Disease Prevention in Women and the Cullinan Assessment

Posted in by Miss Kornelija Dedelaite

A fundamental component of preventative medicine is screening tests. You may often get these screening tests through your primary care provider. However, some examinations are only available through specialist service providers. It is recommended to talk early on about these screening tests with your doctor because some depend on your age, and the doctor will be better equipped to inform you which tests would be most appropriate for your and your health concerns.

The following tests are examples of helpful (usually quick and secure) screening procedures that can aid in identifying diseases and disorders common among women before they are able to spread and cause more serious issues in the future.


Osteoporosis is a disease marked by a gradual loss of bone density that can result in fractures. Oestrogen is crucial for preserving bone density. After menopause, as oestrogen levels fall, bone loss quickens. As a result, postmenopausal women are more likely to develop osteoporosis.

Screening tests

There are several techniques which allow the imaging of bones and the surrounding area, the main three are as follows:

DEXA Scan: A DEXA scan – the Dual-Energy X-ray Absorptiometry – is a type of bone density scan. It is used to measure the mineral content of your bones usually in your lower spine and hips. It operates using a transmission of low dose x-rays.

CT EOS scan: The EOS dual source upright CT scanner can be broken down into its individual parts:

  • Dual source: two x-ray beams scan the body simultaneously and show the frontal and lateral images.
  • Upright: the client stands or sits in an upright position.
  • CT scanner: uses x-rays to generate cross-section images of your body. EOS scans also allow this to be 3D.
  • EOS: a medical imaging system which aims to provide high resolution images whilst limiting the X-ray radiation the patient is exposed to an extremely low level. It does this by utilising Nobel Prize winning detector technology derived from the CERN project.

CT Bone density scan: This is the gold standard for detecting osteoporosis. The Computed Tomography scan (CT scan) is similar to the DEXA scan. It is also a non-invasive imaging procedure that uses x-rays combined with computerised technology to produce incredibly high-definition images of the bones. It can also show muscles, fat and other organs, and all images from CT scans are more detailed than normal x-rays.

They each have their pros and cons, so if you would like more information about these technologies, please read which bone scan is the best option to detect bone disease.

How often should I test for osteoporosis?

The UK National Osteoporosis Guideline Group recommends bone density testing for all postmenopausal women and men aged 50 years or older (NOGG, 2021).

The following are high risk factors for osteoporosis:

  • early spontaneous menopause
  • family history of osteoporosis and related bone fractures
  • cigarette smoking and/or heavy alcohol abuse
  • over-active thyroid gland (hyperthyroidism)
  • thin body habitus
  • conditions associated with poor absorption of calcium or vitamin D
  • problems with missed menstrual periods

Advantages of Early Detection

Before a bone fracture, osteoporosis oftentimes goes unnoticed. Osteoporosis-related bone fractures can be brought on by even a modest fall, blow, or body twist that wouldn’t typically result in an injury. Bone fracture risk can be reduced through osteoporosis prevention and therapy.

To help reduce risk of osteoporosis, you should quit smoking and reduce alcohol intake. Exercising regularly can help with better mobility, range of motion, strength and balance. You should also ensure that you get enough Vitamin D and calcium.

Although oestrogen-containing hormone therapy (HT) has been demonstrated to reduce bone loss, boost bone density, and lower the incidence of fractures, it has also been linked to some health hazards. Hormone therapy is currently advised only for menopausal women. Hormone therapy should only be continued until symptoms have subsided and only used with the lowest effective dosage.

Breast Cancer

In the UK, breast cancer is the most common cancer among women, with around 55,500 new cases every year (Cancer Research UK, 2022).

Screening tests

Mammogram: The best screening tool for finding early breast cancer is a mammogram. Mammograms are X-ray films that provide images of the breast tissue. A mammography is a quick procedure that is done on a regular basis to check for anomalies.

A biopsy, MRI, or ultrasound scan may be carried out for further clarification of an abnormal mammography. An abnormal mammogram does not always indicate the presence of malignancy; however, a healthy mammogram does not rule out the possibility of malignancy.

