It doesn’t make for polite dinner conversation and it’s a test many people want to avoid.
But colon cancer screenings are high on the list of basic health tests that Dr. Jeff Hambleton recommends to his patients.
Hambleton, chief medical officer for Providence Physicians Group, is a fa
mily practice physician at the organization’s Monroe clinic.
Basic colon screening tests can be done at home and are recommended every year. In addition, they must be done on three different days within one week to get the most accurate reading, he said.
One big plus for them: They’re done at home, at the patient’s convenience.
The downside: Many people who take them home don’t actually execute the test. It involves taking tiny samples of stool and mailing it to a lab for testing.
Yes, a tool and instructions for how to conduct the test are provided.
Hambleton calls colonoscopy, a much more comprehensive test that checks the length of the colon, the gold standard of colon screening and recommends it be done every 10 years.
Although it’s an outpatient procedure, it does take some preparation. A liquid to clear the bowels must be drunk the night before, then, let’s just say, plan an evening at home.
“The next day you’ll get a little sedation and it’s a breeze, not a big deal at all,” Hambleton said.
In addition, colonoscopies find polyps that can turn into cancer.
“It’s a preventative measure as opposed to purely a screening measure,” he said.
With all this in its favor, it still involves something of a sales job to get patients to go through with it.
“It’s expensive, invasive and it sounds yucky,” Hambleton said.
“My experience is that by having that discussion year after year is that at age 50 they’re not interested. At age 54 they say ‘You know, you’re right, my friend or family member had colon cancer. I’m ready to get that done.’ It’s a continuous education process.”
Anyone with a family history of colon cancer should be tested a decade before a close family member, such as a parent, was diagnosed, he said. So if a parent was diagnosed at 55, get checked at 45.
Here are four other basic medical tests that Hambleton recommends:
1. Blood pressure.
“That one is at the top of my list,” he said. “It’s the screening that makes the most sense as far as identifying a risk that we can treat in early stages when they don’t have organ damage from the condition.”
The heart, blood vessels and kidneys can all be damaged by high blood pressure, he said.
Some area stores and pharmacies offer blood pressure tests for free. If you do get the test at a store or pharmacy, do it twice, he said. “The first one tends to be higher.”
2. Cholesterol tests.
Regular tests that require fasting before they’re conducted are recommended. If the results are normal, the tests can be conducted every five years, Hambleton said.
If not, the patient will be counseled about education, diet, exercise and lifestyle changes and the test will be repeated in three to six months. After that, the test tests should probably be conducted annually.
The tests can detect fatty substances in the blood that are a major risk factor for develop coronary artery disease.
3. Mammograms.
There’s been a lot of debate in the past year over just how often women should get mammograms. Some patients believe firmly in annual screening, Hambleton said, while others have not had one for several years.
“I think the evidence is very clear at age 50 to get annual mammograms,” he said.
Between the ages of 40 and 50, annual screening will find some cancers that wouldn’t have been found otherwise. But there will also be a lot of “false positives,” he said, where the screenings find a lump that may be cancerous but ultimately is found not to be.
His advice: Talk to your doctor about how often the tests should be conducted.
4. Pap smears.
Hambleton does not recommend annual pap smears, citing recommendations by the U.S. Preventive Services Task Force. If a woman has three normal pap smears within five years, “it’s reasonable to go every other year,” he said.
Women over the age of 30 who have normal pap smears and are negative for the HPV virus, which can cause cervical cancer, can get the test once every three years, he said.
<PSA test?
And what about the PSA test for men? Controversy continues to swirl about PSA tests, which can detect signs of prostate cancer, Hambleton said. Even physicians vigorously debate the issue.
Some studies show prostate cancer screenings result in reduced deaths, he said.
“There are many who would say that we have this very good, very sensitive way of screening,” he said.
Black men have a higher incidence of prostate cancer, so they’re recommended to get the test at age 40; for white men, the recommendation is age 50 or to at least discuss it with their doctor, Hambleton said.
Follow-up screenings are not recommended after age 70 to 75, he said.
The problem arises on when to treat prostate cancer if it’s found.
“We may very well be overdiagnosing prostate cancer that may not kill them,” he said.
That’s why physicians sometimes recommended “watchful waiting” to see if treatment is needed. “It may be appropriate, but it’s really difficult for patients to get their brain around that,” he said. “Once you’re diagnosed with cancer, the idea that you’re not going to take it out the next week is very difficult.
“I don’t think we know for sure what the right thing is to do.”
The recommendation from the federal preventative services task: Patients should be counseled on what action to take by their physician but ultimately it should be their choice.
Opinion is split between those who say early treatment is the right thing to do and those who worry a lot of unnecessary surgery is being conducted, “which haunts those of us who think about that,” Hambleton said.
“That’s hard; it’s a dilemma.”
The checklist
What common medical tests should you get as good measures of your health or for preventing or diagnosing serious disease?
Here are some recommendations from Dr. Jeff Hambleton, chief medical officer for Providence Physicians Group and a Monroe family practice physician.
1. Blood pressure tests
2. Colon cancer screenings
3. Cholesterol tests
4. Mammograms
5. Pap smears
Colon cancer facts
• Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer death.
• More cases are being diagnosed in the United States but the mortality rate is decreasing.
• The risk of the disease increases with age, beginning around age 40.
• Men are at higher risk than women.
Who’s at risk? Anyone who has:
• A family history of colorectal cancer
• A family history of polyps in the colon or rectum
• Inflammatory bowel disease
• Had polyps in the colon or rectum removed
Source: The Agency for Healthcare Research and Quality
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