Regular tests vital in monitoring health

Press, 28 November 1988, Page 30

Regular tests vital in monitoring health

Family Doctor

We are well past the stage of suggesting that taking certain preventive measures simply seems like a good idea for women. We now have incontrovertible proof that having a smear test every three years saves lives, as do two-yearly mammography past 50, having a blood pressure check every two years, and having a tetanus shot every 20. Some preventive procedures are still at the “good idea” stage, certainly — breast selfexamination, doctor examination of the breasts, blood cholesterol testing, bone-density measurement at the menopause, to name a few. And there are many other health issues either specifically women’s or regarded as such — fertility and its control, menstruation and menopausal problems. How should we address the problem of making at least the proven tests available to all women? Australia has set up State-funded women’s health clinics; here some have advocated expansion of family planning clinics, suitcase clinics in the workplace, caravan clinics in the street, portable mammography machines like the old chest X-ray vans in the days of tuberculosis. Others see the family doctor service as the appropriate place for these activities to be organised. Will simply offering choice and leaving it up to women to avail themselves of these services be enough? Many would think not — with cervical smears we know that often those most at risk are the very ones we miss out because they do not ask. We do know that a reminder from the family doctor

will often spur a person to accept a test when otherwise they might not ask, but this is a delicate matter, seen as paternalistic or intrusive by some women. A paper in the “British Medical Journal” (1988, 297:271) by Hill and others, has reviewed the evidence for the efficacy of breast self-examina-tion. They looked at 12 studies involving a total of 8118 women with breast cancer. These studies had related the practice of breast self-examination to the size of the tumour and to the presence of spread to local lymph nodes. In 39 per cent of the women who had done breast self-examination the tumour had spread to local nodes, and this was compared with 50 per cent in women who had not regularly examined their breasts. Fifty-six per cent of women who practised breast selfexamination had a tumour of more than 2cm diameter, and this was compared with 66 per cent of women who had not. “These findings appear,” wrote the authors, “to be good evidence of

the benefit of encouraging women to practise selfexamination of the breasts regularly.” Not so, wrote a correspondent several issues of the “British Medical Journal” later: the statistical method used by Hill and others could not show real benefit. What are women to do, and how are their family doctors to advise them when there is conflicting opinion like this? The best advice can only be to continue to examine breasts regularly after each period: we cannot be yet sure that it will be helpful, but it certainly can do no harm. Regular mammography, at least for women aged over 50, and for those with a first degree relative with breast cancer, and those who have had breast cancer, and for those who have had surgery for a benign breast lump, certainly seems to be the preventive procedure of choice for this disease. A recent paper in “Ca,” a cancer journal for clinicians on the emotional assault of breast cancer, gives us some idea of the enormity of having the condition, “It is an outrage to have one’s breast turn cancerous. The change in breast tissue from life-giving to life-threatening is a betrayal, a form of somatic treason.”