Wellness Screening

Well-Woman Screening and Preventative Care: Today, women have a much better chance against cancer than what someone might think. In fact, nearly 100% of women who find breast or cervical cancer early survive it. And the best way to find cancer early is to make sure you get routine breast and cervical cancer screenings. This is part of the Women wellness screening.

Here is a list of some of the diseases that could come from the wellness screening and their recommendations.

Disease Illness Tests/Examinations Recommendations
Breast Cancer Clinical breast exam
  • ≥ 40 y/o à Annual screening
  • 20-39 y/o à Every 1-3 yrs, UNLESS @ high risk, then annually
Screening mammography
  • ≥ 40y/o à Annual screening
  • PLUS MRI for very high risk woman (>20% lifetime risk by FHx risk assessment or who have a primary relative with positive BRCA1 or BRCA2)
BRCA risk assessment and genetic counseling / testing
  • Women with family members with breast, ovarian, tubal, or peritoneal cancer wit hone of several screening tools designed to identify an family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes (BRCA1 or BRCA2)
  • If above screening is positive, patient should receive genetic counseling, and if indicated after counseling, BRCA testing
Preventative medications
  • Females at increased risk for breast cancer and low risk for adverse medication effects à prescribe risk-reducing medications (e.g. tamoxifen, raloxifene) (B)
Cervical Cancer Pap smear (A)
  • 21-29 y/o à Every 3 yrs with cytology
  • 30-65 y/o à Every 3 yrs with cytology or Every 5 yrs with cytology & HPV testing
  • > 65 y/o à Recommend AGAINST screening in women with adequate negative screening (3 consecutively negative cytology tests or 2 consecutive co-tests in 10 yrs) AND negative history of CIN2 or higher diagnosis within the last 20 yrs
  • After hysterectomy for benign conditions with removal of cervix à Recommend AGAINST screening for vaginal cancer w/o history of CIN2 or higher
  • History of CIN2, CIN3 or adenocarcinoma in situ à Continue screening for a total of 20 yrs after spontaneous regression or appropriate management, even if it extends screening beyond 65 y/o
HPV vaccine (HPV 2 or 4)
  • 11-26 y/o à 3 dose vaccination @ 0, 1-2 & 6 months
Colorectal Cancer Colonoscopy
  • Starting @ 50 y/o à Every 10 yrs until 75 y/o

Other acceptable screening tests:

