Maggie McKay (Host): Welcome to Mountain Medicine, a podcast from Northern Inyo Healthcare District. I'm your host, Maggie McKay. Today, Jennifer Figueroa, OB-GYN physician assistant, joins us to talk about women's health screenings. So good to have you here, Jennifer. Thanks for joining us.

Jennifer Figueroa, MS, MS, PA-C: Thank you for having me.

Host: Of course. Before we talk about women's health, tell us a little bit about what brought you back to the Eastern Sierra and why you chose to practice here.

Jennifer Figueroa, MS, MS, PA-C: So, my husband and I, after undergrad, we actually moved to Mammoth and we worked there for a few years, not in the healthcare field at all. We taught snowboarding, worked in restaurants, and then decided to go back to grad school with the intent of moving back to the Eastern Sierra with professional careers where we could help the community. So, we did that. We got a couple of master's degrees in the interim. And then, I ended up picking physician assistant, and my husband's a veterinarian. And we just love the mountains, being able to hike, bike, take our dogs off leash pretty much anywhere. We have good friends that still live here, you know, over 20 years, and I love being part of a small community.

Host: That is so awesome.

Jennifer Figueroa, MS, MS, PA-C: Yeah. So, it worked out. So, we ended up moving back in 2017. So, we were gone for about nine years, did a bunch of schooling, and then came back, and we don't intend to go anywhere. We love it.

Host: That is great. That's awesome. So, you know, preventive care can mean different things at different ages. What does preventive care for women include across the lifespan?

Jennifer Figueroa, MS, MS, PA-C: I would say starting from age 21 is when we recommend getting a Pap smear. So, all you younger women out there who are listening, if you're 21, that means we would love to see you for your first annual well-woman exam. Pap screening generally occurs every three to five years based on the results. And what it is, is it's actually screening for cervical cancer. We do a pelvic exam, take a look at the cervix, and we take a very small sample of cells, which then are looked at under a microscope. And depending upon your age, they'll be either tested for human Papillomavirus, which is a virus that's the most common cause of cervical cancer, and then also they will look really closely at those cervical cells. So, that's probably the earliest screening that we recommend, along with just kind of routine STD screening. If you're sexually active, it's good to get preventative screenings, I would say yearly, especially if you have new partners.

And then, as you get older, your screenings increase. So, generally, mammograms start at age 40. That can be earlier depending upon your family history, and even just personal risk factors. So, what we've started recommending to a lot of our patients is to actually go online and do a breast cancer risk assessment tool. The name is Tyrer-Cuzick, which is pretty hard to spell. So, I just say look online for breast cancer risk assessment tool. And it's like a 10-minute questionnaire. And it basically, based on your breast and then also family history will pop out a number giving you your percentage risk of breast cancer. And then from that, we determine do you need a mammogram early, do you need a breast MRI, should we order breast ultrasounds, or are you okay just sticking with the, you know, mammogram annually starting at age 40?

Host: And as you said, as we mature we need more. What else?

Jennifer Figueroa, MS, MS, PA-C: Next would be colon cancer screening. We recommend either doing the Cologuard test, which is a home test that's sent to you where you can actually just send in a small stool sample. That starts at 45, or you can opt to do the full colonoscopy also at 45. Depending upon the results of those, the Cologuard is generally good for three years, and a screening colonoscopy, if it's normal, is good for every 10 years. Again, family history can dictate whether or not you need an earlier colonoscopy.

At 55, we recommend getting your first DEXA scan, which is a bone scan, looking for osteoporosis. So as women age, they go through menopause. Estrogen is known to keep your bones nice and strong and healthy. So when we lose that estrogen, your bone density can go down. And so, it's nice to get a baseline. If you have a family history of osteoporosis, you actually sometimes can get a DEXA scan approved through insurance earlier than 55.

And then, also, I think it's good to see your women's healthcare provider just to discuss annual labs every year. So, checking thyroid, cholesterol. We check to make sure you're not anemic, vitamin D3, look at your liver and kidney function. And then, it probably is also a good idea because we live in the Eastern Sierra where it's super sunny to go see your dermatologist once a year just to get like an annual skin check so they can look over any new growths or lumps and bumps that may have popped up.

Host: Jennifer, what screenings are especially important for women to stay up-to-date on every single year?

Jennifer Figueroa, MS, MS, PA-C: Every single year is definitely the mammogram. Otherwise, Pap smears, they've now kind of spaced it out. If you've never had an abnormal Pap in your entire life, it's now every five years. If you've had an abnormal, depending upon what it is, those can be every one to three. So if you've had an abnormal Pap, I would also say that that's probably important that you go in and check in and say, "You know, should I be getting these yearly, or can we move to every three years?" But really, the mammogram, if you're over age 40, that's the big one.

