Talking testing for women's health

June 1, 2010

The Women's Health Awareness Center recently listed 10 health screenings all women should have and offers the following checklist to get women started. Because these tests are considered preventive, many insurance plans cover them.

1. Blood pressure screening
Starting at age 18, every woman needs to have her blood pressure checked at least every two years. Ideal blood pressure for women is less than 120/80 mmHg (millimeters of mercury).

2. Cholesterol check
Women should have their cholesterol checked at least every five years starting at about age 20. This screening is important for decreasing your risk of heart disease. The ideal level is below 200 mg/dL for total cholesterol.

3. Pap smears and pelvic exams
Beginning at age 21, or earlier if sexually active, women need to have a pelvic exam and Pap smear every two years to check for any abnormalities in the reproductive system (guidelines for this cervical cancer screening recently changed from once a year, as studies found no benefit to such frequent screenings). Barring any problems, women age 30 and older only need a Pap smear every three years if they have had three normal tests in a row.

4. Mammograms and breast exams
Starting around age 20, women should have a clinical (manual) breast exam at least every three years until age 40, after which this should be done annually, according to most experts. Mammograms are done every one or two years once a woman turns 40. Despite a recent government task-force recommendation to push the start of mammograms back to age 50, the American Cancer Society still recommends earlier screening.

5. Bone-density screen
Women should start being screened for osteoporosis with a bone density test at age 65. Women with risk factors for osteoporosis, such as having a slender frame or a fractured bone, should be screened earlier. Healthy bones show a T-score (the measurement used to describe bone density) of -1 or higher. The frequency of this health screening varies from woman to woman based on bone density and risk factors.

6. Blood glucose tests
Women should get a blood-glucose test every three years starting at age 45 to test for diabetes or pre-diabetes; before age 45, blood-glucose levels should be tested if symptoms of diabetes or several risk factors are present. The range of normal test results can vary, but generally a test result of 100 mg/dL or higher indicates pre-diabetes or diabetes.

7. Colon-cancer screening
Colon-cancer screening tests for women generally start at age 50. The more traditional tests are the flexible sigmoidoscopy, and a colonoscopy. Unless a problem is found, a flexible sigmoidoscopy needs to be repeated every five to 10 years and a colonoscopy only every 10 years. The non-invasive virtual colonoscopy is another option. People with a greater risk of colon cancer may need earlier or more frequent cancer-screening tests.

8. Body-mass index
A full yearly physical exam includes measurements of height and weight, and a calculation of body mass index (BMI). Or calculate BMI at home using an online BMI calculator. BMI indicates obesity, which can assess the risk of serious health conditions like diabetes and heart disease.

9. Skin examination
Women should examine their skin every month starting at age 18, and by the time they are 20, a doctor or dermatologist should conduct the examination during a routine check-up. Women should carefully inspect the skin all over their bodies, looking for any new moles or changes to existing moles to spot the early signs of skin cancer. The American Academy of Dermatology offers free skin-cancer screenings from dermatologists. Visit

10. Dental check-up
All adult women need twice-yearly dental check-ups and cleanings. Regular dental check-ups, which involve examining the teeth and sometimes taking X-rays, can keep teeth healthy and spot early signs of decay or any problems with the mouth or teeth. For more details, go to

ASCO and CAP aim to improve hormone-receptor testing for breast-cancer patients

On April 19, 2010, the American Society of Clinical Oncology (ASCO) and the College of American Pathologists (CAP) issued a joint guideline aimed at improving the accuracy of immunohistochemistry (IHC) testing for the expression status of estrogen (ER) and progesterone receptors (PgR) in breast cancer. The two groups conducted a systematic review of medical research literature in partnership with Cancer Care Ontario to develop the recommendations. The guideline was published in the April 19 issues of ASCO's Journal of Clinical Oncology (JCO) and CAP's Archives of Pathology & Laboratory Medicine.

