Routine health checks GPs should conduct with their female patients

What routine health checks should general practitioners conduct with their female patients in the primary care setting?

The Australian Government recommends regular health checks, which are largely focused on identifying health issues early and helping to prevent and detect serious illnesses such as cancer and cardiovascular disease. Routine health checks are guided by risk, with some women requiring more regular checks than others.

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Engaging in the National Cervical Screening Test (NCSP) is recommended for all people with a cervix from age 25–74 and aims to facilitate early detection of cervical cancers. Cervical screening should be offered to all eligible women who are due and can be performed in general practice. This involves passing a speculum to visualise the cervix and obtaining a sample of endocervical cells using a specific endocervical. The cells are checked for the presence of human papillomavirus (HPV), which is implicated as the likely cause of 91% of cases of cervical cancer. Women’s samples which are positive for HPV are tested for the presence of abnormal cytology and managed accordingly. In those whose samples are positive for HPV, with no evidence of cell abnormality, repeat screening is indicated in 12 months.

Women should be asked about their sexual history and offered testing for sexually transmitted infections where appropriate. There is no evidence that the GP should perform routine pelvic examination. While taking a sexual history, this is an ideal opportunity also to discuss contraceptive and reproductive needs.

“Heart health” checks are recommended every two years for women over 45. This involves physical examination (heart rate, blood pressure, weight, and BMI), discussing lifestyle (diet, exercise, smoking and alcohol consumption), assessing medical and family history, and performing blood tests (cholesterol and fasting glucose levels). This allows the practitioner to evaluate the risk of cardiovascular disease and embark on appropriate risk-reduction methods.

Women should also be screened for risk of diabetes, and at-risk women should be offered more regular fasting glucose checks accordingly.

Women aged 50 to 74 are automatically invited to participate in screening mammograms for the detection of breast cancer. However, the GP should encourage women to perform breast self-examination and alert the general practitioner to any changes. Routine breast examination by the GP is not recommended.

Women should be screened for the risk of osteoporosis, and a bone density scan may be performed on those over the age of 70 or who are at increased risk.

Women should also be encouraged to attend other regular health checks, such as engaging in the National Bowel Cancer Screening Programme every two years from the age of 50 to 74, attending an optician for an eye health check every two years and attending a dental health check every 12 months. Routine vaccinations, such as influenza, COVID-19, shingles, and pertussis, should also be promoted and administered when appropriate.

In summary, GPs should conduct comprehensive health assessments for women, aligning with individual risk profiles and national guidelines. Factors such as chronic disease, family history, and lifestyle factors are essential for determining the frequency and scope of screenings. 

Dr Samantha Miller, MBChB

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References

1.    Australian Government. Department of Health and Aged Care (2023). Yearly Health Checks. https://www.health.gov.au/resources/publications/yearly-health-checks-easy-read?language=en 
2.    Australian Government. Department of Health and Aged Care (2024). About the National Cervical Screening Program. https://www.health.gov.au/our-work/national-cervical-screening-program/about-the-national-cervical-screening-program 
3.    Health Direct Australia. (2022). Human Papillomavirus and HPV Vaccine (2022). https://www.healthdirect.gov.au/human-papillomavirus-hpv-vaccine 
4.    Centres for Disease Control and Prevention (2023). HPV and Cancer. https://www.cdc.gov/cancer/hpv/statistics/cases.htm 
5.    The Australian Centre for the Prevention of Cervical Cancer (2022). Cervical Screening Pathway Quick Reference Guide. https://acpcc.org.au/wp-content/uploads/2022/10/National-Cervical-Screening-Program-Quick-Reference-Guide-3.pdf 
6.    Department of Health, State Government of Victoria, Australia. Better Health Channel. Health Checks for Women. (2022). https://www.betterhealth.vic.gov.au/health/healthyliving/health-checks-for-women#bhc-content 
7.    Stewart RA, Thistlethwaite JE. Routine pelvic examination for asymptomatic women: Exploring the evidence. Aust Fam Physician 2006;35:873–7. 
8.    Breast Cancer Network Australia (2023). Breast Cancer Screening. https://www.bcna.org.au/resource-hub/articles/breast-cancer-screening 
9.    Royal Australian College of General Practitioners. Guidelines for Preventative Activities in General Practice: Early Detection of Cancers: Breast Cancer. https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/guidelines-for-preventive-activities-in-general-pr/early-detection-of-cancers/breast-cancer