Health check for women in the NHS

  • I will describe here what gynecological screening is done in andalucía, other autonomous communities might do something different, but usually the differences are minimal. When in doubt check at your healthcare centre.

    There is always a protocol published by the sanitary institutions of the community, so what/when to do things is never the decision of a lone doctor. If you have doubts or concerns, ask for the protocol, they should have it there in the computer system, if not, let us know and I’ll try to find it for you. 

    Smears (citologia cervical) It is done by either family doctors (gp) or nurses trained for that

    First patients are divided in two risks groups to know when they should have the smear:

    * high risk group: annual smear

    • start of sexual relations before 18 yo
    • has HPV (human papiloma virus)
    • has/had multiple sexual partners or partner has had multiple sexual partners (risk of contagion)
    • has/had cervix dysplasia (in this case you would be in the follow up anyway)

    *low risk group: those not i the above group:

    • first, annual smear, after 2 normal smears continue every 3 years.
    • over 65: after 2 annual smears: stop

    Mammograms: There is a huge controversy about this, experts are fighting all over the world, but they have moved along the debate. I think it has been clearly established that mammograms are useful for breast cancer screening , now they are debating when to start & finish…

    The junta de andalucia gives mammograms for women from age 50 to 69 to women with no symptoms, family history of cancer, or personal factors that could increase the risk. 

    BUT! Check in your healthcare centre as MANY change this protocol and start before & continue after I do not agree with stopping at 69, that is young nowadays, with easily 20 years to live and capable of having treatment for breast cancer. It’s not only here; in the UK it’s also from 50, to 70.

    I do not believe in chronological age, I have treated people with lymphoma with 75 yo, with chemotherapy, and that is more aggressive than surgery or the chemo for breast cancer. I rely (not only me, of course, I wish it had been my idea…) on biological age.

    Some societies (like the American cancer society) start at 40 and do not stop unless the patient is not fit for treatment, I see this as reasonable.

    In Spain after you turn 50, you should receive a letter to do the mammogram, if you don’t, go to your healthcare centre.

    So, in concussion: mammograms: 50 to 69. 

    If before that you have any of this you should go to your gp for an examination:

    • family history (mother or sisters)
    • personal risk factors:
    • Early start of menstruation ( I have no idea what is “early” for them)
    • late menopause (again, the same “late”?)
    • late first pregnancy that got carried to term (again, late?, i think this would be in oour thirties)
    • no children
    • other as smoking, obesity.

    *symptoms

    • new nodule
    • secretion from only one breast
    • alteration of the areola area
    • pain not related with menstruation

    Also, I would do self-examination every month, 3-days before the period (If you have gone through menopause, do your exam on the same day every month).

    This is how it's done:

    Begin by lying on your back. It is easier to examine all breast tissue if you are lying down.

    Place your right hand behind your head. With the middle fingers of your left hand, gently yet firmly press down using small motions to examine the entire right breast.

    Next, sit or stand.

    Feel your armpit, because breast tissue goes into that area.

    Gently squeeze the nipple, checking for discharge.

    Repeat the process on the left breast.

    Next, stand in front of a mirror with your arms by your side. Look at your breasts directly and in the mirror. Look for changes in skin texture, such as dimpling, puckering, indentations, or skin that looks like an orange peel. Also note the shape and outline of each breast.

    Check to see if the nipple turns inward.

    Do the same with your arms raised above your head.

    Most women have some lumps. Your goal is to find anything new or different.

    If you do, go to your gp right away.

    For the non-gynecological issues, normally checkups start at 65, but no GP will deny youif yougo annually and say you would like one. this will consist in screening for diabetes, high cholesterol,high blood pressure and also lifestyle advide: if you are smoking they will tell you to stop, if you dont exercise, they will tell you to do so, etc.