As many as two-thirds of breast cancers are ER and/or PgR-positive with their growth influenced by activation of the estrogen receptor pathway. The purpose of ER/PgR testing is to identify breast-cancer patients whose tumors express ER and/or PgR (hormone receptor-positive) and who, therefore, should be considered candidates for treatment with endocrine therapies, which may include options like tamoxifen, an aromatase inhibitor, and/or suppression of ovarian function, as appropriate. These treatments can substantially improve survival in patients with hormone receptor-positive invasive breast cancer.

Immunohistochemistry is an established assay to determine the ER/PgR status of a tumor by measuring protein amounts of ER and PgR in breast cancer cells — up to 10% to 20% of IHC test results throughout the world may be inaccurate (false-positive or false-negative).

“There is clearly a need to accurately identify breast cancer subtypes as ER- and/or PgR-positive to help us identify those patients most likely to benefit from endocrine therapy and minimize the risk of potentially denying effective and life-saving therapy to patients incorrectly labeled as having ER/PgR-negative invasive disease, while allowing patients with true ER/PgR-negative disease to be considered for other therapies,” says Antonio C. Wolff, MD, FACP, co-chair of the ASCO/CAP Hormone Receptor Testing in Breast Cancer Panel and associate professor of oncology at the Johns Hopkins Kimmel Comprehensive Cancer Center.

The guideline includes the following:

  • Testing ER and PgR status on all newly diagnosed invasive breast cancers (primary site and/or metastatic site), and whenever appropriate, repeat testing in patients with a known breast-cancer diagnosis who now present with a local or distant recurrence. 
  • Establishing uniform testing measures that focus on proven, reliable, and reproducible assays and procedures.
  • Having testing labs validate their assays against existing and clinically validated tests. Results should agree at least 90% of the time with those of the clinically validated assays for positive-receptor status and at least 95% for negative-receptor status.
  • Transporting breast-tissue specimens from the OR to the pathology lab as soon as they are available for gross assessment. The time from tumor removal to initiation of fixation should be kept to one hour or less. Fixation of the sample in neutral buffered formalin must extend for at least six hours and no longer than 72 hours.
  • Performing ER and PgR testing in a CAP-accredited laboratory or in a laboratory that meets the accreditation requirements spelled out in the guideline. CAP will require that every accredited lab performing testing participate in a mandatory proficiency-testing program. 
  • Considering an ER and PgR test performed by an IHC assay as positive if at least 1% of the tumor in the sample tests positive, which helps predict whether a patient is likely to benefit with endocrine treatment. The panel recognized that it is reasonable for oncologists to discuss the pros and cons of endocrine therapy with patients whose tumors contain low levels of ER by IHC (1% to 10% weakly positive cells) and to make an informed decision based on available information.

Dr. Wolff says the main goal of the ASCO/CAP ER/PgR guideline is to improve the accuracy of test results and ensure that patients receive appropriate care, like endocrine therapy as it has the potential to improve survival and save lives. Widespread access to accurate ER/PgR testing is also critical because breast cancer is the most common cause of cancer death in women in low- and middle-income countries, and most of them have ER and/or PgR-positive disease.

According to Elizabeth Hammond, MD, FCAP, Dr. Wolff's co-chair on the panel, pathologist at Intermountain Healthcare, and professor of pathology at the University of Utah School of Medicine, “Increased attention to simple measures such as the handling of tissue specimens from the moment they are taken from the patient to when they reach the pathologist, the uniform fixation of specimens, the standardization and validation of lab assays, rigorous reporting procedures, and greater access to treatment interventions have the potential to significantly improve breast-cancer outcomes around the world.”

In conjunction with the publishing of the guideline, ASCO and CAP have developed clinical tools and resources for oncologists and pathologists that summarize the findings and recommendations. These resources include a slide presentation on ASCO's website and a guideline summary in the Journal of Oncology Practice.

In addition, CAP has developed a Breast Predictive Factors Testing Certificate Program and associated Continuing Medical Education (CME), which will also allow pathologists to gain special expertise in the development and implementation of these tests. Visit and to learn more.

