With one in five Aussie women revealing there are issues they avoid discussing with their doctor, it's clear we need to start prioritising those health checks we've been putting off. Dr Jill Forer explains which tests women avoid and why it's vital we don't let ourselves lapse when it comes to looking after our health.
Whether we're embarrassed, time-poor or can't afford a visit to the doctor, there's always a reason to put off a cervical screening or skin cancer check.
The Jean Hailes 2018 Women's Health Survey reveals only 23 per cent of women first seek information from a doctor or nurse when they have a health concern, with most of us turning to Dr Google in the first instance. Moreover, about half of us (45.2 per cent) don't feel totally confident asking our doctor questions and discussing health issues that concern us.
But with our wellbeing and loved ones standing to lose the most from this lack of self-care, procrastinating important check-ups with the doctor means we're failing to safeguard ourselves from future health problems, even if we had a clean bill of health the last time we checked.
To mark Women's Health Week, Dr Jill Forer, a women’s health GP at Bondi Road Women's Health and board member for charity Twice the Doctor, is urging us to book in with our doctor and look after number one – doctor's orders.
Why is it important? This check is important to detect abnormalities before they become serious and are still treatable. If we find the beginnings of something like cancer we can treat it, but if it’s at a later stage it’s a lot harder.
Why do women put it off? Women put this test off because it’s highly-invasive and they feel embarrassed, scared of the pain or results or they have a poor relationship with their bodies.
If anyone’s hesitant to get this test, I advise them to go to a female doctor who they feel comfortable talking to. It’s not a painful procedure and it doesn’t need to be a big deal if you find the right doctor.
How do women get tested? A doctor will gently insert a speculum into the vagina and take a cervical brush, which looks like a mascara brush, to sweep the inside and outside of the cervix.
If a patient's really reluctant to see a doctor to get this screening, they can ask to do the swab themselves, either in the privacy of the doctor’s bathroom or at home.
A cervical screening checks the cervical fluid for the human papillomavirus virus (HPV) only, as 99 per cent of women with HPV also have an abnormal cervix.
How often should women get tested? If there’s no sign of HPV you’ll receive a letter to confirm you’re at low risk and you should get your next screening in five years.
If a virus particle is found or you’re at high risk of cervical cancer (such as if you have a family history of cervical cancer), the pathologist will examine the cells for abnormalities and your doctor should give you a referral for a colposcopy to examine your cervix. If the results of the colposcopy are normal, you should get your next screening in one to two years’ time.
While the old pap smear required anyone who had been sexually active for two years to get tested, women should now get their first cervical screening at 25.
Breast cancer check
Why is it important? All patients need a breast examination to screen for breast cancer and to learn how to check their breasts themselves.
Why do women put it off? Again, many women find this screening embarrassing, so it’s important to have a good relationship with your doctor.
How do women get tested? Women should visit their GP for the screening. The doctor will examine each breast, including the nipple, areola and armpits, using their hands.
I also teach patients how to check their breasts as I do the examination. They should start on their nipple and areola and then work their way around like a snail, going all the way around and finishing in the armpits. Do this once in the shower and repeat lying down.
For women 40 or older, I also recommend diagnostic screening, which includes a mammogram and ultrasound to avoid anything being missed.
There are many variations in what's 'normal' in each woman and for many women, lumps and bumps are nothing to be concerned about, but if we find anything unusual – a lump, bump, discharge or pain – there needs to be further investigation.
If we can feel something in a woman's breast but it doesn’t come up on the mammogram, or vice versa, I always suggest getting a second opinion from a specialist.
How often should women get tested? Women should check their breasts themselves after each period when their breasts are most quiet. I encourage women to get to know the architecture of their breasts and have a good relationship with them, so you’re not scared to touch them.
From age 40, women should get a diagnostic screening every two years, provided everything’s normal. If it’s not, your doctor will advise when to make your next appointment.
Although the cervical screening is now every five years instead of two, I implore patients to have their breasts checked at least every two years by their GP (in addition to doing it at home), because five years is too long between breast exams.
Skin cancer check
Why is it important? Living in a sunny country like Australia, the risk of melanoma is high, so women should get tested regularly for melanoma and skin cancers. If caught early, melanoma is curable, so skin cancer checks are not worth putting off.
Why do women put it off? Because they don’t want to take their clothes off or pay the money. If a patient is in financial difficulty and I’m concerned they need further investigation, I'll get them bulk-billed, but if they aren't able to get a bulk-billeing, Medicare can reimburse patients a percentage of the fee.
How do women get tested? Women can visit a skin clinic, dermatologist or a GP who is skin-health trained to get checked. Their regular GP can also have a look during their next general check-up, but it’s best to go to a doctor who knows and understands skin.
A patient will (or should) be examined everywhere: Under their bra, on their buttocks, scalp and between fingers and toes. I even check the vulva for skin lesions and moles when I’m doing a cervical screening because melanomas can appear on parts of the body that have never been exposed to the sun.
I encourage my female patients to see a female doctor or dermatologist because they’re likely to feel more comfortable being examined by a female.
How often should women get tested? One to two years is fine unless they’ve had skin cancers before or are at high-risk. If a patient is very fair with blonde hair and blue eyes, for example, I would send them to a dermatologist to get tested as they're automatically at a higher risk.
Why is it important? It’s important to get this test to catch bowel cancer early before it spreads to other parts of the body. It’s a very curable cancer.
Why do women put it off? This health check is the most avoided at all! I think it’s pretty obvious why people don't like it, but many patients find this screening invasive and unpleasant.
How do women get tested? When someone turns 50, the Australian government kindly mails them an at-home bowel screening test, which tests for blood in their stool. They can do this test at home by placing small samples of toilet water or stool on a special card and mailing them to a pathology laboratory for analysis.
While the accessibility of this test is amazing, it can’t diagnose cancer, so if there’s blood in stool we’d send the patient for a colonoscopy or endoscopy to investigate further.
Colonoscopies and endoscopies are quite expensive procedures involving a lot of preparation by the patient, but they’re extremely effective at detecting any early stages of bowel cancer.
How often should women get tested? These at-home tests should start aged 50, unless there’s another indication of bowel cancer, like blood in their stool, persistent bloating or recurring diarrhoea.
If there’s no blood found in their test and they have no symptoms of bowel cancer, they won’t need another test for two years.
If they have a relative diagnosed with bowel cancer at age 55 years or older, screening should be considered every two years from age 45.
Oral health screening
Why is it important? Although I’m not a dentist, oral health is an imperative part of general health. I’m a great believer in the gut microbiome – we are what we eat and we put the environment in our mouth.
Gum disease is linked to diabetes, which controls the gut microbiome and mental health. HPV can also be found in the mouth, which leads to cancer.
Why do women put it off? Dentists are expensive in Australia and we tend to only go in emergency situations. If a patient doesn't have private healthcare, they can book into the dental hospital, which is free but it might take a while to get an appointment.
Many people are also scared of the pain of seeing a dentist and end up going for a long time between appointments.
How do women get tested? When visiting the dentist, they should check our mouths for spots, tumours, ulcers, lesions and gum disease.
We can also look after our oral health by eating well, flossing regularly and taking care of our mouths.
If someone is nervous about visiting the dentist, finding a dentist you like will make the appointment much more pleasant.
How often should women get tested? Definitely every year.