High risk factors for breast cancer

  • Breast cancer history
  • First-degree relatives (mother, sister, or daughter) who have the disease are high-risk factors for developing breast cancer. If a relative acquired breast cancer before the age of 50, if the relative had breast cancer in both breasts, if there is a family history of both ovarian and breast cancer, or if a male family member has been diagnosed with breast cancer, the risk is especially higher.

Benefits of early detection of breast cancer

In the UK, 23% of breast cancer cases are preventable. 76% of people diagnosed with breast cancer survive for 10 or more years.

Regardless of risk factors, early detection of breast cancer is crucial for all women since the earlier a tumour is identified, the more probable it is that it will be treatable. Studies have unequivocally demonstrated that the likelihood of a surgical cure and long-term survival increases with the size of the breast cancer at the time of detection. Additionally, lymph nodes and other organs like the lungs, liver, bones, and brain are less likely to have been affected by smaller breast tumours that have already migrated to them.

Many tiny breast cancers can be found by mammograms long before they are felt during breast inspections. There is a lot of proof that mammography has increased survival rates for women with this disease.

Mammograms miss about 10% to 15% of breast cancers, which are instead found during breast exams. Consequently, a normal mammography does not totally rule out the risk of breast cancer, and self-inspections and professional breast examinations are still crucial.

Skin Cancer

Skin cancer develops when abnormal, mutant cells in the epidermis, the skin’s outermost layer, multiply out of control. Cell mutations brought on by unrepaired DNA damage are the root cause. These mutations cause the skin cells to grow out of control and develop into cancerous tumours.

Melanoma, squamous cell carcinoma (SCC), Merkel cell carcinoma (MCC), and basal cell carcinoma (BCC) are the four main kinds of skin cancer that can develop.

According to Cancer Research UK, there are nearly 156,000 new non-melanoma (SCC, MCC, BCC) skin cancer cases recorded in the UK each year. Of those, 47% are recorded in people aged 75 and over. Over the last decade, non-melanoma skin cancer rates have increased by 56% (Cancer Research UK, 2021a).

Preventing skin cancer

Skin cancer is the most common form of cancer in the UK, and it is the most preventable too. Protecting your skin during the first 18 years of your life can reduce your risk of some skin cancers by almost 78% (Prevent Cancer Foundation, 2021).

There are several things you can do to prevent skin cancer (British Skin foundation, 2021). This includes:

  • Avoid the sun during peak hours: Avoid going out too much during summer between 10 am and 4 pm. This is when the UV rays are strongest and can cause the most damage.
  • Stay in the shade: If you are outside, minimise your exposure to the sun by staying more in shady areas.
  • Use sunscreen: Use a cream that covers a huge spectrum, including UVA and UVB rays. Minimum SPF level should be 15 but aim for 30 or 50 for better protection. Also, use it even on cloudy or rainy days and remember to re-apply it every few hours if you are outside.
  • Wear protective clothing: When appropriate wear hats, scarves, gloves, and long sleeve shirts to reduce the amount of skin that is exposed to the sun.
  • Avoid indoor tanning: Don’t use tanning beds as they expose your skin to intense UV rays and what you call a ‘base tan’ is skin damage.
  • Check your skin regularly: Check any moles, freckles or birthmarks that you have. Also, check your body for any changes or abnormalities regularly and report any concerns to your doctor or dermatologist.

High blood pressure and coronary heart disease (CHD)

Women are twice as likely to die of CHD, the main cause of a heart attack, as breast cancer in the UK and was the single biggest killer of women worldwide in 2019. Despite this, it’s often considered a man’s disease.

There are more than 800,000 women in the UK living with CHD, and sadly, around 80 women die from a heart attack every day in the UK – almost 30,000 women every year. That is almost 3 x as many who die from breast cancer.

But despite these sobering statistics, many women are unaware that they might be at risk of heart disease. As a woman, your hormones might give you some protection from CHD in your pre-menopause years, but after the menopause, the risk rises and continues to rise as you get older.

Your body receives the energy and oxygen it needs from the blood that is pumped throughout it when your heart beats. As the blood flows the sides of the blood vessels are pushed against. The strength of this pushing is your blood pressure. Your arteries and heart are put under additional strain if your blood pressure is too high, which can result in strokes, heart attacks, and other health issues.

