It seems like every day there’s a new recommendation for which screenings you need, how often you should get them and how early to start worrying. We asked Hawai‘i’s medical experts for the latest wisdom, along with tips for avoiding Zika and hepatitis A.
By Katrina Valcourt
The past few years in women’s health have shaken up what we thought we knew. There have been surprises: Did you know breast self-exams are no longer recommended? And there’s new research that certain vaccinations can help reduce your chances of getting cancer. It’s not easy to keep up with everything, so here’s what you need to know, from before you hit puberty to beyond menopause and everything in between.
What to do in your:
The HPV vaccine is recommended around age 11 or 12, and is available from ages 9 through 26
Preventive health care starts from a very young age and includes establishing healthy eating habits, exercising and scheduling regular checkups. It also means getting the right vaccinations. One of the most important is for HPV (human papillomavirus).
“We don’t have any other vaccine to prevent cancer,” says Dr. Bliss Kaneshiro, associate professor in the John A. Burns School of Medicine Department of Obstetrics, Gynecology and Women’s Health. Annually, about 21,000 cases of cancer in the U.S. could be prevented with the vaccine.
The percentage of girls vaccinated against HPV in Hawai‘i
“The most important thing that seems to drive vaccinations is having a physician recommend them,” says Dr. Brenda Hernandez, whose research at the UH Cancer Center focuses on HPV-related cancers. “Many different vaccines are given to children, and sometimes HPV is not a priority from their perspective.” She also says that, because HPV is the most common sexually transmitted disease, it can be a difficult subject to discuss with parents reluctant to think about their children eventually having sex. In addition, not all physicians have reminder systems for patients to come back to get all three shots that make up the vaccine, given over a six-month period. “It’s possible that, in some cases, if someone has two doses rather than three, that could be considered protective, but that’s still in research right now,” Hernandez says.
“The most important thing that seems to drive vaccinations is having a physician recommend them.” —Dr. Brenda Hernandez
Dr. Angela Pratt, an OB-GYN at Kapi‘olani Medical Center, says the vaccines are extremely safe. “A lot of patients are confused about if they should be getting the HPV vaccine and they’re concerned about vaccines in general. I don’t think they realize this is something that’s gonna eradicate, hopefully, someday, cervical cancer,” she says.
THE PERCENTAGE GOAL FOR HPV VACCINATIONS NATIONWIDE
Don’t forget to check your blood pressure: 1 in 3 adults in Hawai‘i has high blood pressure, which can lead to heart failure, stroke, kidney damage and other issues. Testing should begin at age 18 and recur every three years. You can also check your own blood pressure at certain drug stores: 140/90 is grounds for treatment. It’s also a good idea to screen for high cholesterol, or hyperlipidemia, when you’re 17 to 21 years old to see if you’re at high or normal risk, as it’s a major cause of heart disease, the leading cause of death in Hawai‘i.
What to do in your:
Get a Pap smear every three years, starting at age 21
Whether you’re sexually active or not, consider going on birth control, which studies suggest can lower your risk of getting cancer. In addition to the pill—which has an 8-percent failure rate each year, according to Kaneshiro—there are contraceptive implants (injected into the upper arm, last for three years) and IUDs (intrauterine devices, last for up to 10 years). “They are highly effective birth control methods with minimal side effects and [are] super easy to use,” she says. (She notes that some women actually like the side effects, such as lighter or no periods.) There are also new, more effective emergency contraceptives beyond Plan B to prevent pregnancy after sex, such as Ella, which you can get at drug stores, and the copper IUD, which is nonhormonal.
Dr. Michael Carney, chief of the gynecologic oncology division in JABSOM’s Department of Obstetrics, Gynecology and Women’s Health, says birth control can reduce your risk of ovarian cancer (which is hard to catch early and has a high mortality rate) as well as treat endometriosis. There is no FDA recommendation for these uses of birth control, however, since there are particular types of studies that still need to be done to prove these effects.
If you are sexually active, take a urine test annually for gonorrhea and chlamydia, regardless of whether you have symptoms, up to age 25.
Once you turn 21, sexually active or not, it’s time to get your first Pap smear, which looks for cervical cancer. Even if you had the HPV vaccination when you were younger, there are many strains of the virus.
