Larry E. Smith, MD, FACP
Preventing disease is of utmost importance to our community. It is cost effective and decreases the incidence of disabling conditions and death. Screening for diseases detects various illnesses at early stages and in some instances prevents the condition altogether. This is true for the leading causes of death: cardiovascular disease and cancer, as well as other conditions. There are three major types of prevention: primary, secondary and tertiary. Primary prevention prevents the disease altogether. Secondary prevention involves the detection and treatment of the disease before symptoms develop. Tertiary prevention involves treating an existing disease to prevent further worsening and complications. To prevent diseases and associated complications, adults should see physician at least on an annual basis and have various screening tests. We now have ways to screen for many diseases such as cardiovascular disease, high blood pressure, obesity, osteoporosis, cervical cancer, breast cancer, colon cancer, prostate cancer, some infectious diseases, and other conditions. Cardiovascular Disease-Cardiovascular disease is the leading cause of death today. This includes conditions such as coronary artery disease, high blood pressure, valvular heart disease, congenital heart disease and peripheral vascular disease. Coronary artery disease accounts for most deaths and involves the buildup of cholesterol plaques in the arteries that supply blood to the heart. The complete blockage of blood flow in a coronary artery leads to a heart attack. Several things can happen during a heart attack such as spontaneous reopening of the artery, continued blockage and damage to the heart muscle, abnormal heart rhythms and sudden death. The risk factors for coronary artery disease are smoking, high blood pressure, increased cholesterol , diabetes, obesity, age, male sex, stress, depression and family history. Smoking is the most important modifiable risk factor associated with developing coronary artery disease. Modifying these risk factors may prevent coronary artery disease.
Chest pain is a common presenting symptom of coronary artery disease and must be evaluated properly. An exercise stress test is usually the initial step and this may be combined with various types of cardiac imaging. Those findings characteristic of coronary artery disease may require visualization of the coronary arteries and additional interventions. High Blood Pressure-High blood pressure is very common in our community and is often unrecognized. It may lead to devastating consequences. To diagnose high blood pressure at the earliest stage possible, all individuals beginning at age 18 and continuing throughout life should have their blood pressure checked regularly. Those found to have high blood pressure should be followed closely, consume a low salt diet, exercise, lose weight and may require treatment with medications. Obesity-Obesity is common and is a risk factor for many serious diseases and death. To prevent the adverse effects of obesity, all individuals should have both their height and weight checked on a regular basis. We know that being overweight is a risk factor for many conditions including heart attacks, strokes, high blood pressure, diabetes and cancer. Weight control will prevent many other diseases. Elevated Cholesterol- Increased cholesterol is relatively common and is associated with an increased risk for strokes, heart attacks and other conditions. We now know that controlling the cholesterol level will help prevent these conditions. Thus, all individuals above age 18 should have his/her cholesterol level checked and repeated every five years. High cholesterol levels should be checked frequently and may be lowered with diet and medicines. Diabetes Mellitus Type 2-Diabetes is common in the adult population and presently increasing in frequency. The risk factors are age 45 years or greater, obesity or overweight, family history, history of gestational diabetes, polycystic ovary syndrome and ethnic background. individuals with risk factors should be screened with 3 years with a fasting blood glucose, hemoglobin Ale or a 2-hour oral glucose tolerance test. The major complications are cardiovascular disease, blindness, kidney failure, peripheral neuropathy, peripheral artery disease and foot ulcers. Strokes-Strokes commonly occur and may result in long-term disability. This condition occurs when there is a blockage in one of the blood vessels supplying blood to the brain. Major risk factors include increasing age, smoking, increased cholesterol, diabetes mellitus and high blood pressure. Controlling these may decrease the chance of a stroke.
Osteoporosis-Osteoporosis (thinning of bone) is a disease commonly seen in older females and is related to an increased chance of fracture and death. Major risk factors for this condition include personal or family history of fracture, current cigarette smoking, low body weight, advanced age, dementia, poor health, estrogen deficiency, low calcium intake, excessive alcohol consumption and inadequate physical activity. To prevent or diagnose this condition at an earl y stage, bone mineral density testing should be offered to all women age 65 or older and all postmenopausal women with one or more risk factors. Lifestyle modification and medicines play important roles in prevention and treatment of osteoporosis. Cervical Cancer- Cervical cancer involves the reproductive system of both younger and older females. There are many risk factors for cervical cancer and avoiding these can decrease the chance of developing this condition. The Pap smear is a screening test for cancer of the cervix and should be performed every 3 years for women ages 21-65 years. In women ages 30-65 years if testing for human papilloma virus (HPV) is added to the PAP smear then screening can be extended to every 5 years.
