Screening Tests for Women Archive

The carotid arteries carry oxygen-rich blood from the heart to the front half of the brain. But these crucial arteries can become narrowed by the cholesterol-laden plaques of atherosclerosis. Blood clots, or thrombi, can form on the plaques, then break off and travel as emboli to the brain, where they lodge in small arteries, interrupting the vital flow of blood to brain cells. If the interruption is partial or brief, the brain cells recover; the patient experiences a transient ischemic attack (TIA) with no permanent damage. But if the blockage is complete, brain cells die, producing a stroke.

In many cases, a TIA warns of a future stroke, giving doctors time to perform a carotid ultrasound test to see if the artery is mildly (less than 50%), moderately (50% to 69%), or severely (70% to 99%) narrowed. Once the diagnosis of carotid stenosis (narrowing) is established, several treatment options must be considered.

Annual screening for ovarian cancer with the CA-125 blood test and transvaginal ultrasound (TVUS) does not reduce a woman’s risk of dying from the disease, according to the results of a large clinical trial sponsored by the National Cancer Institute. Ovarian cancer is 90% curable when treated early, but most cases are diagnosed late, when the five-year survival rate is less than 30%. Nearly 14,000 women die from the disease every year.

As part of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, researchers at the University of Utah evaluated whether yearly screening could lead to earlier detection and reduce mortality. Results were presented at the American Society of Clinical Oncology meeting in Chicago and published online in The Journal of the American Medical Association on June 4, 2011.

The carotid arteries that run up either side of the neck are prone to becoming narrowed by cholesterol-filled plaque. A test called carotid ultrasound can identify a narrowing, also called a stenosis, quickly, safely, and without any immediate potential for harm. This test makes perfect sense for someone experiencing lightheadedness, memory loss, or the warning signs of a stroke or mini-stroke.

In people who have their carotid arteries checked "just in case," ultrasound doesn't do much good. University of Wisconsin researchers tracked almost 600 people who underwent carotid ultrasound for this reason. A year later, those whose scans had shown a significant narrowing were no more likely to have their blood pressure or cholesterol under control — two key steps for managing carotid stenosis — than those whose arteries were clear, or to have made healthy changes in diet, exercise, and other long-term health behaviors (Archives of Internal Medicine, March 28, 2011).

You don't have to be a brain surgeon to know it is vitally important for your brain to receive an uninterrupted supply of blood. That's because nerve cells require a constant supply of oxygen. Even a brief disruption stuns nerve cells, impairing their function, while more prolonged oxygen deprivation kills the cells. If only a small, noncritical area of your brain is affected, you may not notice the damage. Unfortunately, however, the damage is often very noticeable indeed. Brief or partial interruptions of blood flow cause transient ischemic attacks (TIAs), while prolonged or complete blockages are the major cause of cerebrovascular accidents — strokes.

Shocking statistics

Stroke is the fourth leading cause of death in the United States, taking about 136,000 lives annually. Another 660,000 Americans survive strokes each year, but many are so disabled that they cannot return to work. In human terms, it's an enormous burden of suffering; in dollar terms, it costs $74 billion a year to care for stroke victims and make up for their lost productivity.

Q. When you talk about breast cancer screening, why don't you mention thermography? I've been using it for several years instead of mammography, which uses radiation.

A. The short answer is, we don't have good evidence that thermography is useful, and it definitely is not a substitute for mammography.

Q. I have a family history of cardiovascular disease. Although I don't have high blood pressure, high cholesterol, diabetes, or any other risk factor, I'm concerned about how my cardiologist is screening me, because women can have small-vessel disease and not necessarily arterial disease. How should I be screened?

A. In general, the decision to screen a woman for cardiovascular disease depends on her risk for the disease and whether she has symptoms. The risks include some things that are out of our control, such as a strong family history (that is, heart attack or stroke in a father or brother before age 55 or in a mother or sister before age 65). But we can prevent or lessen many other risks through lifestyle changes, or, if necessary, medications. Major risk factors include obesity, smoking, physical inactivity, high blood pressure, high cholesterol, and diabetes. All of these affect both genders, but several have a greater impact on women. For example, diabetes raises the risk of heart disease in women more than in men.

Q. I recently had a nuclear stress test and the contrast agent got stuck in my gut, so the image couldn't be read. Is this a common problem, and is there anything that can be done about it?

A. The purpose of a stress test is to identify problems with blood supply to the heart muscle or the coronary arteries that supply it with blood. The standard test involves measuring the heart's electrical activity with an electrocardiogram (ECG) while the patient "stresses" his or her heart with exercise, which usually means walking on a treadmill or pedaling a stationary bike.

Whether the check-up should include an electrocardiogram is an unanswered question.

Sports, and the physical fitness needed to participate in them, provide an extra layer of cardiovascular protection by strengthening the heart, improving the lungs, and making arteries more supple. Sometimes, though, something goes horribly wrong and an athlete suddenly dies while engaged in his or her sport.

Most people with this genetic condition develop thickened heart muscle but lead normal lives.

"You have a really big heart" is usually a wonderful compliment — except when it comes from your cardiologist and the term cardiomyopathy crops up in the conversation. An oversized heart usually isn't a good sign.

Q. I'm 50 years old and have never had an HPV test. Do I need one as part of my health screening?

A. The short answer to your question is, no, you don't need the HPV test for routine cervical cancer screening. However, it's complicated, and there have been some changes in screening guidelines for cervical cancer that women should know about.