In England, 26% of women have high blood pressure. In the UK, high blood pressure is the third biggest risk factor for all disease after smoking and poor diet. Half of people with high blood pressure are not diagnosed or receiving treatment. In England alone, there are more than five million people that are undiagnosed (Blood Pressure UK, 2022).

High blood pressure is known as the “silent killer” since it rarely causes any symptoms. Getting your blood pressure checked is the only method to determine if you have the condition.

Blood pressure measurements

  • Normal blood pressure is 90-120/60-80.
  • High blood pressure is 130-139/85-89.
  • Stage 1 hypertension is 140-159/90-99.
  • Stages 2 and 3 blood pressure are >160 / >100.

Benefits of early detection

Diseases can be brought on by high blood pressure without having any prior symptoms. There is strong data showing that treating high blood pressure can lower the risk of kidney failure, heart disease, and stroke.

In reality, there is strong evidence that adults with high blood pressure of any severity can benefit from blood pressure reduction. It’s crucial to talk about weight loss, exercise, and stress reduction with your doctor.

Cullinan Assessment

Women’s experience of various disease is different because women’s symptoms are often milder, they can arise later in the illness, and they can be unusual. Because heart disease in women often goes undetected, the damage caused can be more advanced and outcomes can be poorer than for men.

Some tests used to diagnose heart disease are also less accurate in women than they are in men. Women may experience a heart attack with no symptoms of chest pain. They may experience nausea or vomiting, which are oftentimes confused with acid reflux or the flu.

Clinicians believe that the decline in bone density and its complications solely affect postmenopausal women, which may create health disparities. However, osteoporosis and its complications affect both genders but at different ages and rates. Osteoporosis is four times more common in women than in men, but some evidence indicates that men tend to have more osteoporosis-related complications.

The Cullinan Assessment was created by Echelon Health with women in mind, starting from scratch to address this difference in experience.

The Cullinan Assessment is designed for women who are 40 years of age or older and is intended to allow for early detection of diseases associated with this stage of life as well as the diseases that are the leading causes of premature death in women, including osteoporosis, breast and ovarian cancer, coronary heart disease and more. The following scans are part of this assessment:

  • Comprehensive bloods + Hormonal Profile + cancer markers
  • Digital mammogram
  • Transvaginal Ultrasound
  • ECG
  • CT Coronary angiogram
  • CT Chest
  • CT Bone Density
  • Full Body Mole Check

It is designed as a holistic experience, with body and soul in mind. In addition to the highly detailed health assessment, our clients benefit from a chauffeur driven round trip transfer within 100 miles of our Harley Street clinic and an overnight stay at The Mandarin Oriental Hyde Park, which includes a CBD oil deep relaxation massage.

The Cullinan assessment is a ground-breaking preventative health evaluation specifically designed for women. It enables them to take charge of their health and get an unmatched understanding of their bodies at a critical juncture in their lives.

Please do not hesitate to contact us if you have any questions concerning the Cullinan Assessment or any other assessments provided by Echelon Health. We would be happy to assist you.





NOGG (2021). Clinical Guideline for the prevention and treatment of osteoporosis. Available at:  https://www.nogg.org.uk/full-guideline (accessed 14/11/2022).

Cancer Research UK (2022). Breast cancer statistics. Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer#heading-Zero (accessed 14/11/2022).

Blood Pressure UK (2022). Blood pressure facts and figures. Available at: https://www.bloodpressureuk.org/news/media-centre/blood-pressure-facts-and-figures/#:~:text=Around%20one%20in%20three%20adults,high%20blood%20pressure%5B4%5D. (accessed 14/11/2022).

Cancer Research UK (2022a). Non Melanoma skin cancer statistics. Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/non-melanoma-skin-cancer#heading-Zero (accessed 14/11/2022).

Prevent Cancer Foundation (2021). Skin cancer. Available at: https://www.preventcancer.org/education/preventable-cancers/skin-cancer/ (Accessed 14/11/2022).

British Skin Foundation (2021). Are you at risk of skin cancer? Available at: https://www.britishskinfoundation.org.uk/are-you-at-risk-of-skin-cancer#:~:text=Skin%20cancer%20is%20the%20most,that’s%20seven%20people%20every%20day (Accessed 14/11/2022).