women's health case

Question 1

age range for women to begin menopause

Answer 1

44-56; avg is 50.7

-late menopause assoc w/ prolonged estrogen exposure and inc. risk cancer

Question 2

benefits of HRT

Answer 2

-relief of vasomotor Sx, prevention of osteoporosis, prevention of vaginal and urothelial atrophy, prevention of CAD (if begun before CAD), prevention of colon Ca/dementia

Question 3

risk of HRT

Answer 3

-vaginal bleeding, endometrial hyperplasia & carcinoma, venous thrombosis, breast cancer, CAD (if begun after CAD established)

Question 4

evidence for and against HRT

Answer 4

• WHI study – “the lowest effective dose for the shortest necessary time”
• decrease risk of CAD by 50%
• no protective effect if CAD already exists

Question 5

how common is ovarian cancer and what is the mortality rate?

Answer 5

• 28,000/year
• 5-yr survival ~40%
• highest mortality of gynecological Ca, 5th leading cause of Ca death in women

Question 6

screening methods of ovarian cancer

Answer 6

• transvaginal US
• serum tumor marker CA-125
• bimanual pelvic exam

Question 7

USPTF recommendations for ovarian cancer

Answer 7

-no screening due to high FP rate

Question 8

how common is breast cancer

Answer 8

-1 in 8 women (12%) will get BrCa; 2nd most common cancer of women

Question 9

what are the risk factors for breast cancer?

Answer 9

-age, Fam Hx, genetics, person Hx of BrCa, race, Rx to chest, smoking, alcohol, obesity

Question 10

results of 3 decades of screening mammography for breast cancer

Answer 10

• the amount of early stage breast cancer detection has doubled
• Presentation w/late stage breast cancer has decreased by 8%.
• Screening mammography has dec. the amount of women presenting with advanced BrCa only very slightly and has had minimal effects on the rate of death due to BrCa.

Question 11

USPTF recommendations for breast cancer screening

Answer 11

• biennial screening mammography for women aged 50-74 yrs
• does not recommend routine screening in women 40-49
• recommends against breast self-exam – increases risk of FP
• insufficient evidence for clinical breast exam

Question 12

If you screen for breast cancer, which method should you use?

Answer 12

mammogram

Question 13

in addition to breast cancer, what other cancers should you screen for in women?

Answer 13

cervical, colon

Question 14

how many women and men experience intimate partner violence

Answer 14

• 35% of women in US experience some form of this in lifetime; 6% a year
• 28% of men experience this, 5% a year