For Men’s Health Week: Screening for Prevention

Today starts Men’s Health Week and it is actually a great time for cancer prevention for men. You might not think so with all the controversy surrounding PSA testing, but we are making enormous leaps in the ability to detect cancers early when they are most treatable in two of the leading causes of cancer death in men – lung and colorectal.

Colorectal Cancer. We’ve had great screening options for colon and rectal cancers for years. Depending on your preferences and a conversation with your physician as to which test is best for you, there are three evidence-based approaches to colorectal cancer screening: fecal occult blood testing (FOBT or stool test), colonoscopy and flexible sigmoidoscopy.

1. FOBT is a non-invasive test that needs to be done every one to two years. If your FOBT test comes back positive (for blood), your doctor will send you for diagnostic testing, which is done via colonoscopy.

2. Colonoscopy can be both a screening test and a diagnostic test. In a colonoscopy, the entire colon and rectum are examined using a lighted scope. Precancerous and cancerous lesions can be biopsied and removed during the test. Colonoscopy typically requires some form of sedation and a thorough cleansing of the colon.

3. A flexible sigmoidoscopy examines the rectum and lower colon, but not the upper colon.

You can read about the government colorectal screening guidelines on the CDC site.

Some people find the preparation for colonoscopy unpleasant and scientists have been working to find other approaches. A virtual colonoscopy uses x-ray equipment to view the colon and rectum. It is non-invasive and doesn’t require the same preparation as a colonoscopy. However, virtual colonoscopy may not detect smaller abnormal tissue areas or lesions. If a lesion is detected with virtual colonoscopy, a standard colonoscopy is typically required to remove it. Scientists are also working to develop genetic stool tests. In FOBT, the test looks for human blood. In these new tests, the cells from the colon lining that are shed into stool are tested for genetic alterations common in colon cancer. At present, neither test is a recommended screening test by either the National Cancer Institute (NCI) or American Cancer Society (ACS).

Lung Cancer. For years, we didn’t have any evidence-based methods for lung cancer screening. Last year, scientists published a study showing older individuals with a strong smoking history, and thus a strong lung cancer risk, do see a benefit to a low-dose helical CT-based screening. Helical CT (sometimes called spiral CT) takes multiple x-rays of the chest to obtain an image of the entire chest. The National Lung Cancer Screening Trial looked at the effects of this screening tool among current and former heavy smokers with at least a 30-pack-year history.

In the trial, those in the low-dose helical CT arm of the trial had a 20 percent lower risk of lung cancer mortality and a 7 percent lower risk of all-cause mortality than those in the standard chest x-ray arm. The study did not include individuals under age 55 or those who were not heavy smokers.

The National Cancer Institute is still evaluating the trial data to determine its effect on lung cancer screening guidelines. The American Cancer Society issued interim guidelines as a result of the trial finding.

At this point, there is not evidence that non-smokers or light smokers benefit from the screening test – it may in fact do more harm than good, particularly for non-smokers. Forty percent of the trial participants in the CT arm had at least one abnormal scan. These scans lead to additional testing, some of which can be extensive and invasive.

Screening isn’t always the answer, but it is a key part of colorectal cancer prevention and a promising strategy for current and former heavy smokers, though of course, quitting or not starting smoking remains the best way of avoiding lung cancer!

Along with not smoking, other lifestyle choices also play an important role in prevention, such as diet and exercise. You can read more about how to reduce your risk for cancers here.

Dr. Kate Wolin is an Assistant Professor of Public Health Sciences at Washington University School of Medicine and Siteman Cancer Center in St. Louis. She blogs about practical approaches to prevention, wellness and disease management at drkatewolin.com and on Twitter @drkatewolin.


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