Most Black women only see the doctor when they are sick. Consider the schedule of the average working mother and this is no surprise — -work, cleaning and chores, taking kids to piano lessons, PTA meetings, helping with homework, bandaging boo-boos — there appears to be no time for medical checkups.
Most Black mothers would never dream of skipping a toddler’s medical appointment and wives routinely urge their husbands to go. Unfortunately, African American women too often are guilty of ranking their own health care below that of those they love. Doctors say you do yourself and your family no favors when you fail to make your health care a priority.
How can you fully care for others if you haven’t taken care of yourself first?
Today, there are dozens of useful tests that can reliably detect disorders before they grow into major problems. At each stage of a woman’s life, the kinds of tests needed and the frequency with which they should be administered differ.
The following guide shows what medical experts recommend for Black women:
General physical: Most physicians agree that women age 18 to 34 should get a general physical every one to three years. Older women should check in yearly. You should expect to be asked to provide information about your medical history and that of your family. Often dietary assessments are taken during the initial screening. You may even be asked to complete a questionnaire identifying habits such as whether you exercise, smoke, drink alcohol or use drugs. Beyond that, the examination can vary widely from doctor to doctor.
University of Washington researchers in 1993 sent actresses to 57 doctors for a first visit. Each woman presented herself as a 55-year-old smoker with a family history of breast cancer. The doctors spent from five minutes to an hour with the women and the charges ranged from $24 to $108. Many doctors did not perform a breast examination or speak about nutrition, reported Patricia A. Carney in the Annals of Internal Medicine. “The doctors’ performance was less than we anticipated,” she wrote.
Dr. Deborah Gomez Kwolek, an assistant Professor in Medicine at the University of Kentucky, says for Black women, a general physical should evaluate the following eleven areas:
1. Height – to see if osteoporosis has reduced your stature.
2. Weight – to check for unusual changes.
3. Blood pressure – to screen for hypertension.
4. Neck – to check for thyroid enlargement and check carotid arteries for narrowing.
5. Lungs – check for asthma or pneumonia.
6. Heart – check for murmurs, valve damage or abnormal rate of rhythm.
7. Abdomen – masses or tenderness, liver or spleen enlargement.
8. Breast – mass or discharge.
9. Legs and arms – pulses, swelling.
10. Skin – melanoma or rash.
11. Musculoskeletal – check joints for arthritis and muscle strength.
Missing an occasional appointment won’t cause big problems for women, who are generally healthy. But, those with specific conditions that are being treated and those at risk for health problems, such as smokers and people who are overweight, are advised to make a date and stick with it.
Exams by Age
Gynecological exam. If you are 18 to 49, you should get a pelvic exam and Pap smear every year, doctors say. “After three consecutive normal tests, the Pap smear can be performed every one to three years based on age, risk factors and the doctor’s discretion,” according to the University of Pennsylvania Health System’s brochure, “For Women Only.” If you are older than 50, rely on your doctor’s instructions.
Pap smears, named for Dr. George Papanicolaou, the doctor who developed the test in the 1940s, are the most common part of the pelvic exam. They can detect abnormalities before they develop into cancer. Since they came into use after World War II, the tests have reduced cervical cancer deaths in the U.S. by 70 percent, making them the most effective cancer-screening tool known to medicine. It can also diagnose cancer of the vagina, ovary, or endometrium (lining of the uterus), although it is not altogether accurate in this regard.
“Women should begin to have their Pap smears by age 18, or sooner if they become sexually active before then,” says Maria Mauldon, program instructor at the Yale University School of Nursing. “Women who have never had sexual intercourse are not at risk for cervical cancer.”
A Gallup poll showed that nine out of 10 women know they should have an annual Pap smear, but last year nearly 40 percent of women did not get one.
Pelvic exams are done as a screening test for cervical dysplasia, a condition that produces abnormal cells that may progress into cancer. A speculum is inserted into the vagina and holds the canal open so the cervix can be visualized. Cells are taken from the cervix and sent off for laboratory analysis. The doctor then removes the speculum and inserts two fingers into the vagina so the size of the uterus and ovaries can be evaluated.
“In order for a patient to have a comfortable pelvic exam, three items are necessary,” says Dr. Martin E. Olsen, chairman of the Department of Obstetrics and Gynecology at the James H. Quillen College of Medicine in Johnson City, Tenn. “A competent physician, the proper size speculum and a patient who is able to cooperate. Some patients are so fearful or have had such bad experiences in the past that they are unable to cooperate. It is very important to have a sensitive physician. A sensitive physician will explain the examination to the patient prior to the exam and answer any questions.”
If you are 18 to 34, your pelvic exam should include a manual rectal exam as well. At age 35 to 49, the exam should include a screening for colorectal cancer. A sigmoidoscopy — an internal examination of the rectum, colon, and sigmoid flexure with an illuminated, tubular instrument — is suggested after age 50. The test does not look for cancer but for growths called polyps. Usually, polyps are benign but they can become cancerous over time. Stool samples are usually requested at this age, too, so they can be checked for blood. Polyps often bleed.
