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Doctor’s Orders: Women’s Health

Don’t skip this year’s annual Medical exam. It could save your life.
By D Partner Studio |
women's health
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As the world took a collective pause in 2020, most everything slowed or shut down. The pandemic forced us to clear our schedules, postponing events and appointments until it was safe to venture back into the world. For many women, annual medical screenings were included in those schedules—and many have yet to be rescheduled.

More than a year has passed since the pandemic began, leaving doctors worried that their patients’ health is at risk. Statistics are beginning to emerge to support their fears. For example, mammography screenings and symptomatic detections decreased more than 80% during the initial months of the pandemic, according to findings published in Journal of the National Cancer Institute. Pandemic-related disruptions in breast cancer care could result in 2,487 excess deaths by 2030 for a cumulative increase of .52% versus no disruption in care. In addition to delayed diagnosis during the pandemic, there has also been delayed treatment, such as chemotherapy and radiation, meaning diseases have progressed that could have potentially been slowed or eliminated. “There are so many diseases and conditions we can screen for in order to detect them early enough to intervene to prevent progression,  avoid morbid treatments,  and ultimately avoid unnecessary death,” says Dr. Kimberly Kho, associate chief of gynecology and the director of the Fellowship in Minimally Invasive Gynecologic Surgery at UT Southwestern Medical Center. “If we can catch some diseases early, such as cervical and breast cancers, and treat them effectively, patients can live without long-term side effects and can avoid premature death.”

A gynecologist, Dr. Kho addresses a wide variety of health concerns—both physical and mental—with her patients during their annual exams. She has watched the ebb and flow of her patient load throughout the pandemic and is hoping those who put off their exams out of fear of COVID-19 will put those fears aside long enough to address their own health and wellness needs. “So many advances in care have been developed since the beginning of the pandemic, including wider access to telemedicine,” she says. “There is a way to meaningfully communicate with your doctor if you are worried about coming into a clinical setting, although I tell all my patients that the healthcare industry is taking every protocol to keep them safe. So many people have waited more than a year now to get their recommended screenings or report suspicious symptoms. These disruptions in care have had a cumulative impact on unwanted health outcomes.”

“I want women to feel reassured that the safety precautions health systems have put into place during the pandemic have made it safe for them to take time for their own health and wellness.”

Dr. Kimberly Kho, UT Southwestern

There is also a collective concern throughout the medical community about how people are mentally and emotionally coping with the upheaval they have experienced since early 2020. Many women have taken on even more roles as they juggle work, kids, and homeschooling in addition to interpreting and implementing the ever-changing COVID-19 safety guidelines for their families.

“So many women have been taking care of everyone else but themselves with homeschooling, working from home, and cooking every single meal,” Dr. Kho says. ”Now is the time to see your doctor and get in these necessary health screenings, in addition to discussing any changes in your mental and physical health.”

Contraceptive needs, concerning health symptoms such as abdominal pains, menstrual changes or postmenopausal bleeding, sexual health, perimenopause and menopause symptoms, depression, anxiety—Dr. Kho strives to cover all these topics with her patients during their annual exams. “These issues can be easy to ignore and push aside because you don’t think they are a priority with everything else going on right now,” she says. “However, they can affect your mood, mental health, and overall wellness which can have a negative impact on you as a parent, partner, and provider. It’s a domino effect. If you don’t check in with your physician and proactively deal with your health concerns on a yearly basis, you will start to see them subtly—or not-so-subtly—affect your quality of life. There are health issues, that if left unnoticed or untreated for over a year, can become dangerous. Make and keep your appointments and put to bed the anxiety of not knowing so you can get back to your life with peace of mind.”

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Women’s Health: The Medical Screens You Need at Each Decade

20s

During this decade, women should see their primary care doctor or OB/GYN for cervical cancer screening with a Pap smear, starting at age 21, and this is often when birth control options are discussed. Discussions in the early 20s should be about preventive care and prevention of STI’s for sexually active women, family planning needs, and screening for blood pressure, depression, substance use, interpersonal violence, and counseling about staying healthy with proper nutrition and exercise.

30s

Continue preventive and general health screenings as well as cervical cancer screening with Pap smear and HPV testing, family planning, and STI screening. This is also a good time for women who want to start a family to discuss fertility, as some women have more difficulty becoming pregnant as they get older.

40s

Continue with cervical cancer screenings and discuss the option of changing these screenings to every three to five years based on your personal health history if you have no previous abnormalities. Many women in their 40s will start to experience hormonal changes and menstrual abnormalities, leading them to initial discussions about perimenopause and menopause with their doctors. Women with no family history of breast cancer typically begin annual mammograms in their 40s—earlier for women with a family history or abnormal symptoms. Lipid, blood pressure, diabetes, depression, and anxiety screenings should also continue in the 40s. New guidelines suggest women with a family history of colon cancer or concerning bowel symptoms should also get early screening for colon cancer in their 40s.

50s+

In addition to cervical
cancer screenings and mammograms, doctors usually recommend women in their 50s be screened for colon cancer. Age 51 is the average age of menopause. Therefore, hormonal replacement therapies should be discussed in addition to scheduling bone density scans for osteoporosis. Women in their 50s should also be screen annually for high cholesterol and diabetes.

