House Call: Cancer and other health screenings all women should know about

With International’s Women’s Day this last Monday, it prompted me to reflect on the difficulties faced by women throughout the pandemic. The closure of schools has impacted all parents, but, in the U.S., women have been four times more likely to leave the workforce to take care of their families. At the same time, women were more likely to get laid off from jobs in industries hit hard by the pandemic such as retail and hospitality.

In primary care, doctors have seen a significant decrease among women patients seeking regular preventive care visits and cancer screenings. Understandably, many patients have postponed regular health care checkups during the pandemic, and we are seeing that close to 60% of all young women are forgoing screenings for cervical cancer like Human Papilloma Virus testing and pap smears.

This number is particularly concerning because cervical cancer used to be the deadliest cancer for women in the U.S. before improved screening techniques allowed us to detect both early, pre-cancerous changes of the cervix and the presence of the HPV virus, the root cause of cervical cancer. This early detection is critical to preventing the development of cervical cancer.

We encourage patients to stay on top of normal screenings, particularly when these check-ups could prevent serious issues through early detection. I’d like to dedicate this month’s column to sharing information about common cancers that impact women and screenings that can stop cancers before they become life-threating, as well as touching briefly on other important health screening issues for our female patients.

Breast cancer

After skin cancer, breast cancer is the most common cancer diagnosed in women in the U.S. It is also the second-most likely cancer to lead to death among female patients right after lung cancer. Breast cancer occurs when breast cells begin to grow abnormally. Cancer cells divide more rapidly than healthy cells and continue to build up, forming a lump or mass.

Cells may spread – also known as metastasizing – through the breast to lymph nodes or other parts of the body, which makes the cancer more dangerous the longer it goes untreated. Breast cancer is most frequently found in women who are older than age 50.

Medical science has learned a lot about healthy activities that can help women prevent breast cancer, including regular exercise, breastfeeding (if possible) and eliminating alcohol intake. It is also important to talk to your physician about potential cancer risks if you are taking hormone therapy to relieve common symptoms of menopause or if your family has a history of breast cancer.

Despite all that doctors know about how to treat breast cancer, it is still not clear why some people who have no risk factors develop cancer, yet other people with risk factors never develop cancerous cells. In fact, most women who develop breast cancer do not have a family history of breast cancer.

The best that we can say is that breast cancer is likely caused by a complex interaction of your genetic makeup and your environment. For this reason, consistent breast cancer screenings are the most effective way to diagnose cancer early and treat it before it has a chance to spread.

While there are some differences in breast cancer screening guidelines, the best evidence put forward by the U.S. Preventive Services Task Force is to individualize screening from ages 40-49 based on risk factors and then to begin regular screening every one or two years from ages 50-74 with mammography.

Cervical cancer

Forty years ago, cervical cancer was the leading cause of cancer death for women in the U.S. Today, cervical cancer is much less common than breast cancer because young women are getting regular screening, pap tests and HPV testing (looking for certain strains of the virus that cause cancer), thus allowing early treatment and cure. The HPV vaccination targeting younger women (ideally at ages 11-12) has further reduced cervical cancer rates.

Cervical cancer is a risk for women of all ages, and women should receive screenings to detect it. Cervical cancer is a type of cancer that occurs in the cells of the cervix, the lower part of the uterus that connects to the vagina.

There is clear evidence that certain strains of HPV can cause cervical cancer in women and are sexually transmitted, which is why early detection and vaccination for these strains as well as safe sex practices are so important for prevention. Starting at age 21, women should start getting pap tests – more commonly referred to as pap smears – every three years until age 30. From 30 to 65, the testing options and frequency change.

At this age range, you should receive HPV testing, a pap test or a combination of both every 3-5 years depending on your clinical risk and discussions with your primary care provider. After 65, most women no longer require regular cervical cancer screening, but it is still important to come in annually for all your other regular health maintenance.

Other important items

There is also good evidence to screen for depression and obesity in adolescent and young adults as well as for tobacco use, unhealthy alcohol use, hepatitis C and intimate partner violence in all women starting at age 18. These can be addressed through regular health checkups in addition to regular cancer screenings.

Avoiding cancer

The bottom line is that regular health check-ups with your primary care provider can help you avoid cancer or at the minimum catch it early enough to allow effective treatment and in most cases a cure.

Additionally, this allows us to address many other important medical issues for early intervention in our female patients. With spring around the corner, and more people getting vaccinated every day, I strongly encourage all our patients to resume regular check-ups.

Dr. Jeff Markin is a family medicine physician practicing at Kaiser Permanente’s Veradale Medical Center.