WOMEN'S HEALTH
THE WELL Woman Visit
Nancy Newman, MD
I
am often asked by patients, “Do I really
need to come for an annual exam?” Most
of these patients have read that they do not
need a Pap smear on a yearly basis. They
interpret that to mean they do not need
to be seen for an annual health assessment.
However, recent data collected by the Na-
tional Health Interview Survey for the past
three decades, has indicated that the use of cancer screening tests
for cervical, breast and colorectal cancers is still below the Healthy
People 2020 target. This is particularly the case among individuals
without health insurance. Other factors which have been associat-
ed with lower rates of screening include the loss of a primary care
provider due to insurance changes, retirement, change of practice
location and accessibility. If the patient has not consulted with a
physician in the past 12 months, only 48 to 49 percent of men and
women will have had any cancer screening. The screening rate
for colorectal cancer as of 2015 was little more than 60 percent.
This is still short of the national target of screening 80 percent of
age appropriate individuals. Pap test screening for cervical cancer
exceeded 80 percent during 2000 to 2015 but is still lower than the
target of 93 percent. Mammography for breast cancer screening
exceeded 70 percent, but again is below the Healthy People 2020
target of 81 percent.
The obstetrician/gynecologist can augment the primary care
provider in providing preventive care to women at an annual visit.
We counsel patients on healthy lifestyle and diet, age appropriate
immunizations, and do evaluation and counseling for behavioral
health issues, sexually transmitted diseases, sexual difficulties, and
cancer screening. We provide screening and evaluation of bone
health, menopausal health, sexual health and education on contra-
ception. We provide medical and surgical treatments for abnormal
bleeding, pelvic prolapse, endometriosis, reproductive issues, pelvic
pain, vulvar disorders, etc.
The performance of the physical exam is a key part of the annual
visit. This includes obtaining standard vital signs, determining body
mass index and performing an examination of the neck and thyroid
and lymph nodes. We listen to the heart to screen for murmurs
and arrhythmia. We palpate the abdomen and evaluate inguinal
lymph nodes.
The obvious part of the well woman check up includes a clinical
breast exam and the pelvic exam. Many women have very dense
breast tissue, and up to 17 percent of breast cancer cases can be
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