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Screenings that can help

Dr. Drew Werner

An apple a day keeps the doctor away. I’m not sure who first spoke those words, and even an online search of quotations yielded no help. Nevertheless, I’m sure it must have been the great grandfather of preventive medicine. The idea for this week’s article sprang from the smile of a patient and thoughts of my son. Walking into one of my exam rooms this morning, I greeted my patient as I often do: “Good morning, how are you doing today?” The almost automatic reply usually follows: “Fine, how are you?” I replied, “Very well!” (Because usually I am.) It’s nice to see you.” Then came the smile. The social graces had run their course. The moment of truth was at hand. She simply couldn’t reply, “Good to see you, too.” I immediately caught her meaning. Anything was probably better than sitting in a doctor’s office feeling sick. I empathized with her illness and thought sometimes doctors aren’t bad people to see when you are feeling well.Dear Doc: Why don’t you do an article on screening for cancer?- Staying Healthy in EagleDear Healthy: Thanks for the great idea! What a refreshing idea to see the doctor when you’re well. To better understand the hows and whys of screening tests, I’d first like to share a few thoughts. There are probably a million things I could screen for. I never have a lack of tests to order. So how to choose a screening test?Well, first we should only screen for those things something can be done about. Why do something if it doesn’t lead to a change? That’s why we don’t recommend screening children for premature development of gray hair in adulthood. Secondly, to screen for a disease, there must be an asymptomatic period for which early detection offers a significant opportunity to alter the untreated course of the disease. Keeping with our same example, early detection of risk for gray hair would have no effect whatsoever on the eventual presentation of those first gray strands. Finally, the condition to screen for must be common enough to merit a good opportunity to detect it and thus outweigh the cost of screening.So, what are the recommended screening tests? There are many, of which cancer screening is only a small portion. Some differ based on age and of course sex. The following has been taken from several sources. It is not complete. (Don Rogers wouldn’t devote an entire issue to that list!) But it highlights the most important ones. Many of the screening tests can be incorporated into routine complete health examinations. I don’t have the room here to list all the recommended immunizations, but these are perhaps the single most important preventive measure you can do. While most immunizations occur in childhood, remember they continue and are updated throughout our lives. (When was your last tetanus shot?) Finally, don’t underestimate the importance of talking with your physician. The health-care advice may be worth more than its weight in gold.Back to cancer-specific screening, here is a list of the most important arranged by type of cancer. These apply to healthy individuals without a strong family of the disease or other risk factors, including smoking and personal history of disease.Skin cancer: Periodic, every two-five years or more frequent if there are risk factors such as a history of suspicious moles or a family history of skin cancer. This starts in childhood.Breast cancer: Age 40-49, the yearly benefit of breast exams and mammography is controversial. Age 50-69, yearly breast exams and mammography are recommended.Cervical cancer:Pap smears yearly beginning within three years of the onset of sexual activity. If in a monogamous relationship and there have been at least two consecutive normal pap smears, screening may decrease to every two to three years.Colon cancer: Colonoscopy beginning at age 50 and then every10 years. Sigmoidoscopy with barium enema may be substituted for colonoscopy, although a full colonoscopy may need to be repeated if polyps are found.Prostate cancer: This is perhaps the most controversial recommendation. Neither the Canadian Task Force on Preventive Health Care nor the U.S. Preventive Services Task Force recommend routine screening. The American Urological Association, however, recommends annual screening with a digital rectal exam and PSA blood test after age 50. That recommendation may change based on the level of the PSA test.Lung cancer: There is no recommended screening, so QUIT Smoking!These recommendations are not set in stone. As new tests become available and more research is done, they will continue to change. The best way to decide what fits you is to talk to your doctor.A couple of excellent links on cancer and other screening recommendations:The Canadian Task Force on Preventive Health Care can be found at http://www.ctfphc.org/U.S. Preventive Services Task Force can be found at http://odphp.osophs.dhhs.gov/pubs/guidecps/default.htmWell, I hope you made it to the Fair and Rodeo. I remain so impressed at the hard work of all those who make this great community event happen. Some are recognized, many are not, but thanks and congratulations to all. Most of all, I want to thank and congratulate all our 4-Hers. Their hard work makes it all worthwhile.Dr. Drew Werner of the Eagle Valley Medical Center writes a weekly column for the Daily. He encourages health questions. Write him by e-mail to editor@vaildaily.com or c/o Editor, Vail Daily, P.O. Box 81, Vail, Colorado, 81658.


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