Search the Internet and you'll find plenty of guidelines for women's
health screenings. But women have to ask: is the information current and
appropriate? "The medical guidelines are constantly changing,"
says Nyasha Spears, MD, primary care physician at St. Luke's P.S.
Rudie Medical Clinic in Duluth. "There's new evidence, new data,
and new techniques." Having a relationship with a primary care physician
can help women find the right screenings.
The doctor/patient relationship
"I went into primary care medicine to have a relationship with my
patient," says Dr. Spears. "It's important that I know what
you look like, what you talk like, what's important to you. If I know
what your values are, that's invaluable to me, so I can help you make
medical decisions." Annual visits help develop that relationship,
so the doctor can find the most effective care for you. "We can take
time to talk about your health goals for the year and how I can help you
achieve them," she says.
Changes in breast and cervical cancer screening
In the past there were pretty clear guidelines for breast and cervical
cancer screenings, but these have changed. Dr. Spears relies on information
from the United States Preventive Services Task Force (USPSTF) to keep
updated. The USPSTF is an independent group that evaluates current scientific
evidence about the benefits and harms of cancer screening and other preventive
services. Research shows that the need for screenings depends on more
variables than just age.
"Mammography has gotten very complicated," says Dr. Spears. "There
are very smart people thinking about this and they all want the best for
women, but there's not clear consensus. So much depends on your family
medical history, your personal medical history and your age." Choosing
to start regular mammography as part of breast cancer screening at age
40 or 50 and what schedule each woman chooses depend on the outcome of
a patient-centered conversation with their physician. "The data on
the benefits of mammography screening are complicated for everyone, which
makes it even more important to discuss these issues with your physician,"
she says. "We can't just stick our heads in the sand because
the guidelines are confusing."
There have also been changes in schedules for cervical cancer screening.
"We no longer screen before the age of 21," says Dr. Spears.
The current recommendations, released in March 2012, apply to women ages
21-65. Women need to start Pap testing at age 21 and get Pap testing every
three years. "If a longer interval is desired, at age 30 we can couple
the Pap test with an HPV test," she says. HPV (human papilloma virus)
is a virus strongly linked to cervical cancer. "If both the Pap and
HPV tests are normal and the woman is between ages 30 and 65, we can increase
the interval of screening to five years," says Dr. Spears.
Your choices are more powerful than medicine
Dr. Spears wants to help women see the bigger picture of their health.
"There are many screening tests and immunizations that can really
help. However, the personal choices are very important. I often have to
help people see the forest for the trees. For example, a woman might come
to the office terrified of a particular cancer but she smokes. I can help
her quit smoking, which will dramatically decrease her risk of many types
of cancers. Not smoking is so critically important to the prevention of
disease and the maintenance of overall health."
Dr. Spears recently moved her practice from St. Luke's Chequamegon
Clinic in Ashland, Wisconsin, to St. Luke's P.S. Rudie Medical Clinic
in downtown Duluth. She enjoys helping patients make the changes that
help them meet their health goals. "Women constantly put other people
first," she says. "If you want to take good care of your family,
you need to eat well, sleep well and get enough exercise. If you don't,
you won't be able to take care of the people you care about most.
When you have your annual visit with your physician, we can talk about
your priorities and help you make the right choices for your health. There's
nothing in medicine as powerful as what you do for yourself."
BELOW: Nyasha Spears, MD, at P.S. Rudie Medical Clinic.