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Dr. Rajesh Patel, MD.
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Ask the Doctor!
August 2008
Q:
Based on their age range, how often should adult men and women get physical exams and specific testing such as mammograms, PSA and colonoscopy?
A:
Excellent question! Generally, it's a good idea for people of all ages to make an annual visit to their physician, if possible. A yearly check-up can really help a doctor keep track of a patient's overall health and, if necessary, plan appropriate, prompt treatment. In each visit, it's important to bring in any current medications, including herbal and vitamin supplements. The above-mentioned screening tests are helpful tools that may be conducted in addition to the patient's physical exam.
A mammogram is an x-ray image of the breast(s) that can help identify abnormal growths (i.e. cancer) within the tissue. This screening test is typically done in women, without any symptoms, every 2 years between ages 40-49 and annually after age 50. It is also performed at any age for people experiencing symptoms (like bloody discharge or abnormal growths) and those with a personal or family history of cancer. Mammograms do have some limitations, but they are very effective when combined with a physical exam. While we're on the subject of breast disease, I'd like to briefly mention the self-breast exam (SBE). Recently in the news there has been discussion about SBE limitations in a study in Denmark. Critics of SBE suggest it's causing too many false leads and thus unnecessary grief of the patient. However, there doesn't seem to be enough hard evidence to discontinue this technique. A wide range of physicians and cancer organizations remain supportive of the SBE. This support stems from the notion that the SBE is an easy, early, empowering tool in the fight against breast cancer. I suggest patients discuss the importance and proper technique of the SBE with their physician.
PSA (prostate specific antigen) is a blood protein found specifically in male patients. PSA level can be abnormal in men with any type of prostate abnormality, such a inflammation (prostatitis), benign growth (BPH), or cancer. Because PSA levels can vary with any prostate abnormality, there is still debate about its use as an effective screening test for cancer. In the meantime, PSA levels have been useful in identifying the progress of drug therapies. The PSA is done typically in all men at age 50 and above. The primary risk factor is age, as 65% of these cancers occur in men age 65 and above. Men who also have personal or family history of cancer and those feeling any abnormal urinary symptoms (like urgency or low stream) should consult with their physician.
A colonoscopy is an imaging study involving a tube with a camera end. With this tool, doctors visualize and treat any abnormalities such as bleeding sites or polyps within the lining of the colon. This study is typically performed every 10 years beginning at age 50. However, like other screening techniques, this study is done earlier in people of higher risk. People with a personal or family history of cancer should speak with their physician about the best plan of care. Alternative testing consists of a fecal occult blood test (FOBT), done every year, and sigmoidoscopy, done every 3-5 years. FOBT detects small amounts of blood in the stool, an potential indicator of abnormalities like cancer. Sigmoidoscopy allows visualization of the lower colon and is more limited than colonoscopy.
Colonoscopies and PSA tests are usually performed in conjunction with a digital rectal exam (DRE). The DRE involves a lubricated gloved finger inserted into the rectum in order to feel for any abnormalities. Although it may cause slight discomfort, the DRE is extremely effective and a valuable aid in cancer detection.
Age and genetics are risk factors and do pose some difficult barriers. However, lifestyle choices such as smoking and diet (i.e. high animal fat, excess alcohol, low fiber) play significant a role in cancer as well. Lifestyle modification plays a significant role in the prevention of various cancers. So there are many factors that are in our control. An annual visit to the doctor can help identify and hopefully tackle these issues before they arise.
Submit your questions to askthedoctor@nowoodennickels.org
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