Catch cancer early – that’s the point of cancer screening. During an annual check-up we focus on early detection of cancer. There are things that you can do to monitor for early cancer development and tests your doctor should recommend you consider as well. Knowledge is power and early detection equals cure in many cases
Skin cancer is most prevalent in sunny Colorado. In sun exposed skin we see crusty little pre-cancers called ‘actinic keratoses’ all the time. These are from sun damage and are way common on the face and arms. The more irritated scaly gray ‘squamous cell’ and the smooth gray ‘basal cell’ skin cancers are more serious and generally need excision.
None of the above is as dangerous as the dreaded ‘malignant melanoma’. The brown mole that grows and turns black is the classic presentation. I find several of these each year during routine annual check-ups. And several times each year a patient comes in concerned about a changing mole that ends up being melanoma. The ‘ABCD’ mnemonic reminds us to watch for changes in Appearance, definition of Border, any change in Color or Diameter. Basically if anything changes with a mole get it checked! With early excision we usually catch and cure melanoma.
Around their 50th birthday I usually ask patients “would you like to consider getting a colonoscopy”. We get a good laugh as they always reply “uh, not really” and I rephrase the question. Seriously, at age 50 it is time to get a colonoscopy and they are not nearly as bad as suspected. With IV sedation and a more gentle laxative preparation than in the past, the procedure is usually fairly painless. Every single month I get pathology reports for my patients’ revealing colon polyps, many of which are pre-cancerous. If you have a family member with colon cancer then you are at increased risk and should start screening at least 10 years prior to their age at diagnosis. If not getting colonoscopy then each year then you should check for microscopic blood in the stool using various home test kits, e.g. Hemoccult.
Testicular cancer is another cancer that is usually easily detected and one of the few cancers with very effective conventional treatment. We teach young men and boys how to do self-exams, and emphasize that testicular cancer is most common in young men, age 20-40 range. It usually presents as an obvious lump growing right on the testicle. I diagnose one every 5 years or so in my general practice so they are not uncommon.
Breast cancer screening starts with self-exams, for both men and women. Periodically checking for lumps in a methodical manner is the best screen for breast cancer. The current recommendations for mammograms are every year from age 50 to 75. Some groups also recommend every other year from age 40-50. There are valid concerns about radiation exposure and while mammograms are detecting more cancers, it is hard to say if they are clearly saving more lives. Thermograms, or infra-red imaging, may yet prove to be a worthy complimentary test to mammograms, both avoiding radiation and detecting increased blood flow or inflammation years before full blown cancer develops.
Cervical cancer is easily detected with routine PAP smears. Simply scraping the surface of the cervix will pick up the abnormal cells that lead to cancer. Recent understanding of the role HPV (human papilloma virus) plays in cervical cancer has also increased our ability to detect it early. The controversial Gardasil vaccine is designed to prevent HPV infection and thus cervical cancer, but there are many questions regarding its effectiveness and safety. Girls should start getting annual PAP smears about age 18 or when they become sexually active. After 3 normal PAP smears they can start getting them every 3 years until about age 60.
Men should start screening for prostate cancer at age 50. This should include a yearly ‘digital rectal exam’ or DRE. Early cancer presents as a hard spot or nodule on the prostate. The blood test called PSA (prostate specific antigen) has received its fair share of controversy with some groups recommending it not be tested. It is not a perfect screening test and is often elevated for reasons other than cancer. Furthermore, similar to mammograms, it is hard to make a case that it is saving lives. I still recommend the test, but interpret it carefully in the context of the patient’s overall health, and also consider all the reasons for false positive results (infections, inflammation, etc).
Cancers of the blood and lymph, the leukemias and lymphomas, usually present as an abnormality in the routine CBC (complete blood count) or a physical finding such as easy bleeding or bruising, or swollen lymph nodes.
While there are certainly many more types of cancer, the above list is the main group, and the ones most easily detected early. Just this week I have a patient fighting for life in the end stages of ovarian cancer, while another we just diagnosed with pancreatic cancer. These are very difficult to detect early and usually present after they have metastasized or spread. Symptoms such as weight loss, fatigue, nausea and loss of appetite, abdominal pain or fullness, are often the only warning symptoms.
An exciting new area to consider is the use of ultra-sound technology to perform whole body scans. Using sound waves, without radiation, ultra-sound imaging can peer deep into the body looking for abnormal masses that may represent cancer. This enables early detection of some of the more difficult cancers, such as liver, kidney, pancreas and ovary, plus more effective screening of prostate and breast.
“An ounce of prevention is worth a pound of cure” never rings so true as with health, and perhaps more with cancer than any other area of medicine. A simple physical exam, some blood tests, and some imaging procedures may save your life.
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement for men and women, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call (970) 245-6911 for an appointment or more information.