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We’re all familiar with the saying prevention is better than cure. Notably, going for a routine health checkup is one of the best ways to keep our health in check and to identify any health hazards at an early stage that we may have not known otherwise.
Taking up the roles as a mother, a wife, a daughter, a sister or even a family’s main caregiver, women are often seen shouldering heavy responsibilities from day to day and this may result in little attention to their general health and wellbeing. This should be brought forward as we can’t take good care of others if we’re not properly taking care of ourselves. One way women can start taking care of themselves is by going for a regular health screening.
So what are some of the essential health screenings all women are recommended to take? Let’s have a look!
Pap smear is a screening tool that is crucial in identifying early signs of cervical cancer. This procedure involves your doctor collecting a small number of cells from the cervix and sending it to the laboratory for microscopic examination to see if there are any abnormalities that may lead to cervical cancer.
Despite your sexual history or activity, women aged between 20 to 65 years old should be screened for cervical cancer every 3-yearly, following first two consecutive normal pap smear result, tested one year apart.
In addition, all sexually active women aged between 30 to 49 years old should be screened for Human Papillomavirus (HPV); which is obtained from pap smear specimen every 5 years. HPV is the most common sexually transmitted infection that causes cervical cancer.
Beyond 65 years old, there is generally no further test required if you have had at least 3 normal pap smear results in a row, not sexually active and have not had any abnormal pap test in the past, and undergone adequate prior testing. You may choose to discuss with your healthcare provider to end the screening procedure.
Breast Cancer Screening
Breast cancer is reportedly one of the most common cancers among women all around the world including Malaysia. The good news is that early detection may improve treatment outcomes and make the disease easier to tackle. Having said that, regular mammograms ought to be the best way to prevent breast cancer as intervention can be exercised early on if the disease is detected.
According to the Malaysian Clinical Practice Guideline on Management of Breast Cancer, women are recommended to start biennial mammography screenings (once every 2 years) for women aged between 50 - 74 years old. Screening can be offered to high risk women aged 30 and above. Simply put, mammograms can be considered as an x-ray of the breast using low-level radiation.
Mammogram screening for women below 40 years are usually not done due to the fact that pre-menopausal women have denser breast tissue, thus reducing the effectiveness of this screening tool. All women regardless of age are encouraged to perform a monthly breast self–examination at home to learn about how their breasts should feel and look; so that any unusual changes can be noted early on (eg: new lump or thickening of the breast). Ultrasound of the breast will be offered as an alternative if younger women notice any changes in their breast.
If you have a family history of breast cancer or other risk factors that puts you at higher risk of getting breast cancer, it is encouraged that you speak to your doctor about having an earlier annual screening.
Bone Mineral Densitometry (BMD)
Bone density screening essentially helps to detect osteoporosis, a condition whereby the body loses too much bone or makes too little of it or both. As a result, bones become more porous, lose their strength and may break more easily. Women are typically prone to osteoporosis especially after the age of 65 due to menopause and hence are urged to get a bone density screening then.
DEXA scan utilises low dose radiation to measure the amount of calcium and other minerals in the bone. This special type of X-ray will measure your bone strength and density around the hips and spine region as most people with osteoporosis have an increased risk of sustaining fracture of these two bones.
BMD screening can also help predict the risk of future bone fractures using the z scoring system. The frequency of this screening particularly depends on your bone density upon first screening and other existing risk factors (ie: medications that would compromise bone density, low body weight, alcohol consumption, tobacco use etc). You can discuss with your healthcare provider to find out more about your risk for osteoporosis and if you require this examination.
Image credit: SickKids
Colorectal Cancer Screening
Colorectal cancer is one of the leading causes of cancer death. If caught early, they have a very promising success rate. Most colon cancers originate from polyps (abnormal masses) that grow on the inner lining of the large intestine and they may or may not be cancerous. Cancerous polyps can spread to other parts of the body and hence removing them as early as possible can prevent colorectal cancer altogether. Colorectal cancer screening ideally should start at the age 50 until 75 years old for average risk population; the question is, how is the screening performed?
There are a few screening tools for colorectal cancer which can be done either at your local clinic or at the hospital. They are:
Faecal occult blood test as the name suggests, this test helps to detect hidden (occult) blood in the stool which may indicate colon cancer or polyp - although not all cancers and polyps bleed. Presence of blood in the stool will require a follow up colonoscopy. Whilst this test is easy, cheap and painless to perform, the downside is that it does not address pre-cancerous early growth that may be present.
Colonoscopy is the gold standard but invasive procedure whereby a long, flexible tube with a tiny video camera attached at the tip is inserted via the rectum that enables direct visualization of the entire colon. This test can be done every 10 years after their first normal screening.
CT colonography (virtual colonoscopy) is the advanced type of CT that helps clinicians to visualise colon and the rectum by creating 3-dimensional images of the colon and rectum. This non-invasive method is suitable for someone who does not want or is unable to undergo a more invasive procedure such as colonoscopy and can be done every 5 years once, if indicated.
Regular Blood Pressure Check
Hypertension is the medical term for high blood pressure reading more than 120/80 mmHg persistently. Having high blood pressure can significantly increase your risk of developing cardiovascular diseases (CVD) such as stroke, heart attack, peripheral arterial disease and kidney failure. Although hypertension is a condition that predominantly affects male; women especially in the menopausal age group have a higher risk of developing high blood pressure. Therefore, it is vital to get your blood pressure checked regularly at home and controlled at an early stage, if necessary.
