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APGO educational topic number seven
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preventive care and health means
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obstetrician/gynecologist develop
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substantial relationships with their
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patients through the lifespan often
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taking care of women through their
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pregnancy or pregnancies and with
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gynecologic issues throughout their
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reproductive years and beyond the annual
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health maintenance visit provides a
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great opportunity to counsel patients
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about maintaining a healthy lifestyle
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and minimizing health risks the
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objectives of this video are to be able
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to counsel patients regarding the
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following and suggest appropriate
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referrals if necessary contraception
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intimate partner violence prevention of
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sexually transmitted infections
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immunizations diet and nutrition
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exercise seatbelt use stress management
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sun exposure depression tobacco use and
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alcohol substance use to explain
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prevention guidelines including
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screening procedures for diseases of the
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following organ systems breast cervix
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colon cardiovascular skin and bone and
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to identify risk factors in a patient’s
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personal and family history for diseases
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of the following organ systems breast
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cervix colon cardiovascular skin and
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bone there are many important aspects of
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maintaining a healthy lifestyle that are
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important to emphasize at an annual
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health maintenance visit diet and
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nutrition exercise seatbelt use sun
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exposure alcohol and substance use
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tobacco and depression as women’s health
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providers we also need to think about
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contraception for any sexually active
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women of reproductive age as well as
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screening for sexually transmitted
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infections all healthcare providers need
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to also be more cognizant and deliberate
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and screening for intimate partner
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violence many of our reproductive age
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patients primarily see their
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gynecologist and develop substantive
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bonds with their providers the
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obstetrician gynecologist can help
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provide resources such as nutritionists
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for obesity and diet counseling and
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social workers and support networks for
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women at high risk environments we will
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discuss risk factors and prevention
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guidelines in this video for the
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following organ systems breast cervix
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colon
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cardiovascular skin and bone breast
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cancer is the second most common
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malignancy and women and the second most
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common cause of
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two related death and women age is the
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most significant risk factor at the age
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of 20 a woman’s risk of breast cancer is
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one out of 17 60 at age 38 is one out of
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two 29 at 40 it’s 169 at 50 it’s one out
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of 42 at sixty it’s one out of 29 and at
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70 it’s one out of 27 a woman’s lifetime
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risk of developing breast cancer is one
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out of eight the second risk factor is
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family history and genetics having a
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first-degree relative with breast cancer
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puts a woman at higher risk as well as
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being a carrier for brca1 or 2
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components of the reproductive and
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menstrual history can also be risk
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factors including early menarchy before
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age 12 late menopause after 55 delayed
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childbearing her first child after 30
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and Nullah parity radiation exposure is
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an additional risk factor women who
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received significant radiation for
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Hodgkin’s disease or an enlarged thymus
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gland are at increased risk of
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developing breast cancer and women with
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dense breasts also are an increased risk
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of developing breast cancer for breast
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cancer prevention guidelines the
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American College of Obstetricians and
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Gynecologists recommend starting
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mammograms at age 40 and continuing to
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have them annually the American Cancer
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Society has the same recommendations of
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age 40 and annually the National Cancer
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Institute recommends starting at age 40
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and having mammograms performed every
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one to two years the US Preventive
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Services Task Force recommends biannual
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mammograms starting at age 50 through
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age 74 women should be informed of the
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benefits of mammography and the risks of
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additional imaging or biopsies that may
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be recommended based on screening
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results we will now discuss colorectal
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cancer it is the third leading cause of
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cancer death in women it is diagnosed
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more in women than any individual
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gynecologic cancer screening tests are
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underused in many segments of the
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population risk factors include
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inflammatory bowel diseases such as
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Crohn’s disease or ulcerative colitis
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family history of colorectal cancer or
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colorectal polyps genetic syndromes such
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as familial adenomatous polyposis or
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hereditary nonpolyposis colorectal
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cancer other risk factors include
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lifestyle factors such as lack of
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regular physical activity low fruit and
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vege too
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intake low-fiber high-fat diet
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overweight and obesity alcohol
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consumption and tobacco use ACOG
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recommends colorectal cancer screening
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for average age risk women beginning at
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age 50 and for African American women
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beginning at age 45 and recommends
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colonoscopy every 10 years as the most
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effective screening modality moving now