“We do think that, pretty much, if we eradicated the HPV virus, we would eliminate cervical cancer.” —Dr. Angela Pratt
Pap smears used to be recommended annually, but now it’s every three years. “If you check annually, it only marginally increases the detection of cervical cancer since it’s such a slow progressing cancer. It actually doubles or triples the number of unnecessary interventions such as biopsies,” says Dr. Darlene Ramones, a family-medicine physician at Queen’s Health Care Centers Kapolei. Biopsies can damage the cervix and affect childbirth in the future.
DID YOU KNOW? WOMEN WHO DRINK TWO OR THREE ALCOHOLIC BEVERAGES A DAY ARE AT A 20-PERCENT HIGHER RISK OF DEVELOPING BREAST CANCER.
What to do in your:
Pap smear every three years, or every five years if co-tested for HPV
Once you’re in your 30s, if your Pap smears have come back negative, you can get one every five years, as long as you co-test for HPV at the same time. Hernandez says HPV causes almost 100 percent of all cervical cancers, 90 percent of anal cancers, 70 percent of oropharyngeal cancers, about 30 percent of oral cancers, as well as vaginal/vulvar cancers, so it’s a big deal, especially because there are no routine screenings for most of these cancers.
What to do in your:
Pap smear every three years, or every five years if co-tested for HPV, mammogram every year starting at age 40 or 45
Until recently, women were told to do breast self-exams every month to feel for possibly cancerous lumps. Not anymore. “There can be a lot of false positives, and so women come in in their 20s or 30s and they have large lymph nodes, which can be common with periods,” says Ramones. Of course, if you feel something strange that doesn’t go away in a month, see your doctor.
There’s some controversy going on with the mammogram screening guidelines as well: It used to be yearly from age 40, but, because of false positives that can lead to expensive and harmful biopsies (about 10 percent of women are called back for a biopsy, and only 5 percent have cancer), certain groups now recommend women start screening at age 45 or even 50.
“I’ve had plenty of women who are under 45 come in with a breast cancer that was detected on mammogram.”—Dr. Irminne Van Dyken
“I’ve had plenty of women who are under 45 come in with a breast cancer that was detected on mammogram,” says Dr. Irminne Van Dyken, a surgeon with The Queen’s Medical Center, “so it’s a little bit of a tough call to make.” Many insurance providers still cover mammograms from age 40.
Many women who are diagnosed with breast cancer have a mutated BRCA 1 or BRCA 2 gene, which normally repairs DNA. Carney says it’s not worth screening everybody for it (only 1 or 2 percent of the population has the mutation), but if you develop early breast cancer, you should be screened, since the mutation has also been linked to ovarian cancer, which is less common but very deadly.
“There have been a number of studies looking at ultrasound and the CA 125 test and various combinations and various schedules, and even in trials that have evaluated tens of thousands of people, and we haven’t really been able to make a dent in mortality from ovarian cancer,” Carney says. “The screening trials can find the cancer a little bit earlier than not screening, but it doesn’t result in improved survival.”
In fact, Carney says, people who are screened for ovarian cancer may be more likely to die than those who weren’t screened, because of complications from unnecessary interventions. About three-quarters of ovarian cancer cases are already advanced by the time they’re found and are not curable.
Did you know? Living a sedentary lifestyle increases your risk of getting breast cancer by up to 25 percent.
Fighting Breast Cancer
What you should know about one of the deadliest cancers among women:
29% of newly diagnosed cancers among women are of the breast.
Breast cancer is the leading cause of cancer-related death among women worldwide.
Among certain populations, breast cancer survival rates are as high as 90 percent.
78% of women age 45 and older go in for mammograms annually in Hawai‘i.
What to do in your:
Pap smear every three years, or every five years if co-tested for HPV; colonoscopy every 10 years, or sigmoidoscopy every five years, or fecal blood test every year, starting at age 50
Women might not think too much about colorectal cancer since it occurs more often in men, but Dr. Shilpa Jain says it’s the third-most-common cancer in women and one of the most deadly. A lot of women are reluctant to get a colonoscopy for a number of reasons: There aren’t a lot of female gastroenterologists in Hawai‘i, it can be uncomfortable and the prep is, well, unpleasant.
“The worst thing about the colonoscopy that everyone’s scared about is the prep,” Ramones says. It includes all-liquid meals and taking laxatives to clear out your colon. But certain laxative brands require you to drink less or don’t taste as bad.
