Dr. Kelly O'Brien


As women, we spend a good deal of our time caring for others. But it is just as important to take time to care for ourselves. Kelly O’Brien, MD, shares her thoughts on how women can do just that. Dr. O’Brien references the recommendations of the United States Preventative Services Task Force (USPSTF), an independent panel of expert physi­cians that makes relevant and up-to-date recommendations regard­ing preventative services in primary care. Dr. O’Brien points out that family practice physicians consider the recommendations of the USPSTF to be their gold standard for clinical preventative services, as their recommendations are evidence-based and not financially motivated.

When it comes to routine diagnostic tests specifically for women, the two that come to mind immediately are Pap smears and mammograms. When should these two tests begin, and how frequently should they be repeated?

Cervical cancer screening is performed routinely for women ages 21 to 65 years with a cervical cytology test, or the Pap smear, every three years. The recommendation to space out the Pap smear to every three years came about in 2012, and while this is no longer a “new” recommendation, I have many patients who are still unaware of the change. Some patients are reluctant to give up their annual Pap smear upon learning of these updated guidelines, but it should be reassur­ing that these recommendations are endorsed by the USPSTF and the American Cancer Society, as well as by numerous other medical organizations. Even though, for most women, we now perform Pap smears every three years, it is still important to see your primary care provider annually for a physical. Even though your doctor may no longer be performing an annual Pap smear, for many women, it’s still important to have an updated pelvic and breast exam on a regular basis. An annual well-woman visit is so much more than just the Pap smear.

We currently don’t recommend Pap smears for women younger than age 21, regardless of their sexual history, and we also do not recom­mend them for women older than 65 years who previously have had adequate cervical cancer screenings and are not otherwise found to be at risk for cervical cancer. To be noted, these recommendations apply only to healthy women and may not apply to women with a recent history of abnormal Pap test or those with a variety of other exceptions.

Do you recommend bone density testing for men as well as women? When should this begin, and how often should it be checked thereafter?

The USPSTF recommends screening for osteoporosis in women age 65 and older, as well as in women under age 65 who have significant fracture risks and therefore may be at increased risk of osteoporo­sis. There is currently not enough evidence to recommend for or against routine screening for osteoporosis in men. That being said, I believe each patient needs to discuss their individual risks with their physician to determine if and when they should have a bone mineral density test performed to monitor for osteoporosis. I have multiple male patients with specific risk factors who have undergone testing, been diagnosed with osteopenia or osteoporosis, and are now being treated with medication for these conditions.

Are you an advocate of annual physical examina­tions for healthy adults? What screening tests do you recommend on a regular basis, with or without an annual physical exam?

I would absolutely recommend annual physical exams with your primary care physician. It’s vitally important to have these dedicated visits for physicals in order to spend time with your doctor discussing what screening tests are appropriate for your age group, reviewing counseling services on a variety of topics, and going over any pre­ventative medications, such as aspirin or prenatal vitamins, you may benefit from taking.

Kelly O’Brien is board-certified in family medicine and is with Lee’s Summit Family Care/Midwest Physicians. She is also on staff at Lee’s Summit Medical Center, which is part of HCA Midwest Health System — Kansas City’s largest health care provider. Midwest Physi­cians is a network of 450 experienced, multispecialty physicians located throughout the greater Kansas City metropolitan area, also part of HCA Midwest Health System.