screening testsTests for diabetes mellitus include:

• fasting blood sugar (blood sugar test after at least eight hours without calories), normal level less than 100 mg/dl;
• pre-diabetes is characterized by a fasting blood sugar level of 100-125 mg/dl;
• diabetes is diagnosed by a fasting glucose level greater than 126 mg/dl; and
• two-hour postprandial blood sugar (blood sugar test drawn two hours after a meal), A normal post prandial level less than 140mg/dl.

• excessive weight;
• first-degree blood relative with adult onset diabetes;
• certain ethnic groups such as African-Americans, Hispanics, certain Native American groups, and some Asians;
• delivery of a baby weighing more than 9 lbs or a history of diabetes during pregnancy ("gestational diabetes");
• impaired glucose tolerance, currently or previously; and
• low HDL cholesterol (35 mg/dl or less) or elevated triglyceride level (over 250 mg/dl).