Screening for Better Health

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Why are 3 in 10 adults never screened for Colon Cancer?

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ColonCoverColon cancer is the second-leading cause of cancer deaths in the United States. Unlike many other cancers, however, we have sophisticated, effective methods of detecting colon cancer early and preventing deaths. So why are so many people still dying from this detectable, treatable disease?

The headline above is somewhat misleading. It’s true that about 31% of adults over 50 never screened for colon cancer, but what’s equally troubling is about 33% of adults between ages 60 and 70 have only been screened once in their lifetimes.

Colon cancer is a threat that persists throughout our lifetimes. Screening guidelines approved by the CDC state that most people should start screening at age 50 and repeating every 10 years even if no signs of cancer are found. Many people are not getting their first colonoscopy at 50, and even fewer are bothering to repeat the test at age 60 and 70, despite the risk for developing precancerous polyps increasing over that time span.

So what’s causing people to skip these exams completely? As it turns out, a lot of different factors, carrying surprisingly even weight. Fear of the procedure and preparation, embarrassment, lack of time, poor physician awareness, lack of knowledge that follow-up exams are necessary, lack of health insurance, and poor access to medical care all play major roles in peoples’ decision making with regards to colon cancer screening.

The good news is that there is room to improve. The CDC estimates that 60% of current colon cancer deaths could be prevented with better screening. Considering that we’re already catching a large percentage of colon cancers through existing screening habits, this means we could potentially knock colon cancer several rungs down the ladder in terms of cancer deaths. It also means we need to fight to overcome some of those reasons people are skipping out on their exams.

A lot of that comes with better education for patients. While doctors have a responsibility to educate their patients on important screening tests and procedures, the only way to ensure that you receive the proper tests and the proper point in your life is to keep your physician informed on your medical history and what you have and have not had done. Making sure you get your colonoscopy scheduled at the right age can save your life. Missing it could kill you.

Remember, colon cancer doesn’t care why you missed your colonoscopy.

Do you Qualify for Lung Cancer Screening?

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Image courtesy of the National Cancer Institute
Image courtesy of the National Cancer Institute

Most people know if they are at risk for lung cancer. Smoking, and second-hand smoke, are the most common risk-factors for this deadly form of cancer. In addition, many people work industrial or mining jobs that may expose them to work-related risk factors on a daily basis. In either case, the time-honored means of protecting yourself from lung cancer has always been to avoid the carcinogen itself; if you are smoking, quit. If you are exposed to second-hand smoke on a daily basis, avoid it. And for those exposed to job-related carcinogens, the best defense unfortunately remains to change industries or job-sites if at all possible before the cancer-causing agents catch up with you.

But in recent years, doctors have developed a second layer of defense against lung cancer. It’s not a substitute for avoiding carcinogens, it’s not foolproof, and it doesn’t work for everyone. But lung cancer screening have become a viable tool for early detection of lung cancer in long-term smokers, allowing doctors to treat the disease before it becomes fatal, if caught early enough.

Lung cancer screening has recently been recognized by the American Cancer Society (ACS) and the United States Preventive Services Task Force (USPSTF) as being effective in reducing the mortality rate in lung cancer patients by up to 20%. As of 2013, both groups now recommend lung cancer screening in high risk patients who are 55 or older.

What does this mean for you?

Well, if you’re at least 55 and a smoker, or were a smoker and quit in the last 15 years, and have smoked at least 30 pack-years of tobacco (the equivalent of one pack a day for 30 years) you should talk to your doctor about screening for lung cancer.

Screening can be performed annually, with a low-dose CT scan, and looks to detect the early signs of cancer forming in the lungs, before it spreads to other parts of the body.

There are drawbacks to the procedure – mainly, that it can find “false-positives” where it detects signs or lesions in the lungs that are not actually cancerous. This is why it is recommended you only undergo lung cancer screening if you are at high risk of developing cancer.

In addition, people beyond a certain age are not recommended to get screening (the ACS recommends 74, the USPSTF 79). The logic behind this is that the risk for false positive and the likelihood of dying from other, non-cancer-related diseases before lung cancer can become fatal are measured to outweigh the benefits of screening.

What should you do?

First off, understand that screening is not a substitute for quitting smoking. Nothing is. Lung cancer is a very fatal disease that is extremely preventable by simply avoiding tobacco.

Second, if you are at risk, talk to your doctor about your options. Even if you have quit in the last 15 years, if you meet the other risk criteria, you should speak to your doctor about potential screening options. Whether or not you decide to move forward with screening, it’s important to have the conversation about the pros and cons.

Finally, know that lung cancer screening is now typically covered by insurers and medicare under the Affordable Care Act (Obamacare). Know your rights as a patient, and make sure to take care of yourself!

Supreme Court Ruling Suggests Data can Prevent Gun Deaths

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With the recent 6-2 ruling upholding the federal law banning people with misdemeanor domestic violence convictions from owning guns, the Supreme Court has sent a clear message regarding gun violence: when we have good data about how to prevent gun deaths, the federal government has a constitutional right to act.

