No matter how fast medicine moves us towards treatments, preventive medicine will always be the most effective and cheapest way to keep healthy. In this post, we'll run down some common women's health screening tests, when you should get them, and what you're in for when you walk in.
The key word here is recommendations. These are not rules, they're guidelines aimed at women with average risk (which means no relevant personal or family medical history.) Since there's some bickering among experts as to which tests are appropriate at what age, each of the reccomendations below is informed by a combination of medical bodies.
Also, keep in mind that this list does not include areas covered by your general health checkup (blood pressure, cholesterol, weight, etc) or behaviour related screenings (STIs, lung cancer, etc). Those tests are all absolutely critical to maintaining your health as well: so don't skimp on them!
As always, final decisions about your personal care should be made after a conversation between you and your physician. Not after a quick perusal of the internet.
Manual Breast Exams
What Is It? The manual breast exam looks for signs and symptoms of a number of breast problems, including cancer. There are two types: clinical breast exams (CBE) are performed by your doctor; breast self exams (BSE) are done at home. The goal is to identify signs early on so you can catch any problems before they progress.
Your doctor starts by checking your breasts for rashes, skin dimpling, or other abnormal changes. Once the visual check is done, they use the pads of their fingers to physically examine (palpate) your breast, under arm, and under your collarbone for lumps or abnormalities in your breast tissue and lymph nodes.
What Does A Breast Exam Feel Like? Like someone is kneading your breast and moving your arms around as if you're a wax figure. Not painful but awkward in that "where am I supposed to be looking right now" kind of way. Also, doctors usually have cold hands.
When Should I Get A Breast Exam? Clinical breast exams should be conducted annually for women over the age of 19. There's one caveat, however: research suggests that it can result in a high number of false positives (incorrectly identifying a problem where there is none). Breast cancer is exceedingly rare for women in their 20s: early CBEs may lead to unnecessary additional testing and procedures (not to mention anxiety).
In the past, women were told to perform monthly self-exams, which for most of us meant a half hearted poke on no particular timeline. Research suggests no difference in mortality between women who perform BSEs and those who do not. Doctors now recommend that you practice "breast self-awareness." Breasts come in all shapes, sizes, and consistencies: know your normal.
What Is It? A mammogram is an X-ray of your breast, designed to detect breast cancer. They can be done as a screening (for women who don't have other symptoms) or a diagnostic (for a woman with signs/symptoms of breast disease or a lump). It is the only imaging technique shown to reduce breast cancer mortality.
What Does A Mammogram Feel Like? I haven't had the pleasure yet, so I crowdsourced this question on mammograms. The most common response was "Like your breast is in a vice." General consensus is that the 10-15 minute test is definitely unpleasant, but less so than breast cancer.
When Should I Get A Mammogram? 75 per cent of all breast cancers occur in women over the age of 50 years. Screening mammograms are often less reliable for women under 40 years of age due to the density of breast tissue. All women aged 50 to 74 years are encouraged to have a free mammogram every two years through BreastScreen Australia. (Women aged 40 to 49 years also have free access to the program should they choose to a have a screening mammogram.) To contact your local BreastScreen service, call 13 20 50.
What Is It? Also known as the Angelina Jolie test, a BRCA test looks for genetic mutations that may increase a woman's risk of developing breast cancer.
What Does A BRCA Test Feel Like? It's a blood test, so it feels like a needle prick.
When Should I Get A BRCA Test? Rates of the mutation are very low in the general population and routine screening is not recommended for all women. If there is a family history of breast, ovarian, tubal, or peritoneal cancer, genetic testing may be offered through a family cancer clinic.
What Is It? The pelvic exam is the physical exam portion of your visit to the gynecologist. In addition to checking your general reproductive health, doctors assess your organs, looking for signs of health conditions including cysts, fibroids and STIs.
The pelvic exam includes an external examination and a bimanual examination. During the bimanual exam, two fingers are inserted into your vagina to assess your cervix. The doctor will also examine your uterus, ovaries, and fallopian tubes by pressing down on your abdomen. Depending on your doctor, they may also perform a rectovaginal exam (one finger is inserted into the rectum during exam). This allows a more complete picture of your anatomy, including the position of your uterus and assessment of the rectum.
What Does A Pelvic Exam Feel Like? Pretty much exactly like it sounds. Your doctor inserts fingers into your vagina and applies pressure to your lower abdomen. It's not exactly a life highlight, but should not be painful. Generally you will stare at the ceiling while awkwardly making small talk with the person feeling your internal genitalia. In part of a running theme, if the speculum is metal, it might be cold. Sometimes your doctor will warn you; sometimes it will be an unwelcome surprise.
