M y younger brother recently told me about an experience he had at the dentist. He is a recent college graduate and has his own business teaching piano lessons. As you can guess, being self employed he doesn’t have the best health coverage. He was at the dentist getting a check up and asked whether he ought to get dental coverage. The dentist reached over to a cupboard, pulled out a pack of dental floss and said, “Here’s your dental insurance.”
The message is clear. For many things prevention is “insurance.” Now I’m not advocating canceling your dental and health insurance. But there is a great deal of prevention that you can do. First and most obviously you can stop smoking, eat a better diet, do some exercise and oh yeah — floss your teeth regularly. Beyond this there are several important screening tests that you should consider. We’ll break these into tests for men, women and everybody.
Women should have regular pap tests. This is a check for cervical cancer prevention. Essentially the physician sends in a sample of cervical cells and the pathologist looks for any abnormal looking cells. If any abnormal cells are present this can be taken care of before there is any progression to cervical cancer. The other important test for women is mammograms to screen for breast cancer. You should ask your doctor when to start and how often you should get these tests as recommendations vary based on medical and family history. Mammograms are especially important if you have family members with a history of breast cancer — particularly first degree relatives such your mother or sisters. Its also a good idea for women over 60 should also get a bone density test to screen for osteoporosis.
Testing for men is more nebulous. Prostate cancer is a leading cause of cancer mortality in men. We can screen for it with a PSA blood test and prostate exams. Recently this test has become more controversial. I would suggest speaking to your physician about whether it would be appropriate to have this test. It may be more important if you have a family history of prostate cancer.
Everyone should have colon cancer screening. If there is no family history of colon cancer this should start at age 50. There two ways to screen — heme-occult cards and colonoscopy. The cards involve putting essentially a stool smear on a card and sending it back to the doctor where it can be checked for any occult, non-visible bleeding. If there is any blood then a colonoscopy is indicated. It’s also OK to skip the heme-occult cards and go straight to the colonoscopy. People are almost universally hesitant to do either of these tests. Neither is as bad as it sounds and both are a lot better than colon cancer. In fact colon cancer is one of the most preventable cancers. Get screened!. Everyone also should have a cholesterol check. There really isn’t an optimal age to do this. Family history does play a role here as well. I usually have people start getting tested between age 30-40. Some may need to start sooner. Everyone should also have some immunizations. We should all have a flu shot once a year. Those over 65 should have a pneumonia vaccine. Some should have it sooner — those with lung disease such as asthma or emphysema and those with diabetes should have a pneumonia vaccine with a booster at age 65. It is also advocated by some that those who smoke have a pneumonia vaccine. People over 60 who have had chicken pox should also have a shingles vaccine.
Obviously this is not a comprehensive list but I think that it’s a good place to start. I also recommend having a dialogue with your physician about what tests would be indicated for you. In the meantime keep your health insurance and dental insurance, get tested and don’t forget to floss.
Dr. Grant Jackson is a family physician practicing in Montesano and writes a monthly column on health.