screening Archives - Screening for Better Health

When Screening Might be a Mistake: Prostate Cancer

March 27, 2016 by drjaffer

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.

I hate being sick: The Fundamentals of Preventive Medicine

February 15, 2016 by drjaffer

Getting sick is awful. Even a common cold can ruin your week; being laid low for a single day still leaves you sluggish and tired, sets you behind on work, and can easily snowball into a weekend of stress and helpless catch-up. More serious illnesses are obviously even worse – from a lengthy sinus infection all the way up to life-threatening illnesses and afflictions.

Our society has traditionally focused on Reactive Medicine – curing and treating diseases after they are detected. But with every passing year, more and more attention is paid to Preventive Medicine – preventing illnesses before they occur through early detection and healthy living. The argument for preventive medicine is simple and convincing: preventing diseases is often cheaper and more effective than treating them. In many cases, prevention is the only option for diseases that are otherwise fatal! The good news is that you obviously can’t die of a disease you never get.

Prevention seems simple on the surface, but there are many factors that go into it. Most of us receive vaccines as children and adults, and perform common preventive techniques such as washing our hands, trying to eat healthy, and avoiding dangerous carcinogens such as tobacco smoke. This is known as primary prevention: preventing diseases before they actually occur. When a doctor takes your blood pressure and makes recommendations for keeping it under control, he or she is practicing primary prevention.

Most people are familiar with common screening tools such as blood tests, Pap smears, x-rays, and other medical exams designed to detect the early signs of diseases. This is known as secondary prevention. By detecting diseases at an early stage before symptoms have begun, doctors can treat these illnesses more effectively and with much higher rates of success. A disease that is detected early may have close to a 100% 5-year survival rate, meaning people who have the disease treated during this early stage tend to live a normal life span. The very same disease detected late may have a dismal 15% or less 5-year survival rate if detected during the late stages, meaning most people who are diagnosed late will likely die within 5 years.

The final piece of the puzzle is called tertiary prevention. This involves preventing the adverse effects, including the recurrence and complications, of existing diseases. A simple example is the use of aspirin to prevent heart attacks and congestive heart failure in patients who already have coronary heart disease. Another example is the use of the drug tamoxifen to help prevent the spread or recurrence in patients with history of breast cancer.

So when is preventive medicine most effective? The answer boils down to risk, cost, and potential complications.

The patient and doctor must always ask themselves: What are the risk factors for the patient that make this disease likely and worth screening for? In many cases, a disease is more likely based on family history, sex, or lifestyle factors. In these cases, certain tests should be considered and certain preventive techniques should be undertaken. In other cases, a patient is at such low risk for certain illnesses that screening is more likely to result in a false positive test or undue hardship than to provide a benefit, and should be viewed with skepticism.

The cost of screening and prevention often goes hand in hand with the risk factors. One of the goals of preventive medicine is to reduce the overall cost in healthcare, and in many cases it is significantly cheaper to prevent diseases than to treat them reactively. However, this is not always the case, especially when considering the countless number of potential tests and procedures that exist to detect illnesses. It is important to weight the benefits of a test against the likelihood of the patient actually being at risk, as excessive testing can create unnecessary financial burden. The good news is that while screening can be expensive, many preventive measures can be taken by the patients themselves cheaply or free of cost. It costs nothing to avoid smoking, to avoid excessive sugar and alcohol, and to exercise daily, for example.

Finally, the potential complications of any preventive procedure must be considered. Some procedures are invasive or stressful, and in many cases false positives can lead to additional stress, invasive follow-up procedures, and time/money lost. It is important to focus on procedures that are most likely to contribute toward a long and healthy life without causing undue hardship.

It’s important to discuss all these factors with your doctor, as well as to research them for yourself. In a future post, I’ll be detailing some of the most common preventive tools and the ages you should start scheduling certain procedures with your doctor. Preventive medicine is often the best tool for staying healthy – but it requires you to know your body and your options better than ever!

Why the new breast cancer screening guidelines matter

February 15, 2016 by drjaffer

In October 2015, new breast cancer screening guidelines were published by the American Cancer Society. At the time, we were halfway through the publishing process for our new book. We immediately threw on the breaks and started all over again in order to rewrite the chapter on breast cancer. Even though the ACS is one of several organizations that propose breast cancer screening recommendations, their recent data provides strong evidence that screening too early for breast cancer can do more harm than good.

It may seem like a minor change to have pushed back the starting date for mammograms from 40 years of age (the previous recommendation) to 45 years of age, along with decreasing the frequency of exams after age 54, but the change represents a significant shift in how doctors are approaching early breast cancer detection. [1]

Most people are not aware that 1 in 8 women will develop breast cancer over the course of their lifetimes, and are unfamiliar with the progression of the disease. Breast cancer is a serious life-threatening condition, though the difference in life expectancy between early-detection and late-detection can be enormous. Finding breast cancer early is key… but doctors and medical data have often disagreed on the best way to do it.

While many doctors still recommend breast self-exams, and perform breast exams in the clinic, there is no longer scientific consensus that these tests are effective at detecting early cancers. I’ll be discussing the reasons behind this in a future post, but for now it’s important to understand that the most important and accurate test for breast cancer remains the mammography.

There are several reasons for these changes in recommendations. The most significant is that while mammograms are reasonably accurate tests, they do sometimes result in false positives, and the test performs poorly in young women. The younger you are, the less likely you are to have breast cancer, and the more likely you are to have a false positive test. New research has shown that a large percentage of positive mammograms performed on young women are false positives, and a relatively low frequency represent actual cancers. [2]

A false positive can result in enormous amounts of stress and mental anguish, as well as medical costs, time, and invasive procedures. Unless you are a high-risk individual (in which case starting your screening early is advised – speak to your doctor about this), pushing back the screening start-date should help alleviate the frequency of these false positives while continuing to detect early and potentially fatal cancers.

A review of the new guidelines for women of average risk follows, from the American Cancer Society’s website:

Women with an average risk of breast cancer – most women – should begin yearly mammograms at age 45.
Women should be able to start the screening as early as age 40, if they want to. It’s a good idea to start talking to your health care provider at age 40 about when you should begin screening.
At age 55, women should have mammograms every other year – though women who want to keep having yearly mammograms should be able to do so.
Regular mammograms should continue for as long as a woman is in good health.
Breast exams, either from a medical provider or self-exams, are no longer recommended.

It’s important to keep abreast of changing screening recommendations, especially with something as common and potentially deadly as breast cancer!