Healthcare Check-ups for Women

I will describe here what gynaecological 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 community health institutions, so what/when to do things is never the sole decision of one 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)

A smear can either be performed by a family doctor (GP) or a trained nurse.
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 years old
• Has HPV (human papilloma 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 in the above group – as below

• To begin with an 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 arguing 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 Andalucía offers mammograms to women aged between 50 and 69, 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 more to live and able to receive treatment for breast cancer.
It’s not only here in Spain; in the UK it’s also from 50 to 70. Again, I do not believe in chronological age, I have treated 75-year-old people with lymphoma with chemotherapy, and that is more aggressive than surgery or the chemotherapy 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.

After you turn 50, you should receive a letter offering a mammogram, if you don’t, go to your healthcare centre.

So, in conclusion: mammograms: 50 to 69.

If, before that age, you have any of the following factors, 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 our thirties)
• No children
• Other as smoking, obesity

Symptoms

• New nodule
• Secretion from only one breast
• Alteration of the areola area
• Pain unrelated to 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.
• Make sure that you are covering all of the breast tissue.
• 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, call your health care provider right away.

I hope this brings some clarity to the subject.

For the non-gynaecological issues, normally check-ups start at 65, but no GP will deny you if you go annually and say you would like one. This will consist in screening for diabetes, high cholesterol, high blood pressure and also lifestyle advice: if you smoke they will tell you to stop, if you don’t exercise, they will tell you to do so, etc.

Please note: The information provided is based upon our understanding of current legislation. It is not legal advice but is provided freely to enable you to be properly informed. We recommend that if you are considering taking action, you should seek professional advice.