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    Calling All Men: Health Screenings Really Do Matter!

    It’s often said that what you don’t know can’t hurt you, but when it comes to health screenings, the opposite is true: What you don’t know can hurt you— and routine screenings are the best way to detect illnesses before symptoms appear. Despite this, men are notoriously stubborn about keeping up with routine health screenings. Men are 24 percent less likely than women to see their primary care physician for an annual checkup, even though their cancer mortality rates are far higher.

    A Wife’s Cancer Diagnosis Leads to Her Husband’s First Colonoscopy
    R. Logan Faust, M.D., a Sutter Health gastroenterologist in Santa Rosa, has had many male patients who have neglected crucial health screenings. “Women tend to be far more organized about keeping up with their health care,” he says. “Often, a wife will schedule her own colonoscopy and then urge her husband to do the same.” A case in point involves Charles and Helen Day, both patients of Dr. Faust. “Helen got her first colonoscopy as soon as she turned 50 in 2014,” says Charles. “Dr. Faust found a mass and she was diagnosed with a very early stage of colon cancer that was successfully treated with surgery six weeks later.” This prompted Charles to schedule his first colonoscopy soon after his own 50th birthday, during which a precancerous polyp was removed.

    Most Common Cancers for Men
    The three cancers most commonly diagnosed in men are prostate, lung, and colon cancer, and while the lifetime risk of developing colon cancer is only 5 percent, a full 90 percent of colorectal cancers appear over age 50, and even earlier for African Americans. While more than 140,000 new cases of colon cancer were diagnosed in 2013, the rate of new cases declined an average of 2.9 percent per year between 2004 and 2014, and death rates from colorectal cancer dropped 30 percent — all due chiefly to more people realizing the importance of routine colonoscopies.

    When Screening for Colon Cancer, Timing Is Everything
    “I recommend that most of my male patients have their first colonoscopy at age 50,” says Dr. Faust, “and if you have an immediate family member who had colon cancer, you should schedule your first colonoscopy 10 years before the age that family member’s cancer first appeared.” Risk factors aside, generally accepted guidelines indicate that screening should begin at age 50 and be repeated every 10 years before age 75, and every five years for those with risk factors. Dr. Faust notes that colon cancer is very treatable as long as it’s detected early. “The five-year survival rates for people treated for Stage 1 colon cancer is over 90 percent,” he says. “But if the cancer metastasizes, the survival rate drops precipitously to 12 percent.”

    A Harsh Reality Check for Drinkers and Smokers
    While nobody can change their family history, anyone can make a choice to change their lifestyle, especially if it means living a healthier, longer life. With his practice based in Santa Rosa, the majority of Dr. Faust’s patients live in Napa and Sonoma counties, the heart of California Wine Country. So it may surprise many readers to learn that imbibing three or four alcoholic drinks a day, or 45 grams of alcohol, increases the risk of getting colorectal cancer by 40 percent. Higher rates of polyps and cancers are also seen in smokers, especially those who have used tobacco for more than 20 years. “Smoking is a key risk factor for heart disease,” he says, “so for my patients who smoke, I’ll recommend cessation counseling…" In addition, obesity is closely linked to the incidence of colorectal cancer and resulting mortality rates: People with a body mass index (BMI) over 30 are nearly one and a half times more likely to die from colorectal cancer.

    Prostate Cancer: Prevalence Dictates Annual Screening
    Prostate cancer is rare before age 40, and most cases occur in men age 60 or older. But by age 80, 60 percent of men will have occult or hidden prostate cancer. Prostate cancer is by far the leading cause of cancer among men, second only to lung cancer for mortality. The PSA (prostate specific antigen) test—along with a digital rectal exam—has long been the most widely accepted screening for prostate cancer. Yet in 2012, the U.S. Preventive Task Force issued a recommendation against PSA screening because many physicians used test results to justify performing biopsies, which often lead to infections. As a result of the Task Force recommendation, some physicians have abandoned the PSA test in favor of the 4KScore and PHI (Prostate Health Index). “There is a wide discrepancy between general practitioners and urologists on this issue,” says urologist Raul Hernandez, M.D., who has cared for patients at Sutter Health’s CPMC in San Francisco for more than 25 years. “The PHI and 4KScore do reveal prostate size and urinary flow obstruction, but neither test will identify prostate cancer.” Dr. Hernandez states that he and his colleagues stand firm in their position to perform annual PSA testing on all their male patients starting at age 50, and at age 45 if an immediate family member had prostate cancer. “If PSA levels are elevated, I retest in six months,” he explains. “If levels continue to go up, I will perform a biopsy.” Dr. Hernandez notes that PSA testing is not recommended for men over age 75 unless other risk factors are present.

