Screening for Better Health

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Should I still check for lumps? The Controversy over Breast Exams

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If you are like millions of other women, you may have learned at an early age to check your breasts for lumps or other abnormalities. The self-breast exam is one of the most well-known screening procedure and an iconic symbol in the fight against cancer. For years doctors have been recommending and performing breast exams in an effort to detect early signs of one of the most common and deadly cancers in the world, an affliction that strikes approximately one in eight women in their lifetimes. But today, many medical professionals have stopped administering these tests in their offices… and have even stopped recommending self-breast exams to women!

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Photo by Linda Bartlett for the National Cancer Institute

So what gives? Why have many doctors abandoned a decades-old practice? And does this mean you should stop performing self-breast exams?

The answer to both of these questions lies in the numbers. Specifically, the lack of them showing that breast exams help reduce deaths to breast cancer. In fact, some research has suggested that breast exams, performed at home or by a doctor in a clinic, may actually do more health than good!

There could be a number of reasons for these problems. The US Preventive Task Force suggests that some of the problem may arise because the clinical breast exam “currently lacks a standard approach and reporting standards.” It also highlights the tendency of breast exams to give false negatives, where a woman believes she has cancer but in reality is cancer-free. This can lead to needless tests, biopsies, anxiety, and medical costs, all of which can do a great deal of harm to a patient who mistakenly believes they are sick. The American Cancer Society points to the lack of research supporting the use of breast exams, but reminds women that they “should be familiar with how their breasts normally look and feel and report any changes to a health care provider right away.”

 

There is still research being done on this subject, and many doctors are optimistic that one day a standardized test with reasonable accuracy will be available for women that do not have access to mammograms. And many medical professionals still recommend that women be familiar with their body – even going so far as to recommend traditional breast self-exams. But as a woman, it’s important to understand that scheduled mammograms are your best defense against this deadly cancer – and to understand that, if you do find something unusual with your body, it could mean any number of things. So be sure to talk to your doctor, and keep up with your scheduled mammograms!

For more information on the recently updated Breast Cancer Screening Guidelines, click here!

Osteoporosis: Treatment starts with prevention

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Most of us are familiar with the symptoms of osteoporosis. It is a fairly common condition: approximately 44 million Americans have thin bones from calcium loss! It’s very likely you have relatives with osteoporosis, and there is a reasonable chance you or someone you are close to will develop it some day.

Osteoporosis is a condition in which your bones lose the calcium from their matrix or structure and become fragile. This loss of calcium results in a decrease in bone mass and bone density, and the outer mineral layer of your bone begins to thin. The inner mesh skeleton of the bone also begins to thin. This results in very brittle and fragile bones. People who have osteoporosis are at risk for fractures that can occur with very minimal trauma. A step down the stairs, a minor fall in the house, a slight slip on ice, or in some rare cases, even a hard cough can result in bone fracture.

You might be aware that osteoporosis affects both men and women, though women are about 4 times as likely to develop it as men. And it is fairly well known that the risk of developing the condition increases with age. But did you know there are several other major risk factors, many of which are controllable?

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Treatment for osteoporosis can help mitigate the effects of the disease, but the best defense is to prepare your body in advance to fight off the approach of the disease. Taking care of yourself now can lead to a long and healthy future!

 

 

The Stool Test: How a fecal test can help detect colon cancer, and where it falls short

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Colorectal Cancer Cells. Source: NCI Center for Cancer Research

The Stool Test, also known as a Fecal Occult Test, is sometimes given to patients for aid in screening for colon cancer. While it can help aid in detecting colon cancer, it is important to understand why it, and other tests like it, are only supplemental tests and not a replacement for more accurate and rigorous screening procedures – in this case, colonoscopy.

The reasons for a stool test are simple: it is easy and quick enough to conduct at home, and much less invasive than a colonoscopy. You receive a simple card kit, and you smear a fecal sample on each card before returning them to your doctor. The most up-to-date versions of the test are designed to successfully detect tiny, microscopic bits of blood in the stool. Since this is one of the major warning signs of colon cancer, this can help give early warning to patients who will then need to get a full colonoscopy as a follow-up.

The downsides, however, are very real. Stool tests are not very accurate, and have a high chance for either a false positive (where blood is present but does not come from colon cancer or pre-cancerous polyps) or false negative (where no blood is detected, but colon cancer is present). In the case of the false positive, you’re still going to need to undergo a full colonoscopy to confirm the presence of cancer or polyps. And in the case of a false negative, you may have been able to detect the cancer early if you had undergone a colonoscopy instead of the quicker and easier stool test.

