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Medical check-ups and issues for women in their 40's
Mammograms, pap smears & heart disease screenings are a few of things that can save your life.

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This is our first newlestter based upon questions submitted by patients like you!  If there are other topics which you would like to see addressed in subsequent newsletters, please feel free to email me at newsletter@DrRuman.com  and let me know about them.


Hi Dr. Ruman:
I will be turning 40 this year. What medical check-ups and issues arise in this decade for women?

One of the most common questions I am asked by patients is what types of screening tests are appropriate given one's age and gender. There are various task forces that have put together information to answer this particular question.

The US Preventative Services Task Force (USPSTF) is one such group of health experts that reviews published research and makes recommendations about preventive health care.

I will try to summarize this data for you in regards to women in their 40s. I hope that it will give you some direction and framework as to what can and should be discussed in your annual visit with your doctor.

In fact, these preventative screening tests/topics are what a typical yearly exam should address in addition to any specific questions or concerns pertaining to you individually.

Nearly all North American medical organizations support mammography screening, although they vary in the recommended age to begin screening and the interval for screening. In general I recommend that you have a mammogram every 1-2 years women beginning at age 40.

The USPSTF found fair evidence that women 40 to 69 years of age who have screening mammograms every 1 to 2 years die of breast cancer less frequently than women who do not have screening mammograms. The benefits increase as women become older.

The USPSTF recommends that women 40 years of age and older consider having screening mammograms every 1 to 2 years. Women should understand that there is a possibility that they will have false-positive results on mammography. They should then weigh the potential risks (anxiety and additional procedures, such as breast biopsy) and the benefits (reduction in breast cancer death rates for women their age) when deciding whether to get a mammogram.

For women 70 years of age and older, the USPSTF recommends screening mammograms every 1 to 2 years unless a woman has other serious illnesses that are likely to reduce her life expectancy.

The potential harms of mammography include anxiety, procedures, and costs that result from mammograms that suggest cancer when there is none (false positives). The USPSTF found no evidence that breast-self examination or clinical breast examination reduced breast cancer death rates.

Women should have yearly Pap smears starting either at age 18 or when they become sexually active -- whichever comes first. After three or more normal results, and depending upon your risk factors, your doctor may recommend that you have Pap smears every three years.

Routine screening may discontinue:
At age 65 if pap results have been normal in the past and is not in a high risk group for cervical cancer
If you have had a hysterectomy for benign (non-cancer) reasons.

A lot of women get diabetes in middle age or older, but it's rising in the young. African American, Hispanic/Latino, American Indian and Asian/Pacific Islander women are 2 to 4 times more likely to develop diabetes than white women. Besides being a member of these racial or ethnic groups, the risks for developing type 2 diabetes are age, obesity, lack of physical activity and a family history of the disease, history of diabetes during pregnancy, polycystic ovary syndrome, high blood pressure, and high cholesterol .

The ADA recommends getting tested for type 2 diabetes every three years beginning at age 45, if you are at average risk for diabetes. If you have any of the risk factors listed above or if you are overweight or obese -- overweight: body mass index (BMI) is 25 to 29; obese: BMI is 30 or more -- you should be tested at an earlier age or more frequently.

A. Blood pressure: The USPSTF recommends that all adults ages 18 and older be screened regularly for high blood pressure. If your blood pressure is less then 130/80, you should be screened every two years. If it's higher than that, or if you have other risk factors for heart disease (such as high cholesterol or diabetes), you should be screened more frequently.

B. Cholesterol testing: A simple blood test that measures total cholesterol, low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol), high-density lipoprotein (HDL) cholesterol (the "good" cholesterol) and triglycerides.

Cholesterol is a form of fat carried in your blood by lipoproteins. LDL deposits cholesterol in your artery walls and HDL carries cholesterol away from your arteries and to your liver for disposal. Problems occur when your LDL deposits too much cholesterol in your artery walls or when your HDL doesn't take enough away. This can lead to a buildup of cholesterol-containing fatty deposits (plaques) in your arteries (atherosclerosis).

The USPSTF also recommends that women ages 45 and older have their cholesterol levels checked regularly every 1-5 years. If you have other risk factors for heart disease (diabetes, cardiovascular disease before age 60, hypertension or are a smoker), you should have your cholesterol checked, beginning at age 20.

This blood test checks your TSH (thyroid stimulating hormone) level for signs of thyroid problems. The American Thyroid Association recommends that women be screened for thyroid dysfunction beginning at age 35, and again every five years.

Not usually recommended for women in their 40's except under specific conditions.

A DEXA scan is a quick, painless scan of your lower back and hip region. This test measures the density of your bones, indicating your risk of fracture at the most common sites affected. Several different types of scans are available, including ultrasound, computerized tomography (CT) and dual energy X-ray absorptiometry (DEXA). Dual energy X-ray absorptiometry scans of the lower spine and hip region are the best standard for deciding when treatment is needed and for assessing the effects of treatment for osteoporosis.

The U.S. Preventive Services Task Force (USPSTF) recommends that women age 65 and older be screened routinely for osteoporosis. However, if you're at increased risk of osteoporotic fractures, the USPSTF recommends that you begin routine screening five years earlier  at age 60. Certain factors put you at increased risk of osteoporosis, such as a low body weight, a history of fractures or a family history of osteoporosis. Factors associated with a risk for rapid bone loss include menopause or discontinuing estrogen therapy.

The USPSTF recommends that women ages 50 and older be screened for colorectal cancer if they are at average risk. If a woman has a family history of familial polyposis or hereditary nonpolyposis colorectal cancer, or a personal history of ulcerative colitis, screening at an earlier age may be advised.

Several screening methods are available: fecal occult blood test (FOBT), which looks for blood in stool samples; sigmoidoscopy, which uses a thin, flexible tube to examine part of the colon and rectum for precancerous polyps; a colonoscopy, which uses a longer flexible tube to examine the entire colon and rectum for precancerous polyps.

The U.S. Preventive Services Task Force doesn't recommend for or against having routine eye exams if you're a healthy adult. However, the American Academy of Ophthalmology recommends the following screening schedule for having your vision checked:

  • At least once between ages 20 and 39
  • Every two to four years between ages 40 and 64
  • Every one to two years beginning at age 65

Although the U.S. Preventive Services Task Force doesn't provide a specific recommendation on screening for skin cancer, the American Cancer Society recommends that beginning at age 20, a skin exam should be part of a routine cancer-related health checkup.

Please stay healthy and I look forward to being there for you when you need me.


If there are other topics which you would like to see addressed in subsequent newsletters, please feel free to email me at newsletter@DrRuman.com  and let me know about them.

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Andrea Ruman, M.D. - Doctor of Internal Medicine
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Dr. Andrea Ruman: Female medical doctor, physician, internist for Marina Del Rey, Santa Monica, West Los Angeles (LA), and Culver City in California. Specialties include women's health (including physical examinations, pelvic exams and pap smears), weight loss support and preventive medicine.