For Women Only

By Ian K. Smith, M.D.

Recently, during one of our regular Sunday dinners, my mother complained of some aches and pains. She asked me my opinion, and like any good doctor, I replied, "When did you have your last complete physical and blood tests?" The time it took for her to remember was answer enough. Not only had it been too long, but she hadn't been given basic blood tests that most women should have on a periodic basis. So when the American College of Obstetricians and Gynecologists revised its screening recommendations for women two weeks ago, I immediately sent a copy to my mom.

ACOG is a professional group representing more than 40,000 physicians involved in women's care. It issues periodic recommendations, based on a patient's age and risk factors, on what types of screening, evaluation and counseling should be part of a woman's routine exams. The new recommendations replace a set issued two years ago.

One of the major changes to the list is the addition of screenings for hepatitis A and hepatitis C. The hepatitis-A vaccine is being recommended for groups at high risk for the disease, including international travelers, drug users and workers in the food-service, health-care or day-care industry. The test for hepatitis-C virus has been added for all women 13 and older and for women at particularly high risk (women who take intravenous drugs and those who received an organ transplant or a blood transfusion before 1992).

Diabetes testing is another major change. A glucose test is now recommended every three years for all women over age 45--not just for those known to be at high risk for diabetes. ACOG also changed its definition of high risk, expanding it to include women in ethnic groups that are disproportionately vulnerable: African Americans, Hispanics and Native Americans.

The HIV high-risk group was expanded as well. In addition to tests for pregnant women, ACOG now recommends HIV tests for all women seeking preconception care and any woman with invasive cervical cancer, regardless of age.

The recommendations also addressed the scope of the questions physicians routinely ask their patients. All women, beginning at 19, for example, should be asked if they have any bladder- or bowel-control problems. While these problems are not very common in younger women, the question is easy enough to ask, and if there is a problem, early intervention could make life a lot more comfortable.

For low-risk women in their 40s, ACOG still recommends a mammogram every one to two years and annually after age 50. However, a study released last week in the Journal of the American Medical Association brings into question the use of mammography in women after age 69. Researchers studied 10,000 women to try to determine whether annual mammograms provided enough benefit to warrant their use. The results showed, rather dramatically, that the gains in life expectancy for these elderly women were minimal. With some variation depending on the sample, only 1 death per 10,000 women is likely to be avoided.

With her copy of these new recommendations, and a list of key questions to put to her doctor, my mother will certainly be prepared for the next checkup. You should be too.

For more on the guidelines, visit ACOG's website at www.acog.com You can e-mail Dr. Ian at [email protected]