Like many screening tests that have issues with accuracy, the recommendations for taking the stool test vary depending on the organization. The CDC lists it as a “recommended” test, saying you should take it once a year. The American Cancer Society specifically recommends the more modern, accurate version of the test.  And the USPSTF gives the test an “Inconclusive” rating, meaning there is not enough evidence to recommend the test as a primary screening tool.

The good news is that tests like this are always been improved, and newer versions of the stool test have shown more and more promise in accurate detecting colon cancer. It is possible that in the coming years, we may see an accurate enough version of the stool test that it replaces regular colonoscopies as the primary means of early detection in patients. But for now, it’s important you talk to your doctor about when to schedule your first colonoscopy – remember, if you catch it early, colon cancer is a beatable disease!

A look at Lung Cancer: When Prevention is the Only Cure

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Lung Cancer is an unusual disease in that it was once incredibly rare, so much so that many doctors would never see a case in their lifetimes, and is now a leading cause of death almost entirely due to a single, controllable factor – which just happens to be tobacco smoking. It is also one of the most visible diseases, and is relatively well-understood by the public. We know what causes it, we know it is a fatal disease, and there’s not much debate over these points any more.

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Smoking causes lung cancer, and other than a small percentage of cases that arise from industrial and environmental carcinogens, in general exposure to tobacco smoke is the one controllable risk factor for lung cancer. Smokers have ten times the risk of nonsmokers to develop lung cancer, and that’s not including the #2 risk factor, which just happens to be second-hand smoke.

And while there are screening tests for detecting early signs of lung cancer, these tests are limited in ability to help and can carry sizable risks. Screening, while critical in treating some otherwise fatal diseases, cannot keep you safe from lung cancer. In this case, the only realistic solution is abstaining from smoking, or quitting if you already smoke. The earlier you quit, the higher your expected life span and the less likely you are to get cancer, but quitting at any stage of life has a dramatic increase on your life expectancy.

Most people understand the relationship between smoking and lung cancer. They understand that it is an extremely fatal disease that can be prevented in a very straightforward manner, even if it may be hard to do so. But it’s important to also look at the big picture with regards to prevention as a means of achieving better health and preventing fatal diseases.

There are many diseases where prevention, before the fact, is the most reasonable “cure”.  Type 2 Diabetes, for example, can be prevented in many people by exercising, avoiding obesity, and eating in a healthy manner. While there are treatments and techniques for managing the disease once it has been acquired, the only safe option is not developing it in the first place! Even better, these same lifestyle choices can help prevent Heart Disease and Strokes, which are among the most deadly and frequent killers of Americans.  Cervical Cancer is one of many diseases that can be largely prevented with proper vaccination at an early age. Esophagal Cancer can be prevented by proper treatment of chronic acid reflux disease before it develops into something more.

Remember, you have the ability to manage your own health better than any doctor can. You might not be a medical professional, but you control what goes into your body, when you exercise, and how often you visit the doctor’s office. You have a great deal of power. It’s important to take your role of caretaker of your body seriously!

When Screening Might be a Mistake: Prostate Cancer

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Prostate Cancer is the most common internal organ malignancy in men in the United States. Every year, over 30,000 men die from complications of prostate cancer,  making it the second leading cause of cancer death after lung cancer in men. All signs point to it being one of the most important cancers for doctors to discuss with their patients and to catch early.

And yet the American Cancer Society (ACS) and the United States Preventive Services Task Force (USPSTF) do not recommend routine blood testing for prostate cancer screening – even though it is effective at detecting cancer early. Why would these groups not recommend screening, in that case? It would seem to be a “common-sense” issue to most patients that an early catch equals an early cure. However, with prostate cancer, the situation is much more complicated.

An early American study published recently found that annual use of blood testing and digital exams (where a doctor physically searches for abnormalities with a finger) detected prostate cancer early, but did not lower the death rate from this malignancy. And while a recent large, well-structured study from Europe found a small benefit of blood testing, on the other hand a preliminary result of a large prostate cancer screening trial published in the New England Journal of Medicine in March 2009 showed no survival benefit from screening.

What this means is that while we don’t have much evidence that catching early prostate cancer allows us to do much about it. Furthermore, there is controversy over whether screening in older men, who might die other natural causes before the cancer took its toll, is actually improving quality of lives or simply encouraging them to undergo difficult treatment that is unlikely to extend their lifespan.

Most doctors still believe that catching early prostate cancer can save lives, and most will tell patients this if asked. Nearly every health organization recommends discussing screening options with your doctor, and knowing the warning signs of prostate cancer in order to make better decisions. But this controversy serves as a reminder that screening, even when it is effective at detecting a disease, is not always the answer for finding a cure.