    Routine Screenings: The Best (Preventive) Medicine
    Certainly, regular health screenings are important for both men and women. “I strongly believe in preventive medicine, especially when risk factors are present,” says Jonathan Nordlicht, M.D., a Sutter Health internal medicine physician. “I have all my patients come in for an annual physical, where I’ll check for blood pressure, cholesterol, diabetes, and other conditions, and examine the skin for any changes. For my patients over age 50, I also screen for colon and prostate conditions, and refer them for colonoscopy screening.” Dr. Nordlicht stresses that screenings must always be individualized to the patient, and that regular exercise is important for people of all ages. “Smoking is a key risk factor for heart disease,” he says, “so for my patients who smoke, I’ll recommend cessation counseling—and for patients over 65 who smoke, I also order an ultrasound to screen for abdominal aortic aneurysms.”

    Dr. Faust adds that it’s especially important for men to manage heartburn or gastrointestinal reflux disease (GERD). “When a patient has reflux for more than five years, I order an upper endoscopy to screen for Barrett’s esophagus, a condition that can lead to esophageal cancer,” he says. In addition, anyone born between 1945 and 1965 should be tested for hepatitis C, which can progress unnoticed for decades and now, thanks to new drug therapies, is 90-plus percent curable. Dr. Hernandez adds that low testosterone levels can produce a host of symptoms, from lethargy and insomnia to lack of libido and low sperm count, so he recommends testing on a case-by-case basis.

    Wise Advice from Man to Man
    Charles Day doesn’t hesitate to offer his own hard-earned advice for readers: “Don’t wait,” he says. “Don’t rely on how you feel or your family history. You may think you don’t want to know, but if there’s a problem, you’ll have much more to deal with.”

    A guide to routine health screenings for men

    We’re here to partner with you in your complete health and wellness. Find out when checkups, screenings and immunizations are generally recommended, then talk with your doctor or care team about what’s right for you. To find a doctor, visit sutterhealth.org/findadoctor.

    ScreeningTo test for:Starting age & frequency
    4KScoreProstate health, need for PSA testingAge 50+ consult urologist
    Abdominal UltrasoundAbdominal aortic aneurysm Age 65-75, once for any man who has ever smoked
    Blood PressureHypertension, risk of heart disease or strokeAge 18, annually, more often with risk factors
    CholesterolRisk of atherosclerosis and heart disease Age 35-79 every 5 years, earlier or more often with risk factors
    ColonoscopyPrecancerous polyps, colorectal cancer Age 50-75 every 10 years, earlier or every 5 years with risk factors
    Complete Physical ExamWeight/BMI, blood work, urinalysis Age 18-39, annually, age 40+ every 1-3 years
    Digital Rectal Exam (DRE)Prostate or colon cancer, hemorrhoids Age 50+, age 45+ for African-Americans, consult urologist
    Fasting Plasma Glucose (FPG)Diabetes Age 40-70, annually for overweight or obese men (BMI of 30+)
    Full-Body Skin ExamMelanoma, basal or squamous cell carcinoma Age 18+, annually, more often with risk factors
    HCV AntibodyHepatitis C virus (HCV) Once if born between 1945 and 1965, consult gastroenterologist
    Prostate Health Index (PHI)Prostate health, need for PSA testingAge 50+ consult urologist
    Prostate Specific Antigen (PSA)Prostate cancer Age 50-75, annually, start at age 45 with risk factors