The concept of well women’s health care embraces the principle of preventive medicine whereby the patient undergoes certain examinations and tests in the absence of any symptoms in an attempt to detect any disease process before it is clinically evident.
Breast self examination
Breast self examination should be performed by all women from 25 years of age and this is best done on a monthly basis just after menstruation. This is particularly important in those with a strong family history of breast cancer who should also have mammography done from 40 years of age onwards.
Mammography is a low dose x-ray performed on the breasts to detect the presence of calcification which may be the earliest sign of breast cancer. Mammography is performed every 2 years from 50 years of age until 70 years of age and is particularly important in women who are on hormone replacement therapy. Mammography screening is free of charge when performed by Breast Screen who will also send out reminders to patients every 2 years. The central telephone number for Breast Screen is 13 20 50.
Thermography can also be used to screen for breast cancer and has a place in patients from 40 to 50 years of age who are at high risk of developing breast pathology and in whom the patient does not wish to be exposed to the low dose of radiation which occurs with mammography. A special digital infrared thermal camera is used to take a thermogram of both breasts: this may detect a ‘hot spot” in the breast which may represent an area of increased blood flow and a possible site of tumour formation. Thermography is totally non-invasive and may be useful in high-risk groups such as patients who are BRCA1 / BRCA2 positive and who require surveillance from an early age.
Cervical cytology (Pap smears)
Cervical cytology screening should commence within 2 years of becoming sexually active. A Pap smear be done every 2 years in all sexually active women and every 12 months for those considered to be at high risk. You can attend your family doctor for this and you will be referred for further investigation whenever an abnormality is detected.
Vulvar self-examination is very important in those patients who have chronic vulvar disorders characterized by persistent irritation, itch or soreness. The aim of vulvar self-examination is to know your vulva and to be able to recognize any new changes that have occurred such as a lump or changes in colour of the vulvar skin. Vulvar self-examination is performed by the patient who is in a comfortable semi-recumbent position with the legs parted. Using a mirror with a handle and a good light, gently part the outer labia first and then the inner labia looking for any change in colour either white, red or pigmented areas and then feel for any raised or indurated lesion. Also inspect the areas around the urethra, perineum and anus. If you are uncertain about any findings you should consult your family doctor.
Extensive pre-cancerous changes on the vulva.
Ovarian cancer screening
Screening for ovarian cancer is not able to be done with our current state of knowledge as there are no specific screening tests that can be performed to detect this disease in the early stages. The incidence of ovarian cancer increases from 50 years of age but can also occur in younger women. All women attending for a routine cervical smear should have a bimanual examination performed to exclude any swelling of the ovary. Beyond 70 years of age when cervical cytology does not need to be done, patients should attend their general practitioner for routine examinations every 12 months to assess for any ovarian enlargement. This is particularly important for those patients with a strong family history of either breast or ovarian cancer. Blood tests such as serum CA 125 or ultrasound screening have not proven to be of any benefit as screening tests for the detection of ovarian cancer. Ovarian cancer usually presents in the advanced stages and often symptoms are present for many months before the diagnosis is made. It is important for patients to recognize symptoms that are new and persistent and to attend their family practitioner for further investigations. The common symptoms of ovarian cancer include include:
- Abdominal or pelvic pain
- Increased abdominal size or persistent abdominal bloating
- Bladder symptoms of frequency of urination or urgency
- Feeling of fullness after eating small amounts
The above symptoms are common and often dismissed or related to gastrointestinal problems, however, if they are persistent over a period of time you should attend your family practitioner.