For decades we’ve known there was a strong link between domestic violence and gun homicides, and in 1996 an amendment was passed barring people convicted of domestic violence misdemeanors from owning handguns. Research shows that abused women are five times more likely to be killed by a domestic violence partner if that person owns a firearm, and that two-thirds of women who had been domestically abused in homes with a firearm had been threatened at some point with that firearm. It’s also been shown that laws that prevent domestic abusers from owning guns are associated with reduced rates of domestic gun homicides.

The recent Supreme Court ruling gives hope to groups that are pushing for better funding for research into gun violence statistics – especially in light of recent events such as the Orlando nightclub shooting, with opposing factions arguing about whether or not restricting gun ownership rights to certain individuals could prevent mass shooting. It sends a clear message that, given strong data on how to save lives, the government has the authority to pass laws that restrict gun ownership for select groups of high-risk citizens.

The problem, of course, is that we still only have limited data on who commits gun crimes and why. The CDC is still hampered by restrictions on research funding, and doctors are still restricted from collecting data on gun ownership and risk. But at least for now we have assurance from the courts that what limited information we do have can be used for the greater good.

Terror Watch Lists aren’t a Solution to Gun Violence

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In the aftermath of the Orlando Pulse nightclub shooting that left 50 people dead and 53 wounded, many have called for increased restrictions to obtain firearms for people on government terrorist watch lists. As we struggle to untangle the shooter’s motives, his possible links to organized terror groups has strengthened fears in many Americans and reignited calls to keep guns out of suspected terrorists’ hands.

But in the midst of this understandable panic, it’s important to realize that the vast majority of firearms deaths in the United States have no links to terrorism – and the numbers aren’t even close.

In 2013, the latest year for which we have comprehensive data available, according to the CDC 33,169 people died from illegal gun violence in the US alone.  This was 1.3% of the total deaths in the country! Even if we discounted suicides by gun, which numbered 21,175, we still end up with approximately 12,000 deaths from homicides and accidents. That’s approximately 33 people killed per day.

Contrast this with terrorism: in all of 2013, 21 Americans lost their lives to international terrorism.

These numbers just don’t add up. Even if every single terror attack on a US citizen was made possible due to ownership of a gun (which we know it isn’t: the September 11 attack was carried out with box cutters for weapons), and even if we could stop every single potential terrorist from acquiring a gun (which we couldn’t, even if we expanded our watch lists and criteria) we would, at best, stop somewhere around 25 or 30 murders in an average year.

Which is less than one-quarter of one percent.

Now don’t get me wrong – any decrease in gun deaths is a goal worth investigating. But targeted watch-lists are never going to be perfect, and they’re never going to stop all potential terrorists from obtaining guns, and most importantly they’re going to do almost nothing to dent our gun violence problem that is largely committed by average Americans living normal American lives.

What we do need is more research, more understanding of why people commit gun violence and how to stop it before it happens. Many doctors are already trying to help with this, but unfortunately there are laws in place keeping us from collecting data to better understand the problem. Rather than focus on flawed watch lists that target a tiny percentage of gun violence cases, we should look at those laws preventing better research and find a way to change them.

Uterine Cancer: Screening means Knowing your Risk Factors

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Screening for uterine cancer – which affects 2% of women in their lifetimes – is a controversial subject. There is no clear consensus of whether early screening in average-risk women can help prevent cancer deaths. On the other hand, we have a very good idea of what the risk factors for uterine cancer are, and they are relatively straightforward. As a result, the best way to screen for uterine cancer is to simply be aware of whether or not you classify as “high-risk”.

In preventive medicine, there are sometimes risk factors that cannot be controlled and must simply be monitored. In the case of uterine cancer, these are your genetics. If your family has a history of uterine cancer, there is a reasonable chance you have inherited genes that make you more likely to develop this disease. Furthermore, many of the same genetic mutations that can cause breast cancer and are passed down from parents to their children can also cause uterine cancer, so if your family has a history of breast cancer you should also be aware of the potential to develop uterine cancer.

There are also risk factors that are a direct result of actions you take, rather than your DNA. For uterine cancer the first major risk factor is being on hormone replacement therapy, which many women use to control menopausal and postmenopausal symptoms such as hot flashes, sweating, and flushed skin. Taking hormone replacement drugs for 5 years increases the chances of developing uterine cancer 30-fold. While it’s possible to use progesterone to reduce this risk, that has the unfortunate side effect of increasing breast cancer risk, so it is controversial as a preventive tool.

The second major risk factor is Tamofixin use, which is used in breast cancer treatment. However, the risk for developing uterine cancer is generally considered much smaller than the risk of not using tamofixin to treat breast cancer, so while you should discuss this risk with your doctor and be aware of the symptoms of uterine cancer, you should understand that tamofixin is important to your treatment.

There are other, less significant risk factors for uterine cancer, and many of them similarly apply to other cancers and diseases as well. These are things such as obesity, poor diet, tobacco smoke, and lack of exercise. These can be controlled for by living a healthy lifestyle and exercising regularly. Uterine cancer also occurs in a higher rate among women who have never birthed a child, and those with early menstruation or late menopause.

The best way to prepare to beat uterine cancer is to know the risks, know your family history, and know the signs of uterine cancer so you and your doctor can catch it early. The survival rate for uterine cancer is high if caught early – so if you suspect yourself to be at a high risk due to relatives with breast or uterine cancer, be sure to speak to your doctor early in life about the signs you should be on the watch for!