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

1. 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

2. 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

3. Routine Health Screenings: Cancer Screening • Cervix • Breast • Ovary • Colorectal • Prostate

4. Cervix: Worldwide • 2nd most common cancer in women • ~500,000 new cases/ year • ~275,000 deaths / year

5. 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

6. 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)

7. 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

8. 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

9. 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

10. Cancer Screening: Ovary (US Impact) • 2nd most common Gyn Cancer • #1 in Gyn cancer deaths • 2010 estimates; ~21,800 new cases, ~13,800 deaths

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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)

17. Routine Health Screening: Benign Conditions • Thyroid • Diabetes • Cholesterol • Bone Density

18. 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

19. 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

20. Routine Health Screening: Osteoporosis • Osteoporosis is characterized by low bone mass (density) and architectural changes in the bone which increases the susceptibility to fracture

21. 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

22. 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

23. Summary: Prevention and Routine Screening • Lung (#2) • Colorectal (#3) • Diabetes • Cholesterol Lifestyle changes (proper diet, regular exercise, no smoking, alcohol in moderation)

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