Routine Health Screenings: What you Should Know - PowerPoint Presentation

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Routine Health Screenings: What you Should Know (A Gynecologist’s perspective)

Palm Beach State College

Lunch and Learn Lecture Series

September 18, 2012

Dudley Brown, Jr., MD, MBA

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Background:

BS in Psychology--University of Miami (Coral Gables)

MD--University of Florida College of Medicine

Residency in Obstetrics and Gynecology--Cook County Hospital, Chicago, IL (Chief Resident)

Private Practice in Woodstock, IL for 8

yrs

(Medical Director)

MBA--Northern Illinois University

Office locations: Forest Hill & N. Flagler

Dr

(by Good Samaritan Hospital) in WPB; University

Dr

in Jupiter

Surgeries and Deliveries at Good Samaritan and St Mary’s Medical Centers in WPB

(561)357-6277

www.tenetfloridaphysicianservices.com

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Routine Health Screenings: Cancer Screening

Cervix

Breast

Ovary

Colorectal

Prostate

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Cervix: Worldwide

2nd most common cancer in women

~500,000 new cases/ year

~275,000 deaths / year

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Cervix: Impact in the US

>70% decline in mortality last 60 years#13 in cancer deaths for womenIn 2010, ~12,200 new cases and ~4,200 deaths

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Cancer screening: Cervix

50% of new cases are in unscreened women10% had not had a screen in 5 years30% due to system error (sampling, interpretation)

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Cervix: Current Pap Smear Recommendations

Under 21 y/o, do not screen

21-29 y/o, Pap every 2

yrs

30 y/o and older, Pap every 3

yrs

if 3 consecutive negative tests

65 y/o and older, stop if 3 consecutive negative tests & no abnormal tests in last 10yrs

Any age after hysterectomy, stop if done for benign condition (e.g. fibroids, abnormal periods) and no h/o HG CIN

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Cancer Screening: Breast (US Impact)

Most common cancer in women#2 in cancer deaths in women37% decline in mortality from 1997 to 20052010 estimates; ~207,000 new cases, ~40,000 deaths

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Breast: Current Screening recommendations

Ages 40-49, every 1-2

yrs

(

varies by organization)

Ages 50-74, every 1-2

yrs

(

varies by organization

)

Age 75 and older, No recommendation for age to stop

ACOG recommends clinical breast exam annually after 19 y/o

“Self breast awareness” recommended

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Cancer Screening: Ovary (US Impact)

2nd most common Gyn Cancer#1 in Gyn cancer deaths2010 estimates; ~21,800 new cases, ~13,800 deaths

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Cancer Screening: Ovary

~75% diagnosed at > stage 2

Nonspecific symptoms

No proven screening test

Recommended screening test is an annual pelvic exam

CA 125 is not a recommended screening test

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Ovary: CA 125 Liabilities

High false positive rate leading to unnecessary surgery and increased cost

Identifies late stage disease

Research continues for an effective screening test

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Cancer Screening: Colorectal

#3 in cancer deaths in women & men (#2 for Hispanic men)50% screening rate in USAverage risk people should begin screening at 50 y/oScreening tests include; FOBT, Stool DNA test, Flexible Sigmoidoscopy, Colonoscopy

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Cancer Screening: Prostate

Most common cancer in men

Walnut-sized organ just below bladder and in front of rectum

200,000 men diagnosed annually and 25,000 deaths

Risks factors: age > 50, African American, 1st degree relative with disease

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Cancer Screening: Prostate

Difficulty in starting

urination

Weak or interrupted flow of

urine

Frequent urination, especially at

night

Difficulty in emptying the bladder

completely

Pain or burning during

urination

Blood in the urine or

semen

Pain in the back, hips, or pelvis that doesn't go

away

Painful

ejaculation

Some men do not have any symptoms

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Cancer Screening: Prostate

Controversy exits regarding screening recommendationsUSPSTF recommends against PSA-based screening in men without symptomsUsual screening tests: Digital Rectal Exam (DRE) and Prostate Specific Antigen (PSA)

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Routine Health Screening: Benign Conditions

Thyroid

Diabetes

Cholesterol

Bone Density

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Routine Health Screening: Thyroid

Recommendations vary per organization

Start at 35 y/o and screen every 5

yrs

with TSH blood test (American Thyroid Association)

Screen at 50 y/o (American College of Physicians)

Other organizations say only screen if someone in symptomatic

Bottom line, discuss with your physician, especially if there is a family history of Thyroid disease

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Routine Health Screening: Diabetes

Screen with blood test if BMI >25 and another risk factor present (e.g. Hypertension, age > 45, certain ethnic groups, habitual physical inactivity) American Diabetes Association

Screen if BP consistently > 153/80 (treated or untreated) USPSTF

Screen in pregnancy

Bottom line, discuss with your physician, especially if there is a family history of Diabetes

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Routine Health Screening: Osteoporosis

Osteoporosis is characterized by low bone mass (density) and architectural changes in the bone which increases the susceptibility to fracture

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Routine Health Screening: Bone Density

Postmenopausal women age 65 and older

Postmenopausal women younger than age 65 if risk factors are present (e.g. previous fracture as an adult, parents with h/o hip fracture, steroid therapy, low body weight, smoking)

No screening for premenopausal women

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Routine Health Screening: Cholesterol

Start screening with a blood test at age 20 and every 5 yrs after that, NCEP IIIStart at age 20 for men or women risk factors for CHD, USPSTFStart at age 35 for men and age 45 for women if no risk factors for CHD, USPSTFBottom line, speak with your doctor

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Summary: Prevention and Routine Screening

Lung (#2)

Colorectal (#3)

Diabetes

Cholesterol

Lifestyle changes (proper diet, regular exercise, no smoking, alcohol in moderation)

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Questions?

Dr. Dudley Brown, Jr.Board Certified, Ob/ GynOffices in West Palm Beach and Jupiter(561)357-6277Accepting New Patients