Breast Cancer- Breast cancer is the second most common cancer found in adult females. Breast examination and mammography are effective screening methods. Starting at age 18, every female should have an annual breast examination by a physician and perform monthly breast self-examination. To prevent breast cancer, an annual mammogram, beginning at age 50 years is required. Those with
a family history of breast cancer will benefit from early screening
Colon Cancer-Colon cancer is one of the most common cancers found in adults and its incidence increases with age. All individuals should have screening beginning at age 50 years. African Americans are at greater risk and should start screening at age 40. Colon cancer and pre-cancerous lesions can cause bleeding thus allowing the early detection.
Various methods are used to screen for colon cancer: annual high-sensitivity fecal occult blood test; sigmoidoscopy every 5 years; and colonoscopy every 10 years. Individuals with a positive stool occult blood test should have a colonoscopy -a procedure used to look inside the colon. Instead, they may also have the combination of a Barium enema (an X-ray used to look for cancer) and sigmoidoscopy -- a procedure used to look for cancer in the part of the intestines closest to the rectum.
Prostate Cancer- Prostate cancer is a common cancer in men and the incidence increases with age. Prostate-specific antigen (PSA) is a sensitive method of screening and it should be discussed with men over age 50. Those individuals with an elevated PSA should have further work-up that may include ultrasound and biopsy of the prostate. The digital rectal exam is also used to screen for prostate cancer. However, this is a much less sensitive method and when positive, tends to diagnose prostate cancer at an advanced stage. Those with a family history of prostate cancer are at an increased risk of developing this condition and should have screening much earlier
Other Cancers-Cancer is the second leading cause of death. Awareness and screening is required to prevent and diagnose this condition as early as possible. For those age
18 and older, screening must be done every three years for cancers of the thyroid, mouth, skin, ovaries, testes and lymph nodes. For those older than age 40, screens must be done yearly. Tn addition, those above age 50 should also be screened for breast, colon and prostate cancer as discussed earlier.
Immunizations-Immunizations have been proven to prevent various infectious conditions. In adults, the major vaccinations of importance are tetanus, influenza and pneumonia and hepatitis B. Tetanus or "lock jaw" can be prevented by tetanus vaccination every ten years.
Influenza is a viral infection of the respiratory system, occurring mostly in the fall and winter months. The influenza virus changes every year and so to prevent the infection, a new vaccination must be given annually. All individuals 6 months of age and older should receive this vaccine.
The most common cause of community acquired pneumonia is still pneumococcal pneumonia and the incidence increases above age 65. Thus, all individuals above age 65 and younger individuals with chronic conditions should have this vaccination at least once. The exceptions to this rule are individuals with protein-losing conditions such as nephrotic syndrome. They should have this vaccine repeated every five years. Hepatitis B is an infection of the Iiver that may lead to cirrhosis or cancer. Individuals at risk for contracting this infection should receive the vaccine in a timely manner as this has been proven to be beneficial in preventing the infection and the chronic complications.
Health Guidance-All individuals above age 18 should see a physician on a regular basis for health guidance. These visits should include issues related to smoking, alcohol and drug abuse, sexual behavior, sexual transmitted disease, nutrition, physical activity, violence and guns, family planning, injuries, occupational health, folic acid use in women of child-bearing age, and estrogen use in postmenopausal women.
The emphasis of physician visits should include discussions about ways to prevent disease and related complications. These visits are particularly important for individuals with risk factors for various diseases and risk factor modification should be emphasized.
Summary-Early screening is an excellent opportunity to prevent disease. Those above age 18 should be seen for health guidance, screening for hypertension, obesity and increased cholesterol, cervical cancers and other cancers. Older individuals should be screened periodically for coronary artery disease, osteoporosis, prostate cancer, breast cancer and colon cancer. Everyone should receive immunizations against tetanus, and those who qualify should receive vaccinations for influenza, Hepatitis B and pneumococcal pneumonia.
For further information on ways to prevent disease please contact:
Dr. Larry E. Smith, MD, FACP Smith Clinic
5116 Northwind Blvd, Valdosta, GA 31605