Agnesian HealthCare Know & Go Friday: Men's Health and Its Relationship to Cancer
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Transcript of Agnesian HealthCare Know & Go Friday: Men's Health and Its Relationship to Cancer
Men’s Health and Its Relationship to Cancer
Adam Liss, MDRadiation Oncologist
Agnesian Cancer Center
The New GuyBorn and raised in FranklinTami is from AntigoMet Tami in MadisonChased Tami around the globe
Madison National Cancer Institute
Still Chasing…to SingaporeBorn and raised in FranklinTami is from AntigoMet Tami in MadisonChased Tami around the globe
Madison National Cancer Institute Singapore
Back to the Midwest, Home to Wisconsin
Completed family in Ann ArborSidney (7)Violet (5)Hazel (2)
Moved home to Wisconsin
Men’s Health and Screening Principles of screening
Primary prevention Prevent a new disease or cancer by reducing risk
factors. Secondary prevention Detect a disease or cancer in early stages,
allowing for early treatment and better prognosis.
Disclaimer Many medical groups have different
recommendations about screening. My bias tends to be for a more conservative
approach. (Because I see patients who have been diagnosed
with cancer, often with a screening test.) It’s best to discuss any screening test or
preventive measure with your primary care provider.
Men’s Health and Screening Created in 1984, the United States Preventive Services Task
Force (USPSTF) is an independent, volunteer panel of national experts in prevention and evidence-based medicine.
Works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services and preventive medications.
USPSTF has published recommendations on screening for 53 different conditions or disease for adult males. Too much to cover today.
Skin Cancer Risk Factors Lifetime UV Light Exposure
H&N and dorsal hand/forearm predilection Chronic Immunosuppression
Organ transplant, HIV, chronic glucocorticoid use Chronic Inflammation (SCC – Marjolin’s ulcer)
Scars, burns, non-healing ulcers, fistula tracts, inflammatory dermatoses (i.e. lichen sclerosis)
Smoking - Mostly SCC HPV - SCC Arsenic exposure
Reducing Risk of Skin Cancer Use sunscreen
Tips on following slide Seek shade
The sun’s rays are strongest between 10 a.m. and 2 p.m. If your shadow is shorter than you are, seek shade.
Wear protective clothing Including a long-sleeved shirt, pants, wide-brimmed hat and sunglasses, when
possible. Use extra caution near water, sand or snow
They reflect and intensify the damaging rays of the sun, which can increase chances of sunburn.
Check your skin for signs of skin cancer. Your birthday is a great time to check your birthday suit. Checking your skin and
knowing your moles are key to detecting skin cancer in its earliest, most treatable stages.
See your primary care provider if you find something worrisome.
What Dr. Liss Does… Apply SPF 50 to high risk
skin of face and ears every morning.
Why…. “H zone” skin cancers
What Dr. Liss Does… Apply SPF 50+ to my children
whenever they are outside. Why….
Even one blistering sunburn during childhood or adolescence can nearly double a person's chance of developing melanoma.
Five or more blistering sunburns in late adolescence increases melanoma risk by 80 percent and non-melanoma risk by 68 percent.
Lung CancerNew cases in the United States - 221,200New cases in Wisconsin - 4,370Deaths in Wisconsin - 3,050
Lung Cancer Risk Factors Smoking
Tripling the number of cigarettes smoked per day was estimated to triple the risk, whereas a tripling of the duration of smoking was estimated to increase the lung cancer risk 100-fold.
3 ppd x 10 yrs safer than 1 ppd x 30 yrs Passive smoking
Accounts for 20 to 50 percent of lung cancers in never-smokers in the United States.
Other Radon, asbestos, indoor and outdoor pollution, male
gender, family history of lung cancer.
Chest. 2003 Jan;123(1 Suppl):21S-49S.
Percent of smokers that get any cancer = 25 percent.
Increased risk of lung cancer in smokers = Up to a tenfold increase risk of lung cancer.
Percent of lung cancer patients that are smokers = 90 percent.
Time to normalize increased risk after quitting = Never.
Better outcomes for smokers or non-smokers in lung cancer? Non-smokers.
Smoking Data
W.H.O. Tobacco Free Initiative
53,000 people who smoked 30 pack years One pack per day for 30 years -or- two packs per day
for 15 years Half had a chest X-ray every three years Half had a CAT scan every three years
20 percent relative reduction in lung cancer deaths CAT scans of the chest picked up more lung cancers
than chest X-rays
Diagnosing a lung cancer early, before a patient notices symptoms, significantly increases chances of cure. Stage I – Three-year survival rate:
60 to 95 percent1,4
One surgery -or- Three to five radiation treatments
Stage III – Three-year survival rate: 25 to 35 percent2,3
30 to 33 radiation treatments combined with chemotherapy
How Can Screening Help In Lung Cancer?
