Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, MD
05, September 2007

DON’T LET CANCER SNEAK UP ON YOU

            In the past 50 years there has been a very substantial decrease in the death rate from cancer in the United States.  This is related to surveillance practices that have been instituted including mammography, colonoscopy to check for colon cancer, skin examinations to look for skin cancers, prostate tests to check for prostate cancer, and pap smears to check for cervical cancer.  Notice that I left out chest films for cancer of the lung because no matter when you find it, cancer of the lung has a 95% five year mortality.  Doing a chest film early to find a cancer of the lung is no significant help in preventing cancer of the lung related death.  The most important step in avoiding cancer of the lung is stopping smoking.  Note that cancer of the lung is still the leading cause of cancer death in the United States.  Fortunately, the percentage of smokers in the United States has decreased progressively over the last 50 years and the cancer death rate is beginning to decline.  But lung cancer is still the leading cause of cancer death in the United States.  Worldwide lung cancer will become a greater and greater percent of the cause for cancer deaths as third world countries continue and accelerate cigarette abuse.  If a person risks being in the very expensive jungle of cigarette abuse, the monster of lung cancer can sneak up unexpectedly any time.

            Unfortunately, there are still certain cancers that we just don’t have a good screening test for.  In addition to cancer of the lung mentioned above, cancer of the pancreas is very hard to diagnose at an early stage.  Much of the time it will be found once metastases to the liver have occurred and the person is having increased pain.  Cancer of the kidney is equally difficult to detect early.  There are no good screening tests for this type of cancer other than checking urine on an annual basis and this is a very dull tool.  Sometimes a person might get lucky.  A patient I once cared for worked in a stock yard and got trapped in a pen with a very angry bull.  The bull gored him and broke several of the man’s ribs.  In the course of evaluation for the injuries the bull inflicted, a CAT scan was done and demonstrated a developing cancer of the kidney.  That kidney was removed and saved his life.  He probably should have thanked the bull, but I don’t think he did. 

            Another type of cancer that is very difficult to detect is ovarian cancer.  Certain families carry a very high risk for developing cancer of the ovary.  Performing CAT scans of the pelvis at an early age or even removing the ovaries at an early age is recommended for some individuals.  Fortunately, cancer of the ovary can sometimes be absolutely cured with chemotherapy even in an advanced stage.

            So what is the most important thing a person can do to avoid cancer sneaking up on them?  It is strongly recommended that individuals have annual physical examinations and appropriate screening tests depending upon their family history, their age, and their gender and occupation.  Finding cancers early by physical examination and appropriate testing can very definitely be lifesaving.  The healthcare providers at your local clinic are the individuals “in the trenches” to get these examinations done.  The local clinics are not cancer treatment centers but to keep you out of the cancer treatment center, the best thing a person can do is get their annual physical exam and screening done at their local clinics.

            Specific recommendations include:

1. Pelvic exam and Pap smear annually for women 18 to 50.
2. Colonoscopy at age 50 and appropriately thereafter.  For people with a family history of colon cancer, first colonoscopy should be at age 40.
3. Prostate tests annually for men over age 50.
4. Mammography for women over age 50.  For women with a family history of breast cancer, mammography should begin at age 40.
5. Annual skin exams especially for those with extensive sun exposures.  With the tanning craze, skin cancers are being found in people in their 20’s.
6. Annual physical examinations to check for abnormalities of the thyroid, lymph nodes, abdomen, oral cavity.

Detecting cancers early really can make a difference in a person’s longevity but more importantly it can improve the person’s quality of life.

This and other columns available at www.macpierre.com.