Screening tests could save your life

Throughout a woman’s life, there are several important medical screening tests recommended by doctors to identify health issues of concern, such as cancer, even before there are any obvious symptoms.

Screening tests can literally save lives by identifying health issues early and enabling the early initiation of treatment.

Dr Dalene Barnard, a gynaecologist at Mediclinic Kloof, highlights the most critical tests for women and in which decade they should be done.

The teenage years

Vaccines play a critical role in preventative medicine. The human papillomavirus (HPV) vaccine, given to girls aged between 9 and 11 years, is effective in preventing the high-risk types of HPV that can cause most cervical and some other types of cancer, such as anal, genital, mouth, and throat cancers.

The HPV vaccine is still under-reported and under-spoken about, but is critical for teenage girls to have, says Dr Barnard, a strong proponent of vaccines: “When I see a healthy patient for a routine visit, I still encourage them to be vaccinated against various diseases as this is part of preventative medicine,” she says.

The 20s

In their 20s, the only vaccine a woman need have is for influenza and this should be given annually.

“Women should have their first cervical (‘pap’) smear in their 20s and their doctor or gynaecologist will recommend the frequency this should be done on a case-by-case basis. Before a woman turns 30, she should have at least three pap smears, even if she is not sexually active,” says Dr Barnard.

A pap smear detects abnormal cells in the cervix that are caused by HPV, and which can become cervical cancer cells. The earlier these abnormal cells are detected, the greater the chance of preventing cervical cancer. The test can also give some indication of other infections, such as candida or bacterial vaginosis. Dr Barnard notes that a pap smear can be done by a GP, and it is not necessary to see a gynaecologist for this.

The 30s

In their 30s, women should continue with the regular pap smears and annual flu vaccinations.

“An exciting new screening test that will become available in South Africa and internationally in the near future is the liquid biopsy, which is a blood test that can identify early markers of cancer, and which is advised to be done in one’s 30s. Most certainly this early warning test will become standard in the next few years,” says Dr Barnard, noting that the South African private medical sector is very much at the forefront of global developments. “We do international medicine at its best.”

The 40s

Starting on their 40^th birthday, women should begin having mammograms, ideally annually. These breast X-rays are used to detect early signs of breast cancer.

From 45 years of age, women should have a colonoscopy, repeated only every 10 years if the results of the first test are normal. A colonoscopy, which is given under general anaesthetic or conscious sedation, can pick up colon cancer and other inflammatory bowel diseases, says Dr Barnard. She notes that it is also an option to do an annual faecal occult blood test, which can also pick up colon cancer and other gastro-intestinal tract (GIT) diseases.

Dr Barnard also advises that women have a bone mineral density scan at 45 even if they don’t have a family history of osteoporosis. “Around the age of 50, most women go into menopause, and they stop producing oestrogen, the hormone that maintains bone density. By starting to have a bone mineral density scan at 45, women can still ameliorate their risk of developing osteoporosis by adding more calcium to their diet or through exercise. Once the oestrogen production ceases at menopause, women’s bone density drops. If the bone mineral density scan is normal, women need only repeat this test every 10 years,” she says, adding that the test is non-invasive and like a full-body, low-dose X-ray. Bone mineral density scans can detect early osteoporosis, which is called osteopenia.

“The bone mineral density test is one of the only tests that we don’t discontinue. Even if you turn 110, every 10 years you should have this test.”

The 50s and beyond

In their 50s, women should continue with the tests they started, including pap smears and mammograms (both of which are usually discontinued when women are in their 70s), colonoscopies (until 80 years) and bone mineral density tests.

Smokers in their 50s should also have a CT scan of their lungs to detect the presence of lung cancer.

“Throughout a women’s life, and especially after she has turned 50, she should individualise her care. For example, if you have a family or personal risk of a certain disease, then you should look at this, but your health care provider can advise. Regularly throughout your life, you should also have your glucose and cholesterol tested,” says Dr Barnard.