Important health categories, and their accompanying diagnostic tests, to keep in mind when discussing women’s health with your physician office lab customers.
In researching this month’s column, I spent some time reviewing the 2021 monthly health observances, which often points to issues on our customers’ minds. January is, among other things, recognized as “cervical health awareness month.” While the topic of cervical cancer and other reproductive diseases is important, I’ve frequently observed that women’s health encompasses reproductive health, but so much more. In this column, I plan to discuss women’s health from a broader perspective and look at women’s health concerns by both age and race to shed light on issues to help us to understand which tests may make sense for women based upon age and race. There are meaningful differences as we will see.
Cervical health
First off, an update on cervical health and diagnosis. There is a growing body of evidence showing that most cervical cancers are related to human papilloma virus infections. What does this mean to us, the POL and our customers? The National Cancer Institute recognizes three diagnostic approaches for women between 21 and 65 years of age:
- Traditional Pap smear alone every 3 years
- HPV testing alone
- A combination of both every 5 years
The US Preventive Services Task Force is currently updating their recommendations, but at present they include PAP smears every 3 years or HPV testing every 5 years or a combination of both tests every 5 years for women ages 21-65.
From our POL perspective this leads to opportunity for Pap smear slides and sample collection kits for essentially every OB/GYN practice and the potential to offer HPV screening for larger practices where the use of a molecular testing system makes sense. As you think of the molecular opportunity for HPV testing, think broadly, understand your customer’s patient and test mix and consult with your trusted lab manufacturer to find the best solution. At the same time, for those of you whose companies offer HPV vaccines, be sure to round out your discussion with a recommendation to consider them for both younger girls and boys, before they reach their reproductive years. The CDC recommends vaccination starting at 11 or 12 for both boys and girls.
The big picture
So, then, what about the bigger picture: women’s overall health? For this question, I refer to the list of the leading causes of morbidity and mortality. For women, heart disease and cancer are number 1 and 2 respectively. But there are differences from men, and age-related differences as well.
First, cancer death rates are rising for all women. In my review of the data, it appears the increase is more likely due to the larger number of women in their elder years now than 30 years ago. But, the take home message remains: screening for heart disease risk factors with lipids and A1C is equally important for women and men and BNP and other cardiac assays need to be considered based on the demographics of the practice and their appetite for more sophisticated testing. HPV/Pap testing clearly falls into the cancer screening category, along with FOBT/FIT and some tumor markers including CA 15-3 and others. Your top immunoassay suppliers will have a comprehensive listing of screening and tumor marker tests to consider recommending.
Beyond the top two leading causes of death, the ranking changes based on age, race and geographical factors. Diabetes is on the rise and some patient groups have a higher predisposition to type 2 diabetes than others. Rural populations and those who are overweight are particularly susceptible. Either way, diabetes makes the list of diseases worth testing for in the physician office. It is worth your time to remind your customers that effective screening for diabetes and pre-diabetes is key to better patient health, particularly for their older population. Glucose, lipids, A1C and albumin/creatinine ratio are the top tier of tests you should consider discussing. Most manufacturers offer these tests as CLIA waived on simple-to-acquire programs for placement agreements or simple disposable meters.
Alzheimer’s makes the list for all women. While there is presently no definitive screening or monitoring test available, there is tremendous progress being made in this area and you need to be on the lookout for both lab tests and other diagnostic options coming to the market in the next few years.
Hypertension and kidney disease are related, and both are firmly on the list of leading causes of death. Clearly, in addition to fostering effective blood pressure control and overall good health habits, your customers need to consider routine screening for kidney disease. You have a wide range of urinalysis and chemistry tests for creatinine, BUN and other tests to assure kidney health and to diagnose troubling signs earlier before they become more serious.
Other health considerations
In addition to consulting your customers to consider lab testing to effectively implement patient testing programs for their female patients for the leading causes of death, there are other important health considerations that women experience more frequently than men to be considered. Thyroid screening with TSH and Free T4 has become more common as a diagnostic tool for women in their adult years. A range of high-quality immunoassays test systems is available for you and your customers to consider.
Autoimmune disease also disproportionately impacts women, and RF, CRP and a range of autoimmune tests are available, usually on specialty testing systems. In addition to automated autoimmune test systems, there are also latex agglutination assays for RF and CRP to consider. Knowing both how frequently your customer encounters these conditions and the extent to which they want to consider a full-service laboratory will guide your recommendations.
Septicemia made the list of leading causes of death in 2018 and is number 9 in Black women and number 10 in Caucasian women. Most tests for sepsis will be performed in acute care facilities and include procalcitonin, lactate and IL-6. They are likely to be more pertinent in free-standing ER centers and urgent care centers than your typical primary care practice, but the use of these assays is growing, fueled by concern for MRSA, Clostridium difficile, urinary tract infections, and other common causes of sepsis. Customers most concerned about antibiotic stewardship are likely to be interested in knowing more, either for their own use or the knowledge of management of their patients in the acute care setting and in their practice for follow up post sepsis.
Finally, I need to remind you of osteoporosis, which is also far more common in women than men. In addition to imaging diagnostic procedures, there are a number of bone markers to consider on immunoassay systems.
As you think of women’s health, be sure to keep the big picture in mind and you will be sure to provide superior service and consultation to your customers.