Jain also says that she and her husband, Dr. Ankur Jain, both gastroenterologists and assistant clinical professors of medicine at UH, perform colonoscopies on Saturdays, which is more convenient (especially since someone else needs to drive you, because you’ll be sedated), and anesthesia can reduce discomfort. For women who can’t get colonoscopies, such as those who are obese, there are alternatives, such as a CT colonography (basically an X-ray of your colon) or a DNA test, though these can often be expensive. At the end of the day, a colonoscopy is a once-every-10-years procedure that is the gold standard for finding polyps and removing them in one procedure, as opposed to more frequent, less effective screening methods. Twenty-five percent of people have polyps, Ankur says, though it’s not known whether they are cancerous. All colorectal cancers come from polyps, so whatever is found is removed.
Conditions caused by the mutated BRCA 1 gene, such as breast cancer or Lynch syndrome, are also linked to colorectal cancer. Irritable bowel syndrome and anemia can also be signs of colorectal cancer, regardless of age.
What about menopause?
A 2002 study by the Women’s Health Initiative condemned hormone replacement therapy, which many postmenopausal women used, for actually increasing the risk of negative health effects, including heart disease and breast cancer.
Some women have turned to laser treatments and radiofrequency technology, which are nonsurgical and nonhormonal, to treat symptoms, says Pratt. She offers these options at the Hawai‘i Beauty and Wellness Center. They can help with dryness, itching and pain during sex, all symptoms of genitourinary syndrome of menopause, which happens after women’s bodies stop producing as much estrogen.
What to do in your:
Pap smear every three years, or every five years if co-tested for HPV, until age 65; colonoscopy every 10 years, or sigmoidoscopy every five years, or fecal blood test every year until age 75; pneumonia vaccine recommended at age 65; osteoporosis screening every two years from age 65
You can stop getting a Pap smear at 65 if the previous three have been negative, but Pratt emphasizes you should still get a pelvic exam regularly, which can detect ovarian cancer: “As long as you have ovaries, you should have a pelvic exam.”
Also, when you turn 65, it’s time for the pneumonia vaccine. Ramones says there are two shots you get: The first covers 13 strains; then, one year later, the second covers 23 more. She also recommends a DEXA, or dual-energy X-ray absorptiometry, every two years from age 65 to check on bone mineral density. “We lose 20 percent of our bone density after menopause because we’re not producing estrogen anymore, which has a protective effect on bone,” says Ramones. One out of every four senior women will be diagnosed with osteoporosis.
What you need to know about Hepatitis A
In August, the primary source of Hawai‘i’s hepatitis A outbreak was determined to be imported scallops served raw at Genki Sushi locations. Dr. Johnnie Yates, the director of travel and tropical medicine with Kaiser Permanente, predicted in August that the peak of the outbreak will have passed by October (unless there is another source). Although, there will still be some cases passed between people, since there is a long incubation period—from 15 to 50 days, according to the Centers for Disease Control.
The hepatitis A vaccine is recommended for anyone age 1 and older and first became available in 1995. If you think you’ve been exposed to hep A, go for the vaccine immediately, which might kick in before the virus takes effect and can lessen symptoms, if not completely prevent the infection. The vaccine is also safe for pregnant women. “If you’re pregnant and infected in the second or third trimester, it may increase the risk of preterm labor,” Yates says.
Why you should avoid Zika
There had been no locally acquired cases of Zika in Hawai‘i at press time, but, with 4.4 million people traveling through the state in the first six months of 2016 alone, it’s best to be on the alert, especially if you are or plan to get pregnant, since the disease has been linked to birth defects. (For everyone else, most symptoms resolve themselves within a few weeks, though some people have been hospitalized.)
“So much has been changing with Zika in terms of recommendations because there’s so little that we know, we’re getting a lot more information day by day,” says Yates. “Those recommendations may change, but, for now, women who are considering getting pregnant, if they’re planning on getting pregnant within a couple of months of their trip, it’s probably best not to go.” Traces of the Zika virus’ genetic material have been found in men more than 180 days after developing symptoms; in women, the longest has been 11 days. “Most people who get infected are asymptomatic. They don’t have any symptoms and you just kind of resolve the infection and then you’re fine. The incubation period is typically a week or less but can be up to two weeks. If you don’t get any symptoms within two weeks of being exposed, you’re in the clear.”
To avoid Zika:
Stay up to date on travel advisories and avoid areas where Zika is active, including Miami, Puerto Rico and Sāmoa.
If you must travel, take precautions to avoid mosquito bites.
Don’t have unprotected sex with anyone who has recently traveled to areas with Zika.
If you contract Zika, wait at least eight weeks after your infection has been resolved before getting pregnant.
READ MORE STORIES BY KATRINA VALCOURT