Cardiovascular disease is the leading cause of death in Malaysia and high cholesterol or also known as dyslipidaemia is well established as a cardiovascular risk factor. The Ministry of Malaysia recommends all individuals, both men and women aged 30 years and above to undergo blood screening which includes a complete lipid profile on an annual basis. For individuals with high risk of developing CVD (ie: family history of early CVD death, obesity, diabetes mellitus, alcohol & tobacco use) should be screened as early as 18 years old.
Prior to testing, you may be asked to fast in order to obtain an accurate measurement of the cholesterol levels in your body. A typical lipid profile (cholesterol testing) would analyse your total cholesterol, LDL also known as the “bad” cholesterol, the HDL, the “good” cholesterol as well as the triglycerides (body fat).
Based on the National Health and Morbidity Survey 2019, there are approximately 3.9 million Malaysians living with diabetes. Just like hypertension and dyslipidemia, diabetes mellitus stems from modifiable lifestyle-related risk factors. Diabetes increases the risk of an individual developing other health complications from head to toe; such as heart problems, kidney disease, blindness, neuropathy (nerve damage), foot ulcers and amputation if not properly managed from the start.
According to the Malaysian Clinical Practice Guideline on Management of Type II Diabetes Mellitus (T2DM), risk-based screening for pre-diabetic and T2DM in adults should be performed in individuals >30 years of age and repeated annually, as more than 50% of people with diabetes are undiagnosed.
Generally, there are a few blood glucose tests that can be carried out, as follows:
Venous plasma glucose which is measured after a minimum of 8 hours fasting period (not eating/drinking anything except plain water). Fasting blood glucose of more than 7.0 mmol/L is diagnostic of T2DM.
HbA1C test that measures your average blood sugar levels over the past three months. In asymptomatic individuals, two abnormal values (high plasma glucose and HbA1c ≥6.3%) from the same blood sample is adequate for diagnosis of diabetes.
Oral glucose tolerance test (OGTT) is the parameter used to screen for gestational diabetes mellitus (GDM). Screening for diabetes in pregnancy is done based on risk factors (ie: obesity, history of GDM in past pregnancy, family history of T2DM) using 75 gram oral glucose tolerance test (OGTT), done at booking visit. Blood sugar is measured before and 2 hours after the sugary drink consumption. Individuals that do not fulfill the criteria of GDM but of high risk group will undergo a repeat OGTT at 24-28 week of gestation.
Skin cancer screening
In Malaysia, skin cancers account for 2.6% of cancer cases nationally. Skin cancer can be divided to non melanoma (basal cell carcinoma and squamous cell carcinoma) and melanoma (aggressive, lethal due to rapid spread). It is important to note that not all skin lesions are cancerous and skin screening is usually performed to detect skin problems before they become cancerous. Having said that, every individual including women should start examining their skin periodically by looking for any new moles or changes (in regards to colour, size, shape, thickness and texture) to existing moles which can be suggestive of early skin cancer. Additionally, crusty sores that don’t heal or small lumps that are red, pale or pearly in colour should be consulted with a doctor early.
Melanoma can be detected early by using the ABCDE approach as below:
Image credit: National Cancer Society Malaysia
These are generally suggestive features that may indicate the lesion is highly suspicious of melanoma and therefore should be tested for cancer.
It’s better to be safe than to be sorry
Now that we have looked at some of the common health conditions and screening tests available for women, we hope that you will be more aware and start taking charge of your own health. Understanding your own body’s needs and health status is important for every individual. In a nutshell, proper screening may not necessarily prevent a disease, but it can certainly detect a disease early enough that can potentially result in positive outcomes and maximize good chance at treatment.
Written by Janelle Leong, Bpharm(Hons)
Reviewed by Ashwini Nair, MB BCh BAO
10 Health Screenings All Women Should Have - Everyday Health. Available at: https://www.everydayhealth.com/womens-health/10-screenings-all-women-should-have.aspx Accessed on 12th October 2022
Health Tests Every Woman Needs - Healthline. Available at: https://www.healthline.com/health/womens-health-tests#s-and-s Accessed on 12th October 2022
Essential Screening Tests for Women - WebMd. Available at: https://www.webmd.com/women/ss/slideshow-screening-tests-women Accessed on 12th October 2022
Health Tests & Screenings Every Woman Should Get - ForbesHealth. Available at: https://www.forbes.com/health/family/health-screenings-for-women/ Accessed on 12th October 2022
Why an annual health screening is important for women – and which checks must you do - CNA Lifestyle. Available at: https://cnalifestyle.channelnewsasia.com/women/health-screening-women-different-ages-gleneagles-hospital-326001 Accessed on 12th October 2022
Breast Cancer Screening in Malaysia: A Policy Review. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8418850/ Accessed on 12th October 2022
Management of Dyslipidemia 2017 - MoH Malaysia. Available at: https://www.moh.gov.my/moh/resources/Penerbitan/CPG/CARDIOVASCULAR/4.pdf Accessed on 12th October 2022
Pap Smear Test- Beacon Hospital. Available at: https://www.beaconhospital.com.my/pap-smear/#:~:text=Malaysian%20MOH%20guidelines%20recommend%20that,HIV%2 Positive Accessed on 12th October 2022
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