Blood test may spot ovarian cancer
Researchers have found a new way to use an existing blood test that may provide a way to screen women for ovarian cancer, perhaps in time to cure more women of the deadly disease. They say combining a test that measures levels of a certain protein, along with a way of measuring risk of the disease, has helped spot early stage cancers in otherwise healthy women.

Researchers from the University of Texas M.D. Anderson Cancer Center discovered a new way to use the cancer antigen or CA-125 test, which measures levels of a protein that is elevated in ovarian cancer cells. The CA-125 test can detect rising levels of this protein and is typically used to see if ovarian cancer has come back. But it is less sensitive in early stage cancers because levels of CA-125 can also rise from non-cancerous conditions, especially in pre-menopausal women.

The team used the CA-125 test in combination with the Risk of Ovarian Malignancy Algorithm, a mathematical formula that calculates a woman's risk of having ovarian cancer based on age, CA-125 level, and CA-125 levels over time. The team studied women over age 50 who had no significant family history of breast or ovarian cancer and put them into three groups. Those at low risk got annual blood tests. Women deemed at intermediate risk were called back for a repeat test in three months. If the risk appeared high, they were referred for a transvaginal ultrasound.

The team found three invasive cancers in 3,238 women who participated in the study — all early stage and potentially curable. Researchers in Britain are evaluating the blood test and risk-algorithm combination in a study of more than 200,000 women. Results of that study are due in 2015.Read more at

Genetic tests represent future of cancer care for women
Important progress is being made in women's health through the use of genetic tests, particularly those that help women detect and treat cancer, according to the American Clinical Laboratory Association (ACLA). The tests identify the genetic and molecular structure of the disease and the individual, which allows for personalized medicine tailored to the exact needs of the patient, says Alan Mertz, ACLA president. Examples include:

HER-2 breast-cancer test: Physicians use a molecular genetic test to detect an overabundance of HER2 protein on the surface of a breast-cancer tumor. For these women, who usually do not benefit from standard treatments, physicians can prescribe the gene-based drug Herceptin that will bind to the protein and deactivate it. The breast-cancer test enables drug treatment that has been shown to increase survival by 33% and reduce recurrence by 50%.

HPV-DNA cervical-cancer test: Genetic tests for the HPV viruses that cause cervical cancer improve the ability to identify the disease at its earliest stages by 51% compared to using the Pap test only. The HPV DNA tests add another important screening tool to the Pap test by identifying the high-risk strains of human papillomavirus (HPV) that lead to cervical cancer. The tests can also determine whether atypical cells identified by Pap tests are actually pre-cancerous.

KRAS colon-cancer test: This test identifies people with a normal gene called KRAS who will respond to a frontline cancer drug called cetuximab. About 40% of patients with metastatic colon cancer carry a mutated form of the KRAS gene that prevents them from responding to this drug. In fact, if they get the drug, patients can suffer damaging side effects. Knowing the patient has the KRAS mutation means doctors can avoid using cetuximab and expedite the best alternative therapy.

More genetic tests are also in development that could lead to earlier diagnosis and more effective treatment for lung, ovarian, and other cancers — as well as other chronic diseases. See

Five new genetic sites that increase breast-cancer risk
Scientists have found five new regions of the genome that increase a woman's risk of developing breast cancer by between 6% and 16%, according to a study in Nature Genetics on May 1, 2010. The results of the study, funded by Cancer Research UK and the Wellcome Trust, and carried out by scientists at the University of Cambridge and The Institute of Cancer Research, takes the total number of common “low-risk” genetic sites associated with breast cancer to 18.

The increased risk conferred by these genetic variants is small. But as more of these “low-risk” sites are found, it may be possible to create tests for a combination of them that, together, significantly increase risk.

One of the sites identified contains a gene called CDK2NA, which regulates the process of cell division and is altered in the DNA of many tumors. This gene has also been linked to increasing the risk of a type of skin cancer — melanoma.

