While the pandemic remains a topic of daily concern, we’ve witnessed the more silent epidemics of social isolation, mental illness and drug poisonings.
I also fear a tsunami of preventable cancers and diseases.
Most of us haven’t seen our family doctors since the start of the pandemic. Most telehealth calls are reactive - in response to acute symptoms - as opposed to the foundational preventive and proactive approaches to your health.
I’ve included a short list of recommended screening tests designed to diagnose problems early while they are more manageable and in many cases curable.
Screening tests are recommended for the early detection and treatment of particular medical conditions in individuals of average risk and no symptoms. For example, the stool or fecal immunochemical test (FIT) is recommended as a screen for colon cancer for adults over 50 to 74 years of age every two years. If it is positive (indicating a source of bleeding in the large intestine), the next test is usually a colonoscopy (in which a flexible scope is inserted into the anus and used to see and remove polyps and other growths in the large intestine).
However, if an older adult has obvious blood in his stools, his physician will likely arrange a colonoscopy without the need for a positive stool occult blood test. If another individual with no symptoms has a family history of colon cancer, the first surveillance colonoscopy should begin at an age 10 years before the age at which the relative was diagnosed. For example, if a woman's father was diagnosed with colon cancer at age 52 and her sister was diagnosed at age 48, she should have her first colonoscopy at age 38.
These are the screening tests for other conditions:
High Blood Pressure: For adults 18 and older, blood pressure should be measured at every appropriate medical visit (e.g. annually) and of course this has not been possible during the pandemic. Most drug stores have removed their blood pressure machines due to infection risks. Once hypertension or high blood pressure is identified, the patient and doctor will discuss the appropriate frequency of rechecking blood pressure. For a list of reliable home blood pressure monitors, check the Hypertension Canada website at hypertension.ca
Cervical Cancer: The pap smear is a sample of cervical cells taken during a pelvic examination, but please note that a pap smear is not necessarily done with every pelvic exam, which may have been necessary for pelvic pain or a possible infection. A woman should always clarify with her physician what tests were done during each examination. Women should start pap smears at age 25 and continue at a frequency of every three years (or more frequently depending on the recommendations of the B.C. Cancer Agency which interprets the pap smears and sends reports to the physician). Women 70 years and older may stop screening after 3 successive normal paps in the previous 10 years.
Diabetes: The fasting glucose blood test was formerly recommended as the screening test for adults over age 40. The confirmatory test was the two-hour 75 gm glucose tolerance test. The newest recommendation is the Hb a1c blood test only in high risk and very high risk patients based on the FINDRISC or CANRISK calculators. Those found to be high risk for diabetes should be screened every 3 to 5 years; those at very high risk every year.
Breast Cancer: Monthly self-examinations and annual clinical examinations by physicians are no longer recommended. Screening mammograms are now the only remaining screening test and the Canadian guidelines recommend them every 2 years in women from age 50 to 74.
Prostate Cancer: The standard screening test is the annual DRE (digital rectal examination). Don't be fooled by the name; it's not high tech imaging. It's high touch with your doctor's gloved finger checking the size and shape of the prostate. The PSA (prostate specific antigen) is a blood test to detect levels of a protein produced by the prostate. It may be elevated by benign enlargement of the prostate or by prostate cancer. It is not generally recommended as a routine screening test, but each man should discuss the value of this test with his family physician as it has to be interpreted in conjunction with the rectal examination. An abnormal PSA may result in investigations and treatment that may cause more harm than a slow growing prostate cancer that may not otherwise affect the patient.
Call your family doctor today, if you’re due for a screening test.
I’ll be giving a free online talk called the Positive Potential of Our Relationships at 7 p.m. on Feb. 25. As part of the Burnaby Division of Family Practice’s Empowering Patients public health education program, I’ll be sharing practical ways to foster healthy relationships and social connections.
For more information, please check https://divisionsbc.ca/burnaby/for-patients/empowering-patients or email Leona Cullen at email@example.com
Dr. Davidicus Wong is a family physician. His Healthwise Column appears regularly in this paper. For more on achieving your positive potential in health, read his blog at davidicuswong.wordpress.com.