Dr Lim Jye Wey, Primary Care Doctor

1 March, 2024

Strategies for Women's Well-being

Women’s health involves a range of factors, including biology, society, and the environment. Among various health concerns, breast cancer is a significant issue, making up a substantial portion of women’s cancer cases. In Malaysia, breast cancer rates have increased, highlighting the need for proactive screening and prevention. Besides breast cancer, cervical cancer, cardiovascular diseases, and osteoporosis are also crucial aspects of women’s health, requiring targeted screening and attention at different life stages. This comprehensive approach aims to empower women with knowledge and guide them in making informed decisions for their well-being.

Among women, breast cancer takes the lead as the most significant form of cancer. The incidence of new cases of breast cancer in Malaysia rose by 2%, climbing from 32.1% from 2012 to 2016 to 34.1% in the years 2007-2011, contributing to an overall increase in cancer cases among women.

How do you screen for breast cancer?

For the general population (women with average risk):

• 40-49 years: Consider annual mammography after discussing benefits, harms, preferences, and risk profile
• 50-74 years: Perform biennial screening mammography
• 70-74 years: Continue screening if healthy, expected to live 10+ years, and without severe co-morbid conditions

For women at moderate risk:

  • 40-49 years: Conduct annual screening mammography
  • 50-59 years: Screen annually or biennially
  • 60 years onwards: Screen biennially or every 3 years

For women at high risk without identified genetic variants:

  • 30-39 years: Consider screening mammography
  • 40-59 years: Perform annual mammography
  • 60 years onwards: Conduct biennial mammography

For carriers of pathogenic variants in BRCA1, BRCA2, and PALB2:

  • • 30-49 years: Offer annual magnetic resonance imaging
    • 40-69 years: Perform annual mammography
    • 70 years onwards: Conduct biennial mammography

Women with a sexual history should initiate cervical cancer screening at 21 years old. The following are the updated Cervical Cancer Screening Guidelines:

Ages 21-29: Pap smear is recommended

  • If the results are normal, repeat the test every 3 years.

Ages 30-65: Three screening options:

  • HPV test only
  • If results are normal, repeat every 5 years.
  • HPV + Pap smear.
  • If both results are normal, repeat every 5 years
  • Pap smear only
  • If normal, repeat every 3 years

65 years old onwards: can continue cervical cancer screening as those age 30 to 65 years old.

However, the woman does not need cervical cancer screening if –

  1. At least three Pap smear or two HPV tests in the past 10 years, with all the test results normal or negative, and
  2. No cervical precancerous condition in the past, or
  3. Have had cervix removed as part of a total hysterectomy for non-cancerous conditions, like fibroids.

Women's Health: Cardiovascular Diseases

When a woman enters menopause, her risk of cardiovascular diseases increases. Therefore, healthcare providers should actively conduct screenings for fasting lipid profiles, blood sugar levels, as well as assess blood pressure, body weight, and waist circumference to detect meta-bolic syndrome—a condition that can contribute to cardiovascular diseases like heart disease and stroke. Additional screening tests, such as the coronary artery calcium score (CT scan of the heart) and carotid intima-media thickness test (CIMT), prove valuable in identifying wheth-er an individual is at a high risk for cardiovascular diseases.

Women's Health: Bone Health

women's health

Postmenopausal women experience bone loss, leading to the development of osteoporosis—a condition that can result in bone fractures even with low-energy injuries. Osteoporosis affects nearly 20% (1 in 5) of women aged 50 and over. For women aged 65 or older, as well as those between 50 and 64 years old with specific risk factors for osteoporosis, a DEXA scan (bone density scan) is recommended to actively screen for osteoporosis.