So, let’s talk about Cancer, shall we?
Are we seeing more, or are we just older and see it more commonly amongst our contemporaries? As a family practice physician, I am supposed to find it and quarterback the treatment. We, as physicians do reasonably well at finding cancers when we use standard screening practices, but what does a doctor do when a loved one (or a patient) gets cancer outside of normal screening ages? WTFN?
We place autonomy in our patients’ hands and hope they will be aware of their symptoms enough to know when things are “just not right,” while the astute physician should be asking the appropriate questions to tease out the answers like untangling necklaces which have been sitting in a drawer for 5 years.
What I’ve come to realize, is that none of this is in our control. You can define “this” anyway you please. We do our best to follow good healthy diets and exercise, quit smoking and don’t do drugs, right? These ideas have been drilled into our heads from 7th-grade health class and the scary-weed-peer-pressure D.A.R.E. programs watched on large tan televisions taken from the janitor’s closet and rolled into the classroom. So, with that said, we see obese smokers live until 90, while fitness gurus die at 50 from a heart attack. It’s beyond nurture at this point, isn’t it? It can be frustrating not to be in control. Our supposed control is a façade anyway, but it gives us some semblance of sanity doesn’t it? It’s kind of like sitting in the driver’s seat of a self-drive car—Just in case thing go awry, I’ll be ready. I’m not saying we have no control, we just have less control than we think.
I digress, let’s go over some important markers in time to recall for screening for cancer:
Cervical Cancer – Pap Smear
21 years old and every 2 years.
When 30 years old, every 3-5 years with HPV screen.
When 30 years old, less than 3-5 years if new penises!
40 unless family history
Every 2 years (I prefer yearly)
Check your breasts, if a lump is found, see a doctor. Can order diagnostic imaging.
50 years old.
Earlier if family history
If persistent blood in stool or change in bowel habits (this is not screening, this is diagnostic)
50 or sooner in African Americans and Hispanics (45)
Done by digital (finger) rectal exam. Yay.
PSA testing – Same as above – Controversial.
Skin – Watch for changes.
ABCDE of melanoma
A – Asymmetry (is it a mirror image if you drew an imaginary line down the middle?)
B – Borders – jagged or smooth?
C – Color – uniform or multicolored?
D – Diameter, less than 6mm? (Size of a pencil eraser – the Ticonderoga-type)
E – Most importantly – EVOLUTION – if it’s changing. Let someone know. If it’s ugly but has been ugly for 20 years, probably not a problem.
Let’s control what we can control and let life’s tide guide you up the river.
Some days I wish I had an Alt-Del–just to start over.