A Woman’s Perspective: What’s New, What’s Not in Women’s Health Care
The Marin Independent Journal welcomed Dr. Lizellen La Follette as their health columnist from 2015-2018. Her A Woman’s Perspective column appeared every fourth week in the Journal during these 3 years.
The United States Preventive Services Task Force, American Cancer Society and American Congress of Obstetricians and Gynecologists — all highly respected medical organizations that regularly review scientific evidence about the benefits and harms of cancer screening and other preventive services — have recommended against routine annual pap smears. Routine cervical cancer screening or cervical cytology testing — a pap smear — is now recommended every three years for women ages 21 to 65, and is no longer recommended for women under age 21.
The recommendations apply to women who have a cervix, regardless of sexual history, but they do not apply to women who have received a diagnosis of a high-grade precancerous cervical lesion or cervical cancer, women with in utero exposure to diethylstilbestrol or women who are immunocompromised.
Of note, the new guidelines and recommendations take into consideration HPV and the natural history of cervical cancer. Over the past 30 years, incidence of mortality from cervical cancer in the States has dropped by more than 50 percent. We have come a long way since 1928 when Dr. Papanicolaou first proposed cancer cells on a vaginal smear as an early warning, then his seminal paper in 1941 on this subject, and the pap smear’s evolution to liquid-based cytology. Today we know that most HPV infections are transient and the body is able to clear them. It is persistence in HPV infections that lead to cervical cancer.
Further, we know that HPV is most common in teens and in women in their 20s. Most women, especially those under age 21, are able to clear the infection within two to three years. In women over 30, however, HPV infections are more likely to be persistent and rates of high-grade lesions are increased. Most HPV-related lesions progress to cervical cancer slowly. It takes, on average, three to seven years for severe dysplasia to progress to invasive cervical cancer.
While pap smear guidelines and recommendations have changed, the importance of annual well-woman preventive care visits and exams has, and will, not. It remains critical for women of all ages to obtain an annual assessment of their health and receive counsel about preventive care. Prevention is important to living long and well.
A woman’s annual health assessments usually include screenings, evaluations and counseling, as well as immunizations based on age and risk factors such as family history, environmental exposures, being from a specific ethnic group, or having a health condition. Your doctor may discuss exercise and healthy eating, sexual and mental health, prevention of injury, misuse of alcohol and drugs, abusive behavior, and even help to quit smoking. Screenings and tests given in a well-woman preventive care exam include height and weight/body index (BMI) measurements, blood pressure and colorectal cancer screening among others.
Statistics show that women are more likely than men to see a healthcare provider for preventive health-care exams and screenings. While women have unique health issues, women and men also have many of the same health problems. These problems can affect women differently, however. Of note, women are more likely to:
• have urinary tract problems than men
• die following a heart attack than men
• show signs of anxiety and depression than men
• experience osteoarthritis.
Taking a significant role in your health care can help you and your practitioner form a strong partnership, as long as both of you actively participate in the process.
Here are some ways to get the most out of your annual well-woman visit:
• Be proactive and prepared. Determine what you want to achieve in the office visit. Make a list of your concerns. Evaluate your health goals and how you want your provider to help facilitate them. Ask questions and don’t leave until you have the answers you need.
• Do research. Explore resources offering information so you can gain a better understanding of your own health situation. Whether you want to learn about a procedure or medication, options/alternatives in treatment, or enhance your knowledge about a specific topic, feel empowered to learn more and have a discussion with your health-care provider during your visit.
• Consider options and alternatives. There are many ways to approach health care today, from conventional medicine offering standard practices, to integrative medicine offering a whole person approach. Investigate them.
• Keep copies of your lab reports, results and progress. It’s good to keep this information to see if things are changing in your body over time. If a shift is occurring in your blood sugar, cholesterol levels, thyroid hormones, vitamin D levels, bone density or mammography, you and your doctor can address them together.
• Communicate your healthcare preferences. Most of us have preferences about what we feel comfortable with when tending to our health. It does not matter what your preferences are; what matters is that you discuss them with your practitioner so you receive the care that feels most comfortable to you.
• Practice good habits in nutrition, sleep and exercise. We live in an incredible area where key research on aging well is around the corner — at the Buck Institute for Research on Aging in Novato. Become familiar with the Institute’s recommendations. In last September’s issue of the magazine Aging, Dr. Dale Bredesen, founder of the Buck Institute, delineated a 36-point lifestyle change regimen that included exercise, sleep, fasting and supplements among others, that when instituted (and not all were strictly followed) resulted in improved cognition in 9 out of 10 patients studied.
I agree with the Institute’s recommendation for a low-glycemic, low-grain diet to minimize inflammation, as well as to maximize antioxidants through fresh vegetables and fruits. Getting eight hours of sleep a night is key to help regulate all the systems in the body. Exercise is another important way to prevent and reverse many common, degenerative, and chronic health conditions.
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