Host: And a lot of women, of course, balance work, family, and caregiving. Why is it still important to make time for their own health visits?

Jennifer Figueroa, MS, MS, PA-C: Yeah. So, I always tell my moms or, young patients that are coming in, "You want to be there for your family when you get older. And also, just don't you want to be happy and healthy, right, for as long as possible?" And so, a lot of these screening tests, they can detect things so much earlier and make them really not that much of a big deal if you do catch it early versus waiting and then potentially, like cervical cancer for instance, it takes a very long time for those cells to change in most cases to progress into cervical cancer. And if we do catch it early, the treatment is so simple versus waiting, you know, the consequences can be pretty catastrophic.

Host: And what are some early warning signs women should not ignore?

Jennifer Figueroa, MS, MS, PA-C: Okay. So, I'm just going to kind of go through the systems. So if you have any change in bowel habits, so you're having more diarrhea than normal, more constipation, you've noticed blood in your stool, I definitely would get in to see your primary care provider or even—at least in Bishop, you would see the general surgeon and kind of like do some research in that, maybe get a colonoscopy to figure out what's going on.

In terms of women's health, any new lumps or bumps in your breast, or a breast rash, nipple drainage, changes in your breast appearance, those need to be checked out immediately. So, you give us a call and we can generally get you in that same week for anything like that. We'll order imaging. And then, bleeding after sex, any sort of irregular bleeding in between periods, that is not normal. Like a different sensation in your pelvis, so maybe you feel more fullness, blood in your urine. Any of those, you need to come in very soon to be evaluated. Those are the big ones if I stick to just kind of OB-GYN stuff.

Host: What challenges do women in rural communities sometimes face when accessing care, and how can they work around them?

Jennifer Figueroa, MS, MS, PA-C: So in Bishop, we're very lucky because we have so many resources here. However, we pull from, gosh, like a 200 to 300-mile radius. So, the biggest challenge here is just transportation and the amount of time it takes to travel here. I do know that we do have a care shuttle, which is nice. So, they can sometimes go pick patients up who don't have transportation. I think they'll go as far as Lone Pine, which is like an hour south of us. And then, we do now have well—we've had it for a few years, but urgent care, so patients can call the same day to get in for urgent-type complaints. But for our small town, we are very blessed in that we have breast radiologists who will do diagnostic mammograms. They come twice a month for two weeks out of the month. We have a breast surgeon who travels up here. We also have two amazing OB-GYNs, like, full-scope robotic surgeons who can do robotic hysterectomies. We have a lot of resources. And yes, do we need to refer patients out? Yes. I would say it's just really the travel that's, you know, it's the most difficult part of living here.

Host: Wow, that's amazing. That's really encouraging. That's great to hear. Jennifer, how can women build a comfortable and ongoing relationship with a primary care or women's health provider?

Jennifer Figueroa, MS, MS, PA-C: So, I think just being open and honest when you come into your appointment with us. We are here to help you. We see so many different things, and we really don't judge, you know? So, just trying to be very honest about what your needs are, what's going on in your life, because women's healthcare is so much more than just ordering tests. It's also, you know, there's family dynamics going on, stress at home. And we like to be there for our patients. Also, I've tried to set all my patients up with a patient portal so they can just send a message instead of having to call. We may not be able to get back to them for a couple of days, and that way they have direct access and contact with us. That's been really great to help build relationships too.

Host: That's great. It sounds like you've got all the bases covered. What message would you most like women across the Eastern Sierra to hear about when it comes to taking care of their own health?

Jennifer Figueroa, MS, MS, PA-C: I think try to not be afraid to come to the doctor or, you know, see one of your medical providers. We are here to help, and we have so many resources available to provide that help that you may need. And just really try and see us every one to two years. If you're young, healthy, you know, it's good to come in and get those screenings and just have conversations about what's going on because we may pick up something that you didn't even know was happening. And it's better to catch things early than to wait.

Host: Absolutely. Great advice. Well, thank you so much for sharing your expertise and making the time to be with us today. This has been really informative and helpful. Thank you.

Jennifer Figueroa, MS, MS, PA-C: Oh, thank you for having me. I'm so grateful the hospital's doing this.

Host: Absolutely. Again, that's Jennifer Figueroa. To find out more, please visit nih.org/womenshealth. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thank you for listening to Mountain Medicine.