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

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

Routine Health Screenings: Cancer Screening

Cervix Breast Ovary Colorectal Prostate

Cervix: Worldwide

2nd most common cancer in women ~500,000 new cases/ year ~275,000 deaths / year

Cervix: Impact in the US

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

Cancer screening: Cervix

50% of new cases are in unscreened women 10% had not had a screen in 5 years 30% due to system error (sampling,

interpretation)

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

Cancer Screening: Breast (US Impact)

Most common cancer in women #2 in cancer deaths in women 37% decline in mortality from 1997 to 2005 2010 estimates; ~207,000 new cases, ~40,000

deaths

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

Cancer Screening: Ovary (US Impact)

2nd most common Gyn Cancer #1 in Gyn cancer deaths 2010 estimates; ~21,800 new cases, ~13,800

deaths

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

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

Cancer Screening: Colorectal #3 in cancer deaths in women & men (#2 for

Hispanic men) 50% screening rate in US Average risk people should begin screening at

50 y/o Screening tests include; FOBT, Stool DNA test,

Flexible Sigmoidoscopy, Colonoscopy

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

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

Cancer Screening: Prostate Controversy exits regarding screening

recommendations USPSTF recommends against PSA-based

screening in men without symptoms Usual screening tests: Digital Rectal Exam (DRE)

and Prostate Specific Antigen (PSA)

Routine Health Screening: Benign Conditions

Thyroid Diabetes Cholesterol Bone Density

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

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

Routine Health Screening: Osteoporosis

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

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

Routine Health Screening: Cholesterol

Start screening with a blood test at age 20 and every 5 yrs after that, NCEP III

Start at age 20 for men or women risk factors for CHD, USPSTF

Start at age 35 for men and age 45 for women if no risk factors for CHD, USPSTF

Bottom line, speak with your doctor

Summary: Prevention and Routine Screening

Lung (#2) Colorectal (#3) Diabetes Cholesterol

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

Questions?

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