All Ages

“Women should not neglect discussing their mental health throughout their lives,” Dr. Kho says. “Issues with anxiety or depression should definitely be addressed with a healthcare provider, particularly during this stressful time. It could be episodic, but both conditions can impact your quality of life and well-being. The pandemic has been a perfect storm for mood and other health disorders. Women should know that there are resources, they don’t have to suffer alone, and healthcare providers are here to help.”

Women's health yogaWomen and Cancer

Prevention begins with healthy habits.

Nearly 2 million cancer cases will be diagnosed in 2021, and more than 900,000 of these cases will be in women—breast, lung, and colorectal cancers being the most common types. According to the American Cancer Society, more than 600,000 Americans died of cancer last year, which translates to more than 1,600 deaths per day. While there is no guarantee a woman won’t get cancer, there are key preventive measures she can take to lower her risk of developing cancer.

Carolyn Matthews, M.D., FACOG, gynecologic oncologist and former director of integrative and functional medicine at Texas Oncology–Baylor Charles A. Sammons Cancer Center, says the preventive measures women routinely hear about to reduce their risk of cancer can’t be emphasized enough because they have such a significant impact on their health. Weight loss is a lifestyle change that tops this list and is a measure she routinely discusses with patients. “Seventy percent of the population in the U.S. is overweight or obese,” Dr. Matthews says. “It has become so common that most people don’t think much of it anymore. Obesity is a risk factor for many cancers, including cancers that commonly affect women—post-menopausal breast cancer, uterine cancer, and colorectal cancer, among others.”

According to Dr. Matthews, the most common gynecologic cancer in the U.S. is uterine cancer, and it is among the few cancers that are increasing in incidence and mortality. The biggest risk factor? Obesity. “This accounts for at least 57% of all uterine cancers,” Dr. Matthews says. “All women know about getting their Pap smear to detect early cervical cancer, but there isn’t a similar for uterine cancer. Many women don’t realize their weight is a huge risk factor. For a woman with a normal BMI, there’s a 3% risk for uterine cancer. For each five unit increase in BMI, the risk of uterine cancer increases by 50%. We are even seeing an uptick in younger women who haven’t had children.”

Dr. Matthews specializes in integrative and functional medicine and talks to her patients about the importance of what they can control when it comes to their health. “You can control what you eat, how much you exercise, and how much time you allot for sleep,” she says. “There is overwhelming evidence that daily exercise is helpful when it comes to prognosis and outcomes for certain cancers, particularly breast and colorectal cancer. I recommend that my patients exercise every day for 30 to 60 minutes and add in biweekly training with yoga or weights. Sleeping seven to eight hours a day is important for mental health and healthy aging—plus the immune system works better when you get enough sleep. For nutrition, I always encourage my patients to eat a rainbow of colors every day. Try to eat mostly plant-based and get anywhere from five to eight servings of day of vegetables and one or two servings of fruit. Eat organic when you can. You can’t really know what you prevented for sure, but most people do feel better when they are eating in a healthy fashion, sleeping well, and exercising.”

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Dr. Matthews also makes sure to include a conversation about alcohol use when talking to her patients about lifestyle habits. “Alcohol—particularly in the last year during the pandemic—has become an increasing problem for women,” she says. “Consumption that is considered low risk is less than one drink per day, no more than three drinks on any single day, and no more than seven drinks per week. When women go above the recommended guidelines, there is an association with cancer, particularly breast, colorectal, esophageal, head and neck, and liver cancer.”

Dr. Matthews recommends the following for cancer screening and prevention:

Breast Cancer

All women should discuss individual risk factors with a physician to determine recommended timing and most appropriate screenings. Beginning at age 50, women at average risk should have a mammogram and a clinical breast exam at least every two years after discussion with her physician, and if recommended by a physician, an annual MRI screening.

Colorectal Cancer

Screening guidelines have recently changed due to an increase in colorectal cancer among younger women. Most doctors recommend screening at age 45. If you have a first-degree relative with colorectal cancer, ask your doctor about getting screened even younger.

Lung cancer

A low-dose chest CT scan is typically recommended for women who are considered high-risk—current smokers, those who quit smoking in the last 15 years, and anyone who smokes or has smoked heavily in their lifetime.

For women in Dallas who are diagnosed with cancer today, new advancements and treatments, technology, and clinical trials are continually underway, arming patients with even more tools to fight the disease. For instance, Texas Oncology–Baylor Charles A. Sammons Cancer Center will be among the first hospitals in Texas to offer adoptive immunotherapy therapy with Tumor Infiltrating Lymphocytes for the treatment of cervical cancer—an alternative to chemotherapy for women with recurrent cervical cancers. A current trial is studying a new treatment for maintenance of remission in recurrent or advanced uterine cancer. PARP inhibitors have transformed ovarian cancer care by prolonging time in remission after chemotherapy.

In addition to healthy lifestyle changes and appropriate screenings, the next steps in fighting cancer are assembling a support team, establishing a good relationship with your doctor, and knowing your personal risk for cancer. “Knowing your family history of cancer is important,” Dr. Matthews says. “There are a number of cancers where there is clearly a genetic predisposition. If you know this, you can take steps early in life to reduce your risk, and also practice steps for early detection. When you hear the word ‘cancer,’ your life changes dramatically. In that moment, you have to accept there are some things about cancer that aren’t under your control—but there are plenty of things you can control as you move forward.”

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D Partner Studio

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