CONTROVERSIES IN WOMENS HEALTH MAINTENANCE

Because the health care system has become more cost-conscious, and bec ause professional organizations vary in their recommendations for wome n's health maintenance, it is more important than ever to use an evide nce-based approach for selecting health maintenance interventions wise ly. The Papanicolaou smear is a gold standard for cancer screening if women undergo regular testing; however, data conflict on how often wom en should be screened and how risk factors for cervical cancer should be interpreted. Postmenopausal estrogen replacement therapy slows oste oporotic bone loss and may decrease a woman's relative risk of coronar y artery disease. The relationship of hormone replacement therapy (est rogen plus progestin) to the risk of breast cancer still remains uncle ar. Although new data suggest that screening mammography may reduce br east 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 controver sial. Family physicians, as advocates for women's health, are ideally positioned for leadership roles in the policy making that may ultimate ly find solutions to these controversial issues.