Breasts. Every woman, regardless of her age, should examine her breasts monthly, two to three days after her menstrual cycle ends. You should inspect your bare breasts in front of a mirror. Start with arms at your sides, and then raise them. Look for dimpling or asymmetry. Using the opposite hand, cross over your chest and use firm pressure to detect masses — they form in all parts of your breasts. Ideally, you should lie down, and place one hand under your head. Inspect the nipple and underarm too. “Any mass felt should be brought to the attention of your physician,” says Kwolek, a staff physician at the University of Kentucky Medical Center and VA Medical Center in Lexington. “Many women will feel lumps which are normal fibro-cystic tissue. It’s best, though that she still discuss these with her doctor.”
A doctor should examine the breasts every one to three years for women age 18 to 34. After age 40, a doctor should examine the breasts every year. Women age 40 to 49 should have a mammogram (a x-ray of the breast) every one to two years — the American Cancer Society says yearly; the National Cancer Institute says every other year. However, most experts agree that those older than 50 should have a mammogram annually.
As a Black woman ages, her risk of developing breast cancer increases dramatically. According to National Cancer Institute statistics, the risk of a 25-year-old woman developing breast cancer is one in 19,608. By age 40, her risk increases to one in 217, and by age 45, to one in 93. “Women find more breast cancer than physicians do,” Olsen says. Mammography can detect tumors that are very small and cannot be felt by the fingers. It can significantly improve breast cancer survival for women over 50, reducing deaths by a third.
Cholesterol. Blood screenings to test for cholesterol levels should be done every five years for women up to age 49 and every three to five years for women 50 and older. The serum lipid profile refers to a blood test for total cholesterol, Mauldon says. This includes both the HDL and LDL types, and triglycerides. A high cholesterol count is associated with atherosclerosis — the development of fatty residue, or plaques, inside the arteries. This puts women at risk for developing heart attacks or stroke. Your count should register below 200.
Heart disease, statistically, is the most sinister health risk to Black women. One in three women will die from it. In fact, heart disease kills more than 500,000 women each year — more than all cancers combined. However, heart disease can be prevented and cholesterol levels can be lowered. A low-fat diet, exercise, adequate sleep, abstinence from smoking and, according to some doctors, taking an aspirin a day, can help.
Dietary recommendations vary, but generally, doctors recommend a diet with no more than 30 percent of calories coming from fat. That can be accomplished by focusing more on fruits, vegetables, and high-fiber grains. Vegetables rich in phytochemicals such as sweet potatoes, red bell peppers, carrots, broccoli, spinach, cauliflower, cantaloupe, red grapefruit, oranges, red grapes and strawberries are particularly beneficial.
As for exercise, a Surgeon General’s report found that doing a moderate amount, for thirty minutes a day, walking, swimming, bike riding, for instance — can help unclog arteries and lengthen your life.
Eyes and ears. Eye and ear exams can be done as part of a general physical, but you may have to ask your doctor to do them. As women get older, the need for these tests increases. Hearing should be screened periodically after age 65. Vision should be checked every two to four years in women age 35 to 65 and every one to two years after age 65, the University of Pennsylvania Health System says. Eye diseases such as glaucoma, cataracts, and macular degeneration typically start after 40. Get to a doctor right away if you have eye pain, discharge, or persistent redness, and immediately check out visual problems such as blurring, double vision or flashing lights.
Skin. Skin cancer checkups are important, too. You should have a thorough inspection by a dermatologist in your twenties, Dr. Lynn Drake, president of the American Academy of Dermatology, says. After that, visit yearly if you have a personal or family history of skin cancer, if you have many moles, or if you’re in your thirties or forties and have a history of frequent burning or tanning. Go every six months if you have a minor chronic condition such as psoriasis that already has been diagnosed. Otherwise, become familiar with your moles and birthmarks. Check them routinely in a full-length mirror — front and back — for changes in size, shape, and color. Mention any changes to your doctor, and have him or her look during your general physical.
Bones. Bone density scans usually are not required until the onset of menopause. Sometime in their 40s, many women experience bone loss as a result of their past lack of calcium consumption and exercise, as well as their, smoking habits, caffeine intake and use of certain medications. Women need 1,000 to 1,500 mg of calcium each day to avoid bone loss. Exercise, including strength training with weights, can help, too.
Aside from scheduling recommended medical examinations, you can take responsibility for your health in other practical ways. Practice safe sex. Limit your sun exposure. Keep up to date on immunizations. Wear a seat belt. Learn about your family’s medical history. Stay aware of the signs and symptoms of major diseases.
Mauldon recommends that women keep track of the types and results of tests their clinician has done. Keeping a record of your blood pressure readings, immunizations, and lab results is not out of order, nor is maintaining a list of your medications and allergies.
“The best health care ‘consumer’ is an informed and proactive one,” she says.
Here’s to your health.
This article was contributed by Sherri M. Owens.
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