  • Fecal occult blood test or Fecal immunochemical test à Annual screening
  • Flexible sigmoidoscopy à Every 5 yrs
  • Double-contrast barium enema à Every 5 yrs
  • CT colonoscopy à Every 5 yrs
  • Stool DNA à interval not established
HIV ELISA (screening test) & Western blot (confirmatory test)
  • 15-65 y/o
  • < 15 y/o AND > 65 y/o with increased risk
  • All pregnant females, including those who present in labor who are untested and whose HIV status is unknown
  • Targeted testing recommended for females with risk factors:
    • H/o multiple sex partners
    • Sexual partner with multiple sex contacts
    • Sexual contact with individuals with culture-proven STD
    • H/o repeated STDs
    • Attendance at clinics for STDs
  • Annual HIV testing for:
    • IVDU
    • Have sex partners who are IVDU or are HIV-infected
    • Exchange sex for drugs or money
    • Have been diagnosed with another STD in the last year
    • Have had 2 or more sex partners since their most recent HIV test
  • Encourage female patient and prospective sex partners to be tested prior to initiating a new sexual relationship
Chlamydia Nucleic acid amplification test (NAAT)
  • ≤ 25 y/o sexually active females à Annual screening
  • ≥26 y/o asymptomatic females @ high risk à Routine screening
Gonorrhea Cervical cultures or NAAT
  • ≤ 25 y/o sexually active females à Annual screening
  • ≥26 y/o asymptomatic females @ high risk à Routine screening
Prophylaxis in newborns
  • All newborns à prophylactic ocular topical medication to prevent gonococcal ophthalmia neonatorum
Syphilis VDRL or RPR (screening tests) & T. pallidum particle agglutination (confirmatory test)
  • Female at increased risk à Annual screening
  • All pregnant women à as early as possible in pregnancy AND at delivery; retest in 3rd trimester if a high risk patient tests negative earlier in pregnancy
Osteoporosis DEXA (measures bone mineral density, BMD)
  • Starting at 65 y/o or younger post-menopausal women with 1 or more risk factors:
    • Medical h/o fragility fracture
    • Body weight < 127 lbs
    • Medical causes of bone loss (meds: phenobarbital, phenytoin, corticosteroids, lithium, tamoxifen; diseases: cushing disease, hyperparathyroidism, hypophosphatasia, IBD, lymphoma, leukemia)
    • Parental medical h/o hip fractures
    • Current smoker
    • Alcoholism
    • Rheumatoid arthritis
Preventative measures
  • Adequate calcium consumption, 1000-1300 mg/day
  • Adequate vitamin D consumption, 600-800 IDU
  • Regular weight bearing exercise and muscle strengthening exercise
  • Smoking cessation
  • Moderation of alcohol
  • Fall prevention strategies
Diabetes mellitus Serum fasting blood glucose
  • 45 y/o à Every 3 yrs
  • ≥ 18 y/o asymptomatic female with sustained BP (treated or untreated) > 135/80 mmHg
  • < 45 y/o if patient has risk factors:
    • BMI ≥ 25
    • Primary relative with DM
    • Habitual physical inactivity
    • High risk race/ethnicity
    • Gave birth to newborn weighing > 9 lbs
    • H/o GDDM
    • Hypertension
    • HDL-c < 35 mg/dL
    • TG-c > 250 mg/dL
    • H/o impaired glucose tolerance or impaired fasting glucose
    • PCOS
    • H/o vascular disease
Thyroid disease Serum TSH levels
  • 50 y/o female w/o risk factors à Every 5 yrs
Hypertension Blood pressure reading
  • ≥ 13 y/o, regardless of BP level à Annual screening
Lipid disorder Blood lipid profile
  • 65 y/o à Every 5 yrs
  • ≥ 45 y/o with increased risk of coronary heart disease (A)
  • 20-45 y/o with increased risk of coronary heart disease (B)
Obesity BMI
  • As part of periodic assessment
  • Categories:
    • < 18.5 à Underweight
    • 5-25.9 à Normal weight
    • 26-29.9 à Overweight
    • 30-34.9 à Obesity, Class I (2x increased risk of death)
    • 35-39.9 à Obesity, Class II
    • ≥ 40 à Extreme obesity
Iron deficiency anemia Complete blood count
  • Asymptomatic pregnancy women à Routine screening
Asymptomatic bacteriuria Urine culture
  • Pregnant women 12-16 wks GA or First prenatal visit if later
GDDM Serum fasting blood glucose
  • Asymptomatic pregnant female after 24 wks GA
Hepatitis B infection in pregnant females Hep B blood test
  • All pregnant females @ first prenatal visit
Domestic violence Screening for intimate partner violence
  • Females of child-bearing age who do not have signs or symptoms of abuse
Preeclampsia Prevention
  • After 12 wks GA in females who are high risk à 81 mg/d Aspirin
Hemolytic disease of the newborn Rh (D) blood typing and antibody testing
  • First prenatal visit
  • 24-28 wks GA, unsensitized Rh (D)-negative women à Repeat Rh (D) antibody testing, UNLESS biological father is known to be Rh (D) negative
Tobacco use Counseling and interventions
  • ≥ 18 y/o à offer tobacco cessation interventions for those who use tobacco products (A)
  • All pregnant females
General fetal health
  • All females planning or capable of pregnancy à Folic acid 0.4-0.8mg daily

 

Beckman et al., Obstetrics and Gynecology, 7th edition

UpToDate.com

USPSTF A and B Recommendations

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