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By Wendy Migdal
Can you complete the phrase, “An ounce of prevention is worth . . . “ You probably can, and you probably also know who said it. Considering that Benjamin Franklin lived to age 84 when life expectancy at that time was about 20 years less, we would do well to heed his advice.
It may seem strange to start the new year by considering the leading causes of death, but in the interest of prolonging life, it’s prudent to do so. According to the Centers for Disease Control, the top five causes of death in the United States for 2021 were, in order: heart disease, cancer, COVID-19, unintentional injuries, and stroke. COVID-19 was also likely responsible for shortening life expectancy by .6 year from 2020 to 2021. Within the second leading cause of death, cancer, the top five causes of death are, in order: lung, breast, prostate, colon, and pancreatic cancer.
Of course, listing causes in order is only part of the data story. How much of a gap separates the leading cause from the second leading cause? What are the rates when broken down by race or sex? And how many new cases are diagnosed each year compared to the number of deaths each year? The CDC has easy-to-understand data to answer all these questions, and we’ve included a few of their graphs here. Go to cdc.gov and click on Data and Statistics for more information.
Primary Preventive Care
But let’s talk in general terms about what you can and should do right now for your ounce of prevention. Many people only go to their primary care doctor when they become ill with an upper respiratory infection. But for heart disease and stroke, an annual visit to your primary care doctor is your best screening tool.
Your primary care doctor checks blood pressure, listens to your heart, feels for swelling around the ankles and glands, and knows your health history. This is also where you go for a cholesterol check, which is recommended every five years for everyone over the age of 20. He or she can order an EKG or ultrasound of the arteries if it seems necessary. Your primary care doctor may also order occasional blood tests to monitor liver and kidney functioning if you are taking prescription medications, since these two organs are responsible for processing and excretion of drugs. A visit every year allows your doctor to monitor changes over time and discover anything out of the ordinary, or out of the ordinary for you.
Your doctor will also advise you about cancer screenings you should get based on your age and health history. Screening refers to checking your body in some manner for a disease before you begin to exhibit symptoms. The idea is to catch the problem early, when treatment is the most effective. This doesn’t mean that you should be screened for every type of cancer, however. Many studies have been conducted for each type of cancer to assess whether early detection results in lower death rates. The data shows that for some
cancers it does, and for others, it doesn’t. In those cases, it may not be worth the trouble. The four cancers in which early detection has been shown to have the greatest impact are lung, breast, colon, and cervical cancers.
Colorectal Cancer Screenings
By now many people have heard that in 2021, the U.S. Preventive Services Task Force lowered the recommended age for colorectal cancer screening to begin, from 50 to 45 years old. The change was made because data showed trends towards younger people developing colon cancer and, at the same time, supported the findings that earlier screenings led to increased life spans. According to the Colon Cancer Foundation, most people with early-age-onset colon cancer do not have a family history of the disease. Colon cancer usually develops from abnormal growths in the colon called polyps. If these polyps are found early, they can be removed before becoming cancerous.
A colon cancer screening is probably the one most avoided by patients, according to a local doctor. People tend to be put off, and reasonably so, by the prep that is involved with a colonoscopy. The patient also has to have someone drive them to and from the procedure, which can limit some people from having the test.
According to the National Cancer Institute, slightly fewer than 72% of people aged 50-75 years were in compliance with current guidelines.
However, other types of screening are available. Colorectal screenings fall into two major categories: stool-based and optical. There are three types of stool-based screenings, which are all self-collected in the privacy of your own bathroom. The fecal occult blood test (FOBT) checks to see if any blood is present in the stool, as bleeding is a common sign of colon cancer. The fecal immunochemical test (FIT) is essentially another way to look for blood, but instead of finding actual blood, it tests for the presence of an antibody to a protein that is found in the blood.
Finally, the fecal DNA test looks for abnormal DNA from cells inside the colon or rectum. The first two tests can be requested by anyone, but a doctor’s prescription is required for the third.
In addition, the FOBT and FIT tests should be done every year, while the fecal DNA test is recommended every three years. It’s important to realize that none of these at-home options are used to diagnose cancer, but instead to point to potential problems.
There are also three optical screenings. A colonoscopy, as most people know, involves the insertion of a camera into the entire length of the large intestine. A sigmoidoscopy is a similar procedure, but the camera does not go in nearly as far, the prep is much less involved, and it doesn’t usually require sedation. Doctors
may sometimes recommend this procedure for people who arenot at high risk for colon cancer and who also do an at home test every year. And finally, with CT colonography, the optical scanner is external. It does involve the insertion of a short probe and the same prep as with a colonoscopy. On the other hand,
the procedure is shorter, doesn’t require sedation, and can reveal other issues in the abdomen if there are any. (A type of CT scan is also used to test for lung cancer in people who are current heavy smokers or who quit within the last 15 years).
Women’s Health Screenings
The statistics on breast cancer are sobering. According to the American Cancer Society, one in eight women will develop breast cancer during her lifetime. The good news is that deaths from breast cancer have been decreasing steadily for the past 30 years, and much of this is attributed to early detection and increased
awareness of the disease.
Since most health insurance plans now provide mammograms every one to two years at no cost, there is little reason not to get one. The U.S. Preventive Services Task Force currently recommends that women aged 50-74 years who are at average risk for breast cancer get a mammogram every two years, though many people begin earlier than that. With many mammograms, there can be a false positive test, or something that looks like cancer but isn’t. This can sometimes cause a great deal of anxiety; however,
once an individual has past radiographs on file, the radiologist has a reference point to compare from one year to the next to look for changes.
There are many additional options for breast cancer screening, such as the 3D mammogram, ultrasound, and breast MRI. In some cases, these are recommended for women with dense breast tissue, and in other cases, they are used as follow-ups for suspicious findings on a regular mammogram. Cedars-Sinai Hospital
recommends that every woman get a risk evaluation at age 30 in order to come up with a screening plan that makes sense for them.
Many factors are used to determine an individual’s risk, so it’s best to talk to a doctor rather than using a one-size-fits-all approach.Both the CDC and the American College of Obstetricians and Gynecologists have reduced their recommendations for the frequency of Pap tests and HPV tests. In the past, a Pap test was
recommended every year for women aged 21-65. Now that’s been reduced to every three years, if the last test was normal. The change is due to the recognition that cervical cancers take a long time to develop.
Osteoporosis, while not a form of cancer, can have serious effects in older adults. A thinning of the bones, osteoporosis affects women more than men due to the dropoff in estrogen levels after menopause. Estrogen is important for healthy bones. The recommended age for a woman at low risk to get a bone density test is 65 years old. But women with a risk factor such as having a parent who broke a hip, for example, may begin testing at age 50.
If you’re a procrastinator, like many of us are, you probably have several reasons why you’re not up-to-date on your screenings. We’re busy, or we really want to do it but just haven’t gotten around to it. If your reason, though, is because you’d rather not hear bad news, remember that most problems are much easier to treat the earlier they’re caught. So schedule a health day: plan ahead, stack a few appointments in one day, and give yourself a little pat on the back for a job well done.
Wendy Migdal is a freelance writer who has lived in the Northern/Central Virginia area since 2000. She enjoys history, reading, and all things dog.