September 12, 2011

Women At 40—Prevention Measures to Stay Healthy
By Leslie Feldman
For The Record
Vol. 23 No. 16 P. 24

By following some key guidelines, this slice of the population can live long and active lives.

A recent survey commissioned by Monistat revealed that 59% of women admit they put others’ health and wellness above their own. Furthermore, 42% of women do not have regular general health checkups, and 44% do not make annual visits to a gynecologist.

As caregivers for their families, women often make themselves the last priority when it comes to health and well-being matters, winding up at the bottom of the family totem pole.

Medical professionals suggest women who’ve reached the age of 40 closely consider the following questions:

• In general, are you taking care of yourself?

• Do you visit a family doctor at least annually?

• Are you getting regular cholesterol checkups?

• Are you having an annual Pap smear and mammogram? If not, is it because of an insurance issue or a lack of time?

According to many health experts, women who’ve reached the age of 40 should begin to take certain measures to remain in good health or improve it.

Second Leading Cause of Death
Perhaps the most significant preventive measure women aged 40 and older can take to help ensure good health is scheduling a mammogram. Age is the most important risk factor for breast cancer; the older a woman is, the greater her chance of developing the disease. Most breast cancers occur in women over the age of 50 while the number of cases is especially high for women over the age of 60. Breast cancer is relatively uncommon in women under the age of 40.

According to the SCRY Study (mammography SCReening of Young women) in Sweden, mammography screening in women aged 40 to 49 has been correlated with a 29% decline in mortality. Despite recent controversy about mammography’s benefits for women in this age group, the majority of healthcare organizations agree with the American College of Obstetricians and Gynecologists’ contention that women with an average breast cancer risk should begin having mammograms at age 40. Women should discuss their personal risk for breast cancer with their providers and decide whether it makes sense to begin screening for breast disease before this point.

“Women need to do monthly breast self-exams, get a clinical breast exam during their annual checkup, and yearly mammograms after the age of 40,” explains Kathleen Greatrex, MD, chief of radiology and nuclear medicine and director of breast imaging at Our Lady of Lourdes Medical Center in Camden, N.J.

“Minority women, mainly Hispanics and African Americans, have a higher death rate from breast cancer, mainly because of their lack of education. Many are single moms that don’t have the resources or time to take for themselves,” explains Greatrex. “Insurance isn’t usually the issue; it is lack of education. We must spread the word on the importance of breast screenings and how they save lives.”

Greatrex says women should know whether breast cancer runs in their family. If there is a history, women should consider getting tested for the presence of the BRCA1 and BRCA2 genes. Standard BRCA1 and BRCA2 tests detect common mutations in the genes that are known to increase the risk of breast and ovarian cancer development. Specific BRCA1 and BRCA 2 mutations are associated with some ethnic groups. If a BRCA1 or BRCA2 mutation has been identified in a family member with breast and/or ovarian cancer, then other family members should be tested.

Getting a mammogram is not the most pleasant experience, but the discomfort is well worth it, according to Jennifer Kelly, MD, an obstetrician/gynecologist (OB/GYN) who practices at the Tualatin, Ore., office of Women’s Healthcare Associates, LLC, a private, independent group practice.

“Most women don’t like mammograms because they’re uncomfortable,” she notes. “I’ve found that most women fear breast cancer more than mammograms, so encouraging them to be screened hasn’t been much of an issue.”

Cervical and Ovarian Cancers
Beginning at age 40, women should get Pap smears at regular intervals depending on the results of previous testing. The National Cancer Institute recommends Pap tests every one to two years. If women over the age of 30 have had normal tests for three consecutive years, they can talk to their doctors about spacing out the exam to every three years.

Kelly believes the change in recommendations for Pap test frequency has prompted some women to question the value of their annual appointment with an OB/GYN. “The annual appointment itself is still a very important preventative health measure,” she says. “The physical exam combined with the detailed health history that we obtain at the annual visit allows us to more accurately determine a woman’s risk for certain diseases. This could lead us to recommend that she begin earlier or more frequent screening. For example, colonoscopies are not recommended until age 50, but a woman’s family history of colorectal cancer may lead us to recommend she start screening earlier.”

Backed by research supported by the National Cancer Institute, women’s health measures have come a long way in the last several decades. For example, since 1990, epidemiologic studies have validated that the human papillomavirus (HPV) infection is the main cause of virtually all cases of cervical cancer. These findings have led to the development of a vaccine to prevent cervical cancer and other HPV-associated diseases. The vaccine can reduce the incidence of cervical cancer by approximately 70%, and second-generation vaccines under development have the potential to reduce it even further.

The Heart of the Matter
According to the Centers for Disease Control and Prevention (CDC), diseases of the heart are the leading cause of death for women. The older a woman is, the more likely she is to develop heart disease. However, women of all ages should be concerned about the disease.

Both blood pressure and cholesterol levels can increase with age and negatively affect the heart. According to the National Heart, Lung, and Blood Institute, individuals should have a blood cholesterol screening at least every five years, and adults should be screened for high blood pressure every two years if their blood pressure is normally higher than 120/80 mm Hg. A fasting glucose test to screen for diabetes is also recommended.

The most common cause of heart disease is narrowing or blockage of the coronary arteries, the vessels that supply blood to the heart itself. Prevention is important because figures show that two-thirds of women who have a heart attack fail to make a full recovery.