Interestingly, most of the regions found appear to predispose predominantly towards estrogen receptor-positive breast cancers. This could open new avenues for research into the use of drugs such as tamoxifen, which can reduce the risk of this form.

The scientists scanned the entire genetic code of over 4,000 women with breast cancer and a family history of the disease for genetic variations that cropped up more often compared to healthy women. They then tested the most promising regions in over 12,000 women with breast cancer and 12,000 women without breast cancer, in an international collaboration.

While the results now take the total number of gene regions linked to the risk of breast cancer to 18, the scientists still do not know which genes are causing this increased risk. Identifying the underlying genes and mechanisms behind breast-cancer development is essential to increasing understanding of the disease and finding new treatments.

Lifestyle factors play a role in influencing the risk of breast cancer, but inherited factors are important in determining an individual woman's risk of the disease. For more details about this study, visit

Every 35 minutes a woman tests positive for HIV in the U.S.
In 2007, more than a quarter of diagnoses of HIV infection in the United States were among women and girls aged 13 years and older. More than 278,000 women and adolescent girls in the U.S. are living with HIV; and almost 94,000 American women and girls with AIDS have died since the epidemic began. Women and girls of color — especially black women and girls — bear a disproportionately heavy burden of HIV/AIDS. In 2007, for female adults and adolescents, the rate of HIV/AIDS diagnoses for black females was nearly 20 times as high as the rate for white females and nearly four times as high as the rate for Hispanic/Latino females. Relatively few cases were diagnosed among Asian, American Indian/Alaska Native, and Native Hawaiian/other Pacific Islander females, although the rates for these groups were higher than the rate for white females.

High uric acid levels linked to risk of gout in women
Elevated levels of uric acid increase the risk of gout in women, a finding that has not previously been reported, researchers said. The risk of gout among women whose uric acid level was 8 mg/dL or greater was 46 times higher than for those whose level was below 5 mg/dL (RR 45.75, 95% CI 19.17 to 109.21), according to researchers at Boston University.

Other risk factors independently associated with incident gout in women were increasing age, obesity, alcohol consumption, hypertension, and diuretic use, the researchers reported in the April issue of Arthritis & Rheumatism. Gout has historically been considered a male disease, and most research has been limited to men. The disease burden among women, however, has been growing with the incidence doubling in the past two decades. Read more at

Group urges women to follow new Pap test guidelines
The Indiana University National Center of Excellence in Women's Health is urging women to follow the new American College of Obstetricians and Gynecologists' (ACOG) recommendations regarding Pap tests. ACOG now recommends that women delay their first Pap test until age 21, rather than the previous recommendation that young women get their first test within three years of becoming sexually active but no later than 21. The group also says women between the ages of 21 and 29 should be screened every two years, and women 30 and older who have had three consecutive normal Pap tests and no history of seriously abnormal findings should be screened every three years.

Chlamydia, gonorrhea on the rise
There were more than 1.5 million total cases of chlamydia and gonorrhea reported to Centers for Disease Control and Prevention (CDC) in 2008 — making them the two most commonly reported notifiable infectious diseases in the United States. Chlamydia remains the most commonly reported infectious disease in the U.S. There were more than 1.2 million cases of chlamydia (1,210,523) reported to CDC in 2008, an increase from the 1.1 million cases reported in 2007.

Adolescent girls and young women are especially hard hit by these two diseases. The largest number of reported cases of both chlamydia and gonorrhea in 2008 was among girls between 15 and 19 years of age, followed closely by young women 20 to 24 years of age. This likely reflects a combination of factors, including biological differences that place females at greater risk for STDs than males, as well as higher STD screening rates among young women.

Syphilis — a disease once on the verge of elimination — began re-emerging as a public-health threat in 2001. This is primarily because of a resurgence of the disease among men who have sex with men, though cases among women have also been increasing in recent years.