Morning everyone!

Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health. 

This week we’re going to be talking about CANCER SCREENINGS. Cancer is the second leading cause of death behind heart disease.

Being a preventative doctor, I like to emphasize PREVENTION!  When we talk about cancer screenings, lifestyle is what we call primary prevention… things like nutrition, obesity, and other risk factors like tobacco, alcohol, sun burns, chemical and hormonal exposures. 

Primarily, these are the things you want to do to prevent cancer. 

Secondary prevention are screening tests that detect an early cancer before you notice it. 

I’ll start off by emphasizing that if you do notice a change on your body (lump in breast or testicles, dark spot on your skin, coughing or pooping blood) then you need to get that checked out! 

Today we’re going to be talking about asymptomatic screening for cancer prevention. To do that we’re going to focus on the top 4 cancer killers : Lung Cancer, Breast Cancer, Prostate Cancer and Colorectal Cancer. 

When and how often should you be screened for these cancers? This has become controversial, and my goal with this Note is to give you a Common Sense outlook. 

You’re going to see different recommendations. The American Cancer Society may look at it differently than other committees like The United States Preventative Task Force. 

They often look at the long term cost benefit.

I look at it from the perspective that I want to keep ALL my patients healthy for as long as possible. Whether that’s a 40 year old or a 90 year old. 


Asymptomatic Screening For Cancer Prevention


Here’s a few things to note before we get started. 

The most commonly diagnosed cancer is skin cancer, so we aren’t going to talk about that one much today. You obviously need a skin check and if something is different you need to get that checked out. 

Lung cancer is the top killer. 

The most commonly diagnosed cancer in women is breast cancer and the most commonly diagnosed cancer in men is prostate cancer. Combined is colorectal cancer. 

These are the cancers we are going to focus on in this Note. 


Lung Cancer


Interestingly enough, when the rate of cigarette smoking goes down the rate of lung cancer goes down. 

With that said, early detection is crucial. 

There’s new ways to screen for lung cancer. The chest rays we have used in the past weren’t that good. 

Now there is a low dose CT Scan for cancer. If you’re at risk (smoker), you need to start getting a baseline at the age of 50 all the way up to 80. You need to get it sooner if you’ve been smoking for a long time (age 40). 

If you continue to smoke and haven’t quit in the last 15 years, this needs to be a yearly screening. 

Remember, if you catch lung cancer early enough it may be curable!

These cancers we’re talking about today are slow growing cancers. If you get them early enough you may be able to cure them. 


Colon Cancer


They have recently changed the guidelines on colonoscopies. Now they are recommending you get a baseline colonoscopy at age 45. This is pretty universal now. 

If you have a first degree relative that has had colon cancer, you need to get this screening done 15 years before they were diagnosed. For example, if they were diagnosed at age 50, you would need to get a colonoscopy at age 35. 

I’ve seen so many needless deaths from colon cancer, where a polyp progresses to a large polyp and then cancer. If they can snip it early you can avoid dying from this! This is so important because colon cancer is a killer. To me, it’s the number one preventable type of cancer by screening alone. 

If you have bowel problems like Crohn’s Disease or Ulcerative Colitis, you need to get a colonoscopy a lot earlier. 

There’s other screening tests like a yearly fecal guaiac, which is a yearly thing you should do after 40. 

There’s a new DNA stool test that most people know as a Cologuard test. This is an acceptable thing to do if for some reason you don’t want to get a colonoscopy or if you’ve had a normal baseline colonoscopy with no risk factors. It may be reasonable to do this every 3 years. Certainly more often than a colonoscopy.  

A colonoscopy is the gold standard and that’s what I recommended for everybody. 


Breast Cancer 


There’s a lot of things around breast cancer that are controversial. It’s the number one diagnosed cancer in the US. I have a family member, Dr. Jerri Fant, who is a breast cancer surgeon in Little Rock, Arkansas and she strongly feels that you should get a baseline mammogram at age 30. I agree with her. This is sooner than most recommendations. 

We are seeing more young women in their 20’s get breast cancer. It’s sneaky at this young of an age. It’s more deadly and fast growing. 

I think this is because of lifestyle, exposure to chemicals, pesticides, and hormones in foods etc. 

So I recommend a baseline mammogram at 30 and then another one at 35. Annually after age 40. 

Women – Get a 3D mammogram. And do self exams. 

Note: Even men can get breast cancer (1/100 is in men). A man diagnosed with breast cancer on average lives 6 years after diagnosis. For a woman it is 15 years with early detection. 

If you notice any changes, like a hard knot, pain, or discharge in your breast, get this checked out! 

Men – Don’t ignore this. It’s a lot more aggressive in men. Get a Bilateral mammogram and a diagnostic unilateral ultrasound if you notice something. 


Prostate Cancer 


This is the second leading cause of cancer deaths in men. 

I recommend you get a yearly rectal and prostate exam after the age of 40. You should get this done sooner if you notice anything different like prostate problems (infection), urinary hesitancy, blood in urine. 

The PSA test is controversial. It’s not a great test because a lot of times it can go up and down because of an infection. This can scare you too much. If you have a slightly elevated PSA, don’t freak out. It just needs to be checked and followed. 

Normal is 0-4, but the most important thing is PSA Velocity (how fast it goes up). 

So get a yearly PSA and prostate check. Perk your ears up if something is going on with your prostate. 

African American men need to get screened a bit earlier (by age 45). 

If you are low risk, at 50 you can start screening with a PSA and digital exams. 

Now there is an MRI of the prostate. It’s easier and less invasive than a biopsy, if your PSA has increased. In my opinion, it’s a better way to do it. 

These are slow growing cancers. You need to realize this and not get freaked out by an elevated PSA. 

Remember that PREVENTION is the KEY, so 

  1. Live a healthy lifestyle.
  2. Get proper screenings at the proper age
  4. Lose weight if you are obese (definitely quit smoking!)

And hopefully (prayerfully), you will live a long healthy life without cancer.