1STARS-ROSEL pooled analysis2RTOG 94103INT 01394RTOG 0236
4-dimensional CAT scan radiation planning
Early Stage Lung Cancer Treatment: SBRT
https://www.youtube.com/watch?v=nZ044EicYO4
Early Stage Lung Cancer Treatment: SBRT
https://www.youtube.com/watch?v=flPWAZk2wkI
Lung Cancer Screening at Agnesian HealthCare
If someone is interested and meets the criteria, please mention this to your provider.
Provider will send you to Rebecca Lentscher, APNP, to review the pros and cons of the CT and make sure the patient meets the criteria.
An order will be placed for the CT. If patient meets the criteria, the insurance companies will pay for it.
Rebecca Lentscher, NP
Medicare Criteria: Age 55 to 77 years old No signs or symptoms of lung cancer 30-pack years or greater history of tobacco smoking Current smokers or have quit smoking within the last 15 years Need written order for LDCT from a qualified healthcare
professional following a lung cancer screening counseling that attests to shared decision-making having taken place before their first screening CT.
Annual screening thereafter.
Lung Cancer Screening at Agnesian HealthCare
Colon/Rectal CancerNew cases in the United States - 132,700New cases in Wisconsin - 2,460Deaths in Wisconsin - 850
Increased risk: Lack of physical activity Alcohol use Obesity Red meat consumption Cigarette smoking Male Family history
Harvard Report on Cancer Prevention, Cancer Causes and Control 1999;10:167.
Colon/Rectal Cancer Risk Factors
”The USPSTF has chosen to highlight that there is convincing evidence that colorectal cancer screening substantially reduces deaths from the disease among adults aged 50 to 75 years and that not enough adults in the United States are using this effective preventive intervention.”
Why a Colonoscopy?Screening and treatment in
one test.Direct visualization.
Many adenomas are flat or depressedDifficult to detect Subtle distortion of mucosal
patternMore likely to contain dysplasia
or cancer than comparable polypoid adenomas
Why a Colonoscopy? Screening and treatment in one test Direct visualization
Many adenomas are flat or depressed Difficult to detect Subtle distortion of mucosal pattern More likely to contain dysplasia or
cancer than comparable polypoid adenomas
Visualize entire colon
Why a Colonoscopy?Screening and treatment in one testDirect visualization
Many adenomas are flat or depressed Difficult to detect Subtle distortion of mucosal pattern More likely to contain dysplasia or cancer than comparable
polypoid adenomasVisualize entire colon
Why a Colonoscopy? Early diagnosis
Precancerous or early-stage cancer Adenoma-carcinoma sequence
Most CRCs arise from adenomas ~10 year progression
Early Diagnosis Regardless of the screening test you and your
provider choose, early diagnosis is key.
Prostate CancerNew cases in the United States - 220,800New cases in Wisconsin - 4,310Deaths in Wisconsin - 590
Prostate Cancer Risk Factors Age
Rare if < 40 years old, chances increase rapidly after 50.
Race African-Americans have increased risk
Family history Especially if diagnosed at a young age
Genetic syndromes Lynch syndrome, BRCA 1/2
What Does Dr. Liss Think? I favor PSA screening in healthy men.
I am biased. I see men with metastatic prostate cancer.
Significant flaws in the evidence the USPSTF used.
Increased understanding of “Active Surveillance”… figuring out who needs treatment.
Improvements in treatment technology decreases the toxicity of treatment which improves the risk, benefit ratio of treatment. 3 Tesla MRI Sparing of normal tissue with RT techniques
76,000 men - ages 55 to 74 Enrolled 1993 to 2001 Randomized to “usual care” or invitation to annual PSA
(4 ng/ml cut-off) and DRE Usual care could include PSA/DRE
Concerns with the trial: 44 percent of patients had PSA in three years prior to enrollment 52 percent of controls screened by sixth year on trial 85 percent screening patients complied
Agnesian Cancer Screening
We have been doing the event for 20 years.
Over the past 15 years we have had 1,591 participants.
Event is scheduled annually in April.
Web Site Resources http://www.uspreventiveservicestaskforce.org/
https://www.nccn.org/
AAD: https://www.aad.org/
http://www.cancer.org/