While people are becoming more proactive about their health in terms of diet and exercise, a regular health screening is an important aspect of staying healthy.
A screening test looks for telltale signs in people who may be at risk for certain diseases. Screening is worthwhile medicine. Screening saves women’s lives. Preventing disease may not always be possible, but screening tests may catch diseases early and allow you to take active steps to deal with them.
Indian women are at high risk for diabetes, hypertension, heart disease, cancer, and stroke. How long women survive with some diseases, such as uterine cancer and breast cancer, is directly related to how early the disease is found. Unfortunately, women are often not diagnosed until a disease has already reached a critical stage. That is why screening is so important.
As far as master health check-ups are concerned, there is an urgent need to get away from the concept of ‘one size fits all’ or in this regard, ‘one package fits all’. Every woman is different and so are her issues. The goal of a health check-up is to obtain the maximum amount of health information with the least number of tests.
Master health checks – the good and the bad
Most hospitals these days have common pre-fixed packages for both men and women. Not only are they exhaustive, their prices differ too. For health check-ups to be meaningful, three very important factors need to be kept in mind:
• The tests should be tailored to the person in terms of age, sex, medical and family history.
• More expensive and larger number of tests are not necessarily better.
• Unnecessary tests may lead to unnecessary interventions.
If none of these factors are considered, there is no purpose to screening or undertaking a master health check-up. Ignorance can be highly misleading or falsely reassuring.
Unless the health check-up includes a complete physical examination where a physician actually examines you, it is an incomplete check-up. In women over 35, a Pap smear and breast examination are an essential part of a health check up.
Body Mass Index (BMI)
Another very important test that should be done for all women across all age groups is to check their height and weight and use those to calculate their BMI. Having a normal BMI is very important for women who are contemplating pregnancy because a high BMI can lead to premature birth, still birth, diabetes in pregnancy and even complications for the baby once it is born. Women with a high BMI also are at risk of developing the metabolic syndrome.
Is there a particular age when women should start having complete health checkups to screen for disease?
It is advisable for women to start screening tests from the age of 35. However, if there is a strong family history of diabetes, high blood pressure or high cholesterol, these tests can be initiated at an earlier age. If a woman is planning on getting pregnant, then it is essential to get a medical check-up done. This is called pre-pregnancy counselling that screens for medical issues which may impact on the pregnancy and the baby. Indians, specifically, have a tendency to have high insulin levels (hyperinsulinemia). The high insulin levels are responsible for converting the food we eat, specifically carbs into layers of fat that get deposited around our waist. This, along with other factors, leads to something known as the metabolic syndrome.
The Metabolic Syndrome
Metabolic syndrome is the combination of diabetes, high blood pressure, high cholesterol, high triglycerides and increased abdominal fat, that lead to health disasters like heart attacks and strokes. Indians are at very high risk for this particular disease.
Between mid-20s to early 30s
This is usually the time a young woman may get married or choose to have a baby. This is a good time to see a physician for a complete physical examination. There are no specific tests that are recommended unless you have a family history of diabetes, high blood pressure or have had a parent dying of an early heart attack or stroke.
Blood test for Anaemia: 70% of Indian women are anaemic. It could be borderline anaemia (10-11 g/dL) where you go through life without any issues or it could be severe anaemia where the haemoglobin levels drop below 8 g/dL. Severe anaemia can be life threatening for the expectant mother and her child. Severe anaemia during childbirth is one of the important causes of women dying in this country. When a woman is between the age group of 25 to 35, ruling out anaemia may be useful.
Tip to prevent anaemia: Parents of adolescent girls are advised to give them an iron supplement. Just giving an iron tablet for 3 months each year is enough to ensure that she has a good store of Iron in her body. There are basically three types of anaemia –, iron deficiency, B12 deficiency and folic acid deficiency. An inexpensive capsule containing iron, B12 and folic acid will ensure that the girl is protected from all three forms of anaemia.
Between 35 and 45
There are five basic blood tests that will screen for the commonest problems. Of these tests, fasting blood sugar and lipid profile are done on an empty stomach.
I. Complete Blood Count (CBC): The CBC test includes haemoglobin count, white blood cells count, and platelet count. It indicates if you have anaemia and what kind.
II. Screening for Diabetes: Fasting blood sugar is done in the morning before breakfast. The last meal should have been at least 10-12 hours prior to the test. This is followed by the 2-hour postprandial blood sugar test. The right way to do this test is to carry breakfast to the clinic, eat it after the fasting blood is drawn and sit there for 2 hours without any physical activity.
III. Thyroid Stimulating Hormone Test (TSH): Women might have abnormal thyroid function without even realising it. Normally, symptoms don’t present themselves early. This test can determine if you have hypothyroidism (low thyroid hormone levels) or hyperthyroidism (high thyroid hormone levels).
IV. Renal Function Tests: Indians are susceptible to infections in their childhood, which might affect their kidneys without them being aware of it. This is why renal function tests are important. Blood urea nitrogen (BUN) and creatinine levels indicate whether the kidneys are functioning normally.
V. Lipid Profile: This test measures blood levels of cholesterol and triglycerides. Cholesterol levels are reported as total cholesterol, high density lipoprotein (HDL) and low density lipoprotein (LDL). The lipid profile is extremely important because abnormal lipid levels are an important part of the metabolic syndrome. The total cholesterol in a woman should be below 180-200mg/dL; HDL (the ‘good’ cholesterol) should be well above 45 mg/dL; LDL should be below 100 mg/dL. High triglyceride levels contribute to heart disease and are a significant factor in Indians. It is considered a ‘rice eaters disease’ because it increases with the consumption of white rice and white sugar.
Screening for cancer
Blood tests apart, there are two more tests that a woman after the age of 35 should definitely undergo.
I. Pap smear: A Pap smear is a simple test where cells from the cervix (mouth of the uterus) are obtained and examined for abnormal changes. Any woman who is sexually active should have this test to screen for cervical cancer. This is one type of cancer that can be identified in the precancerous or very early stages by doing a Pap smear. It is is caused by the human papillomavirus (HPV). Infections with HPV occur with sexual activity but not everyone infected will develop cervical cancer.
II. Breast examination: Every woman undergoing a health check-up after the age of 35 should have a breast examination. It is also important that the doctor teaches you how to perform breast self-examination. This allows you to check your breasts yourself every month and detect any abnormality early.
After 50
In addition to these blood tests and the Pap smear test, a woman after the age of 50 should also have a mammogram done once every two years.
After 60
Tests after the age of 60 should include additional tests for hearing and vision loss, osteoporosis (fragile or brittle bones), mental impairment, depression, and bladder problems.
When should a woman get a mammogram before 50?
A woman with a history of breast cancer or ovarian cancer in her mother, a sister or first degree relative on her mother’s side, should get a mammogram done every year from the age of 40. These basic tests are all that are required for a complete health check-up. Any further tests are dictated by any specific problem that you may have. There is absolutely no reason to choose master health check-up packages like they were holiday packages!