Mammograms and Pap Screenings
The federally sanctioned U.S. Preventive Services Task Force recently issued new findings about women’s health. The panel of experts recommended that women begin routine screening mammograms at age 50. This differs from long-established guidelines advising women at low risk for breast cancer to begin screening at 40, and continue them annually. That’s still the recommendation of the American Congress of Obstetricians and Gynecologists. And, more recently, the American Cancer Society changed its recommendation to age 45.
Mary Melancon, MD, an obstetrician/gynecologist, says patients often ask what they should do. “We are happy they are reaching out,” Dr. Melancon said. “Every woman’s situation is different, and your health provider is your best resource.”
Dr. Melancon notes that the major advisory groups, including the American Cancer Society, agree that women with low risk factors for cervical cancer need a Pap screening every three years from ages 21-29, and every five years for ages 30-65, including a screening for human papillomavirus, or HPV. Women are at high risk for cervical cancer if they have a weakened immune system, are HIV positive, or have a previous history of cervical cancer or pre-cancer.
However, Dr. Melancon emphasizes, even if testing isn’t recommended yearly, it’s still important for women to receive regular gynecological checkups. “We urge women to maintain a relationship with their providers, even after menopause,” she says. “It’s vital to check in, remain current with health screenings and discuss any changes or concerns.”
Blood Sugar Targets for Diabetes Patients
In April, the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) released new guidelines for patients with diabetes, including a lower target for HbA1c test results. (The HbA1c reflects a person’s average blood sugar reading over three months.) The AACE and ACE guidelines recommend an HbA1c of 6.5 or lower. The American Diabetes Association’s target remains 7.0.
“People might have been confused by these different target numbers, but overall, the recommendations have more commonalities than differences,” says endocrinologist Meeta Sharma, MD. The difference between the two recommendations “is actually very small,” Dr. Sharma says. “And all of the organizations stress the need to control glucose levels safely.”
“Glycemic target is affected by a number of factors—how long someone has had diabetes, their age and other health conditions,” Dr. Sharma says. An elderly person with cardiovascular issues may be at greater risk for hypoglycemia (dangerously low blood sugar), and the consequences of keeping tighter control may outweigh the benefits.
“There is never one recommendation or solution that works for all,” says Dr. Sharma.
Taking prescribed medications correctly is vital. When those with cardiovascular conditions, for instance, don’t follow their medication regimes, the consequences can be catastrophic, says Lowell Satler, MD, an interventional cardiologist and medical director of the Cardiac Catheterization Lab.
“Taking drugs incorrectly is a major cause of hospital admission and re-admission,” Dr. Satler says.
Patients with new diagnoses may feel overwhelmed and unaware of medication’s importance in their treatment, he says. One recent study found that more than 25 percent of cardiac patients had not filled their prescriptions a week after their hospital discharge.
Fortunately, MedStar has systems to help patients, including texts and e-newsletters as reminders. Also, Dr. Satler says, “we have the Med-to-Bed program, where a pharmacist sends patients home from the hospital with a 30-day supply of their prescriptions, and our nurses do check-in calls to answer patients’ questions and make sure they understand how to take their medications correctly.”
Dr. Satler is also helping develop an educational video on medication adherence that features a cardiac patient who didn’t comply, and suffered a heart attack.
New Blood Pressure Recommendations
With studies producing different results, “this can be a confusing time for patients,” says Allen J. Taylor, MD, chief of Cardiology at MedStar Washington Hospital Center and MedStar Georgetown University Hospital.
He noted findings from the study of Systolic Blood Pressure Intervention Trial (SPRINT), sponsored by the National Institutes of Health and the National Heart, Lung and Blood Institute. Preliminary SPRINT results indicate that maintaining a systolic blood pressure
of 120 mm Hg — versus a higher target of 140 mm Hg — greatly reduces the chances of cardiovascular complications, such as stroke and heart attack, in adults 50 and older.
(The systolic, or top, number measures pressure when the heart contracts. The current recommended ceiling is 140 mm Hg for most adults, and 150 mm Hg for ages 60 and older.)
Although this new information sounds initially compelling, Dr. Taylor cautions, it’s difficult to determine how much it may change patient care.
“First, we don’t have complete study results,” he says. “When we know the extent of benefits, medications used and any risks of the more intensive treatment, we can better determine how to apply the findings to patient care.”
“Your particular circumstances are always the most important thing to consider in setting healthcare goals,” Dr. Taylor says.
In some ways, it’s never been easier to live a healthy, vibrant life. We have 24/7 access to the latest health recommendations about wellness, preventive testing and treatments for challenging conditions. But sometimes it’s overwhelming to have so much new, and sometimes contradictory, information from healthcare organizations. Which recommendations should you and your loved ones follow?
Fortunately, our MedStar physicians can help. Here, they share their expertise on recent findings about diabetes, hypertension, gynecological health and medication adherence. The common thread: while recommendations are important, no two people are the same, and it’s best to seek advice from your provider before making major healthcare decisions.