Controversies in women's health maintenance

Because the health care system has become more cost-conscious, and because professional organizations vary in their recommendations for women's health maintenance, it is more important than ever to use an evidence-based approach for selecting health maintenance interventions wisely. The Papanicolaou smear is a gold standard for cancer screening if women undergo regular testing; however, data conflict on how often women should be screened and how risk factors for cervical cancer should be interpreted. Postmenopausal estrogen replacement therapy slows osteoporotic bone loss and may decrease a woman's relative risk of coronary artery disease. The relationship of hormone replacement therapy (estrogen plus progestin) to the risk of breast cancer still remains unclear. Although new data suggest that screening mammography may reduce breast cancer mortality by 20 percent or more in women over 40 years of age, its use in women who are 40 to 49 years of age is still controversial. Family physicians, as advocates for women's health, are ideally positioned for leadership roles in the policy making that may ultimately find solutions to these controversial issues.