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in a cervical cancer the incidence of
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cervical cancer has decreased more than
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50 percent in the past 30 years because
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of widespread screening it continues to
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be more common worldwide particularly in
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countries without screening programs
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we’ll begin by discussing cervical
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cancer risk factors most cervical cancer
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occurs in women who were either never
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screened or were inadequately screened
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50% of women diagnosed with cervical
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cancer have never had cervical cytology
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testing an additional 10% of women had
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not been screed within 10 years of
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diagnosis other risk factors for
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cervical cancer include
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immunosuppression there is a higher
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incidence of HPV infection and
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progression in HIV organ transplant and
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other immunosuppressed women smoking and
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early cor turkey the screening
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guidelines are that Pap test should
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begin at age 21 and from age 21 to 30
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cytology alone should be performed every
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three years and from age 30 to 65
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cytology plus HPV every five years is
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the preferred screening screening can
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stop after the age of 65 if she has not
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had any high-grade dysplasia for 20
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years and the HPV vaccine should be
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given if females from age 9 to 26 moving
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now to bone health
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osteoporosis has a 5 times greater
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prevalence in women than in men and
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women’s sustained 80% of hip fractures
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in the United States hip fractures are a
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significant source of morbidity and
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mortality of women older than 80 years
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old with a hip fracture only 56% could
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walk independently after one year and
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approximately 3 to 6 / 7 a woman died of
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complications while hospitalized for a
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hip fracture 4 risk factors for
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osteoporosis Caucasian women have the
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highest rates of hip fracture and
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african-american women have the lowest
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rates increasing age and low body weight
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personal history of fracture family
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history of osteoporosis
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alcohol and tobacco use for prevention
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it is important to address bone health
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in all age groups including puberty and
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adolescence poor nutrition including
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anorexia nervosa inactive lifestyle and
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smoking may prevent girls from reaching
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their peak bone mass screening for
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osteoporosis is with a DEXA scan of the
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lumbar spine and hip it should begin at
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age 65 DEXA scans can be selectively
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used for women less than 65 if they have
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a medical history of aphrodite fracture
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if they weigh less than 127 pounds
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they’ve a medical cause of bone loss of
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parental history of a hip fracture if
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they are a current smoker if there is
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alcoholism or if they have rheumatoid
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arthritis osteoporosis is diagnosed by
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the t-score which is the number of
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standard deviations above or below the
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mean average bone density of young adult
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women a normal T score is greater than
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or equal to minus one low bone mass or
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osteopenia is between minus 1 and minus
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2.5 and osteoporosis is when it’s less
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than minus 2.5 let’s switch gears now
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and discuss skin cancer the incidence of
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melanoma is increasing faster than any
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other potentially preventable cancer in
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the United States risk factors are
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familial having a typical Niva having a
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high nevis count sun or UV exposure and
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phenotypic traits of light skin
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pigmentation having a red or blond hair
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color high density freckling and a light
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eye color
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when performing a skin examination of a
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lesion look at the a for asymmetry B for
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border irregularities C for color
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variation D for a diameter greater than
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six millimeters and E for enlargement or
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evolution of color change shape or
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symptoms our final topic is coronary
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heart disease one out of five Americans
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have a high total cholesterol level
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abnormal cholesterol levels have been
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found to be associated with
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atherosclerosis and cardiovascular
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disease cholesterol levels that are
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checked are low-density lipoproteins or
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LDL high density lipoproteins or HDL
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triglycerides and total cholesterol
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levels dis lipedema is diagnosed if
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there is a high LDL triglyceride or
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total cholesterol level or a low HDL
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level initial screening for women should
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begin at age 45 and occur every five
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years unless she has risk factors for
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cardio
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vascular disease and these risk factors
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include family history of familial
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hyperlipidemia family history of
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premature cardiovascular disease less
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than 54 men and less than 64 women
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personal or family history of peripheral
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vascular disease obesity diabetes
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mellitus or multiple cardiovascular risk
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factors for example tobacco use and
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hypertension the US Preventive Services
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Task Force recommends starting
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cholesterol screening at age 45 for
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women who are at increased risk for
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coronary heart disease this concludes
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the aapko video on preventive care and
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health maintenance we have discussed the
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importance of the health maintenance
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visit as well as talked about prevention
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guidelines and identified risk factors
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for breast cervix colon cardiovascular
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skin and bone disorders