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To Screen or Not To Screen for Cancer!

To Screen or Not To Screen for Cancer!

Dear Hannah,

I read Ken Levitt’s description of the diagnosis and treatment of Prostate Cancer with empathy and great interest. But now my wife and I are having heated discussions about exactly what to screen for and when to begin. I am 75 and she is 71 years old. Amongst our friends, there is no agreement. We need some guidance.

– At average risk, the worried-well  

 

Dear Worried-well,

Screening tests are emotional and controversial. They are done to detect the risk of health disorders or diseases in people who do not have any symptoms of disease, such as cancers, cognitive impairment (early dementia) and diabetes. According to the Canadian Task Force on Preventive Health Care (CTFPHC) “Over diagnosis is an important harm of screening that is different from false positive and false negative screens. Screening that leads to over diagnosis results in unnecessary treatment of cancer that would not have caused harm in a woman’s lifetime.”

Breast Cancer: For women aged 50 to 74, and beyond, screening by mammography is recommended every two to three years, but breast self-examination and clinical breast examination by a physician are not. 

Cervical Cancer: Women aged 70 and older should be screened for cervical cancer until they have three negative tests in 10 years, at which time screening can cease.

Colorectal Cancer: Start screening CRC at age 50 and continue until age 74. Screening is done with one of two tests, the FIT (fecal immunochemical) rest or the gFOBT (guaiac-based fecal occult blood test), done every two years. Or flexible sigmoidoscopy (looking in the sigmoid colon with a camera) can be prescribed every 10 years. With people with first-degree relatives with CRC, the recommendation is to begin colonoscopies 10 years earlier than the age of the first-degree relative diagnosed with CRC – or age 50, whichever occurs first, every five years.

Lung Cancer: The recommendation is for adults aged 55 to 74 with at least a 30 pack-year smoking history (smoking a pack a day for 30 years) who still smoke or quit less than 15 years ago to have up to three annual screenings with low-dose computed tomography (CT scan).

Prostate Cancer: The CTFPHC recommends no screen with PSA at any age and no rectal examination. This is quite different from other organizations. The Canadian Urological Association recommends screening to men at the age of 50 (or 45 for men with a family history). For those who do get screened, the frequency of testing depends on the result of the previous test, with higher scores leading to more frequent screenings. When prostate cancer is diagnosed before the cancer has spread, the five-year survival rate is close to 100%.

Screening tests have to be a joint decision between doctor and patient, once the potential benefits and risks are understood (Dr. Z. Levine, Zoomer, 2/26/2019).

 

Fraud is an Unfair Reality

Dear Hannah,

I am scared to answer the telephone, scared to enter websites online and put in my personal information, even scared to answer the door—I am afraid of fraud, con men and schemes to get my money. Help!

– A potential victim of fraud

 

Dear Potential Victim of Fraud,

The dilemma you face is common and acute. You want to feel free to communicate, to use the Internet, to respond to people, but… My answer to you is to educate yourself, to learn as much as you can about where scams take place, who are the perpetrators, how you can defend yourself—and therefore, AVOID GETTING SUCKED INTO A BAD SITUATION.

Scammers may try to steal your identity, to access your bank accounts or run up debts in your name. They may ask for money outright, as in charity scams or investment fraud. They may even pretend to be a family member who needs cash right away. Once you have lost money in a scam, it may be impossible to get it back, even after you report the scam. Go to this website, open up each link and read carefully: https://www2.gov.bc.ca/gov/content/family-social-supports/seniors/financial-legal-matters/scams-and-fraud/consumer-fraud. Then go to the following website and watch the videos: https://www.bcli.org/project/be-savvy.

Prevent problems with knowledge and determination. Your choice—live in fear, become a victim or be pro-active, get educated, and avoid the scams. I do not read “junk mail” and I do not talk to cold-callers on the phone. I look at my call-display before I pick up the phone. BEWARE!