Preventive Care and Cancer Screening for Women
On World Cancer Day, let's empower women with knowledge on cancer prevention
Prevention
Preventive care is a crucial aspect of healthcare aimed at detecting and addressing health risks before they develop into severe conditions. Women face unique health challenges requiring tailored preventive measures. On World Cancer Day we will learn preventive measures for women, screening guidelines, common cancers and emerging diagnostic tools.
Screening Guidelines and Recommendations: The U.S. Preventive Services Task Force (USPSTF) provides standardized screening recommendations for various health conditions affecting women. These include:
Breast Cancer Screening: Biennial mammography for women aged 40-74.
Cervical Cancer Screening: Routine Pap smear for women aged 21 - 65
Osteoporosis Screening: Bone mineral density measurement testing for women aged 65 and above.
Colon Cancer Screening: Screening for adults aged 50-75 (grade A recommendation), with new recommendations for those aged 45-49 (grade B recommendation).
Depression: The USPSTF recommends screening for depression in the adult population, including pregnant and postpartum persons, as well as older adults
Cancer Prevalence Among Women in Kashmir Cancer remains a significant health concern in Kashmir. Based on hospital-based studies, the most common cancers in Kashmiri women include:
- Esophageal Cancer
- Breast Cancer
- Colorectal Cancer
- Ovarian Cancer
- Lung Cancer
Gastrointestinal malignancies account for over one-third of total cancer cases in Kashmir. Urban-rural disparities are notable, with rural areas exhibiting higher incidence rates due to limited healthcare access and awareness.
Risk Factors: Understanding the risk factors are essential in developing targeted preventive strategies. For example:
Esophageal Cancer: Linked to long-term NSAID (pain medications like Ibuprofen) use, H. pylori infection, obesity and smoking.
Osteoporosis: Higher prevalence among postmenopausal women with low body mass index (BMI), smoking, chronic steroid medication intake, and low levels of calcium and vitamin D (decreased exposure to sun can lead to decreased low vitamin D levels).
Cervical cancer: Human papillomavirus (HPV), smoking, multiple sexual partners, early age of first sexual encounter, long-term use of oral contraceptives, family history, weakened immune system, and multiple child births
Colon cancer: Age (especially after 60), family history (history of colon cancer or polyps), Inflammatory bowel disease (Crohn’s disease or Ulcerative colitis), obesity, low fiber diet, alcohol, smoking, and sedentary lifestyle.
Breast Cancer: Risk factors for breast cancer in women can be divided into:
Non-modifiable factors: Age (most breast cancers diagnosed in women over 50). family history, genetics (BRCA1 and BRCA2 gene), dense breast tissue.
Reproductive factors: Early menstruation (before age 12), late menopause (after age 55), never having children, late age at first pregnancy, not breastfeeding.
Lifestyle factors: Obesity, physical inactivity, hormone replacement therapy, exposure to radiation to the chest.
Challenges in Preventive Care: Despite the significance of preventive care, several challenges persist in Kashmir:
Limited Access to Screening Facilities: The availability of affordable mammography, low-dose CT scans, and DEXA scans remains a concern.
Lack of Public Awareness: Not many women in Kashmir have awareness about cervical cancer and need to have screening test started at age 21. Education on risk factors and public awareness is needed. There is also not much education and awareness on misuse of pain medications (NSAIDs) and acid reducing medications (proton pump inhibitors (PPIs).
Healthcare Infrastructure Limitations: The need for centralized electronic health records (EHRs) and low-cost surgical centers for colonoscopies is urgently needed.
Socioeconomic Barriers: Many women in Kashmir lack access to green spaces and wellness facilities, contributing to sedentary lifestyles, decreased sun exposure and associated health risks.
Strengthening Preventive Care in Kashmir: To enhance preventive care for women in Kashmir, a multifaceted approach is necessary:
Expand Primary Care Services: Strengthening primary care can facilitate early screening and intervention.
Develop Local Screening Guidelines: Given the high prevalence of esophageal and stomach cancers, region-specific screening protocols should be considered and implemented.
Increase Public Health Education Initiatives: Awareness campaigns can help women make informed health choices and go for early screening tests for cervical cancer, breast cancer and colon cancer.
Improve Healthcare Accessibility: Establishing low-cost diagnostic centers and mobile screening units in both urban and rural areas will be helpful to reach out to people who don’t have easy access to healthcare facilities.
Emerging Diagnostic Tools: Embracing and using new scientific methods for screening is the need of the hour. One such test is the Galleri Test. A notable advancement in cancer screening is the test developed by GRAIL Laboratory. This blood-based test can detect signals from over 50 types of cancer, making it a promising tool for early diagnosis. While not yet FDA-approved, it is recommended for adults aged 50 and older, supplementing traditional screening methods like mammography and colonoscopy.
Dr Tasaduq Hussain Mir is based in USA