Healthy Lifestyle
Janine Clayton, MD, deputy director of the National Institutes of Health Office of Research on Women’s Health, says maintaining a balanced and nutritious diet in tandem with a regular exercise regimen are important measures women can take to help reduce their risk of developing chronic diseases. This lifestyle can also help followers maintain a healthy weight and promote overall good health. Features of a healthful diet include an emphasis on fruits, vegetables, whole grains, and low-fat or fat-free dairy products.

“We have learned from research that getting regular physical activity, not smoking, drinking alcohol in moderation—one to two drinks a day or less—or not at all can help reduce the risk of some chronic diseases,” says Clayton, who recommends following the USDA’s recently revised dietary guidelines dubbed MyPlate.

Don’t Lose Sight
Aging affects nearly all aspects of health, including vision. For example, according to the National Eye Institute, presbyopia is a common type of vision disorder that occurs with age, resulting in the inability to focus up close. Beginning around the age of 40, people may begin to notice that small type is more difficult to read. More frequent eye exams are recommended for those over the age of 40 to screen for age-related eye conditions, including cataracts, glaucoma, dry eye, diabetic eye disease, and age-related macular degeneration.

Avoid the Flu
According to the National Institute of Allergy and Infectious Disease and the CDC, everyone aged 6 months and older should receive an annual flu vaccine. This recommendation is an important consideration for women because they often care for others who are at higher risk for complications related to the flu. Pregnant women are also at high risk for developing flu-related complications.

Those Pearly Whites
For women over the age of 40, oral health may not be high on their list of health concerns, but everyday “maintenance” serves a purpose. Regular brushing and flossing help maintain a beautiful smile—and so much more. Proper dental care keeps teeth shiny and clean and helps prevent tooth decay and gum disease. Periodontal disease, which attacks gum, bone, and areas around the teeth, has been linked to numerous other medical conditions. In some cases, it is caused by other conditions. In others, it causes or contributes to them. Conscientious oral care and regular dental checkups can help detect some diseases and aid in preventing others.

Yearly dental exams are important for detecting oral health problems, but they can also uncover signs of problems elsewhere in the body. An attentive dentist can advise a patient of any abnormalities that may be cause for concern. The gums may also hold clues to problems that affect the entire system. People with diabetes, for instance, are particularly prone to periodontal disease and more likely to have frequent oral infections. Signs of HIV may also be found in the mouth in the form of inflammation and lesions on the gums.

Periodontal disease can also contribute to respiratory infections such as pneumonia, chronic bronchitis, or chronic obstructive pulmonary disease. In some cases, it may cause blood clots, resulting in the potential for a heart attack or stroke.
Pregnant women with periodontal disease are at a greater risk of giving birth prematurely or having a baby with low birth weight.

Get the Checkup
Kelly stresses the importance of annual checkups for women aged 40 and over, whether it is with a general practitioner or an OB/GYN.

“In addition to obtaining a detailed health history, the annual exam also allows us to talk with women and counsel them on exercise, diet, nutrition and supplements, and depression, all of which are important to maintaining optimal health,” she says. “We also talk about libido and incontinence, which can have a big impact on a woman’s quality of life but are not necessarily topics she’ll bring up on her own.”

Kelly says an annual OB/GYN appointment may be the only visit a healthy woman over the age of 40 has with a healthcare provider during the course of the year. “I think providing value through education at this appointment is key to making sure women take the initiative to schedule it,” she says.

— Leslie Feldman is a freelance healthcare writer and marketing communications consultant in Philadelphia.

 

Researcher Comments on When to Get a Mammogram
Due to changing guidelines concerning when and how often they should undergo mammograms for breast cancer screening, many women are confused. The American Cancer Society recommends women aged 40 and older get a mammogram every year, but the U.S. Preventive Services Task Force recommends mammograms every other year for women older than 50. A University of Missouri researcher says doctors and patients should better communicate about individual patients’ timing of breast cancer screenings.

“The science related to breast cancer and mammography screening is continually evolving,” says Julie Kapp, MPH, PhD, an assistant professor in the department of family and community medicine in University of Missouri’s School of Medicine. “Conflicting guidelines across organizations suggest there is still a lot of work to be done to send consistent messages to women and healthcare professionals to ensure quality care.”

Although the current guidelines suggest varying ages at which women should get mammograms, previous recommendations have ranged from 35 to 50 for initial screenings. Kapp says women younger than the age of 50 should talk with their physicians to customize the age at which they begin mammography screenings. Decisions should be based on women’s preference, risk factors, and understanding of the benefits and harms of mammograms. Women should also be aware that total health, including diet and exercise, is important for breast health and reducing the risk of other diseases.

“Women who get mammograms before age 40 are more likely to be subjected to the harms of mammograms that many people don’t consider,” Kapp says. “The tests are not as accurate in younger women, so they can produce false-positive results. That means time spent worrying about whether they have cancer, unnecessary biopsies, and additional radiation exposure.”

In a pilot study, Kapp is working to understand women’s knowledge about mammography and their feelings surrounding breast cancer screening conversations with their physicians. Kapp aims to help women understand the advantages and disadvantages of mammograms and help improve the dialogue between patients and healthcare providers about the best time to begin breast cancer screenings.

The goal of the study is not to encourage women to avoid mammograms but to discover more effective ways to educate women on the benefits and risks of breast cancer screenings as well as improve communication between doctors and patients.

“Most of the information women get about mammograms does not come from their physicians; it comes from friends, family, and the Internet,” Kapp says. “Women and doctors should have frequent conversations about their overall health and breast cancer screenings.”

— Source: University of Missouri News Bureau