When Should I Get A Pelvic Exam? As with many of these guidelines, it depends on who you ask. Some medical bodies recommend annual pelvic exams beginning at age 21, while others claim there is no need for an annual pelvic exam for asymptomatic, non pregnant women. Regardless, an annual visit to your gynecologist is recommended for STI screening, general reproductive health counseling and birth control as needed.
What Is It? Although the pap smear was first developed in the 1920s, it didn't gain real traction until decades later. At the time, cervical cancer was the number one cause of death in women. With the advent of pap smears as a standard of women's health, and improved cancer treatments, death rates have decreased dramatically. Today, the pap smear is considered one of the most critical screening tests for women. It aims to identify any cervical changes in the precancerous stage, before they develop into cervical cancer. It does not test for HPV infection. In 2012, a co-screening blood test for the human papilloma virus itself, the cause of nearly 90% of cases of cervical cancer, was incorporated into the guidelines.
For the test, a speculum is inserted into your vagina to give the doctor visual and physical access to your cervix. Your gynecologist will use a small spatula and brush to take a sample of your cervical cells. These scrapings are stained and examined under a microscope to look for dysplastic changes -- in other words, to see if any of the cells are growing abnormally.
What Does A Pap Smear Feel Like? Not surprisingly, the pap is uncomfortable because your legs are up in stirrups and you are being propped open by a cold piece of metal (or plastic) while someone stares at your genitals. The test itself feels somewhat akin to having something dragged across your cervix for a few seconds (which is exactly what's happening). The discomfort is fleeting.
When Should I Get A Pap Smear? All women over the age of 18 who have ever been sexually active should have pap smears every two years, or two years after first sexual activity (which ever is later.) Pap smears should continue to be a part of your health check-up until age 70.
Colorectal Cancer Screening
What Is It? Most people associate colorectal cancer screening with colonoscopies -- a multipurpose test that can screen for colorectal cancer, ulcers, polyps, and bleeding. There are actually a few methods of testing for colorectal cancer, each with a different screening recommendation. The unique advantage of the colonoscopy is that it visualizes the entire colon and allows for tissue sampling and removal of polyps as appropriate.
There are also several screening tests that look for blood in the stool, a possible sign of colon cancer.
What Does A Colorectal Cancer Screening Feel Like? As for the mammogram, I had to outsource this question. For the colonoscopy and sigmoidoscopy prep, the almost universal responses were either "I don't want to talk about it. There's just so much poop." For the colonoscopy itself, most people are sedated so you will have no memory of the experience. Because the sigmoidoscope does not travel as far up the digestive tract, patients are awake through the procedure. This was described "like someone is snaking a pipe...only it's your rectum."
For the faecal occult blood screening test (FOBT), your doctor will insert one finger into your rectum and test for blood. This feels exactly as it sounds. For the faecal immunochemical test (FIT), you will collect samples of your own stool. This is painless, but kind of gross.
When Should I Get A Colorectal Cancer Screening? Doctors recommend screening every 1-2 years beginning at age 50.
Bone Mineral Density Screening
What Is It? Osteoporosis is a condition in which bones lose density and weaken, making them brittle and more likely to fracture. It is a common consequence of decreased estrogen levels during menopause. It's also significantly more common in women, with 1 in 2 post menopausal women at risk for an osteoporosis related fracture. That's where the bone mineral density screening comes in.
Bone density is measured by an x-ray that determines the level of calcium and other minerals in your bones. Specifically, it is a dual energy x-ray absorptiometry (DXA) machine, which reveals more than a standard x-ray. Although screening is also possible by an ultrasound of your calcaneus, or heel bone, diagnosis and treatment standards are based on DXA findings.
What Does A Bone Mineral Density Screening Feel Like? The bone density test is an x-ray, typically of your hip and spine. You lie on a table and a technician will manipulate a machine to point at different parts of your body. It is painless. Unlike almost every other preventive test on women, this time you get to keep your clothing on.
When Should I Get A Bone Mineral Density Screening? Women over 50 or with an estimated fracture risk equal to or greater than that of a 65 year old woman. Some risk factors may also require women under 50 to have a bone density scan.
Regular screening and early treatment remains your best bet for reaching (or outliving!) the average Australian lifespan of 82.1 years (if you don't live in Oz, your average life expectancy can be found here.)