No matter how fast medicine moves us towards treatments, preventive medicine will always be the most effective and cheapest way to keep healthy. Yesterday, we went over the most common screenings for women. Today we’ll look at men’s health screenings, when you should get them, and what kind of experience you’re in for. Not surprisingly, men and women can look forward to different screening tests throughout their lifetime. In today’s case we can solidly notch a point in the “better to be a man” column: There is only one recommended screening test for men of average risk (i.e. with no personal or family medical history). That, of course, excludes routine things checked during your annual primary care visit (blood pressure, cholesterol, blood sugar, urinalysis, abdominal circumference, physical exam, etc) or behavior related screenings (STIs, lung cancer). Those tests are all absolutely critical to maintaining your health — don’t skimp on them just because you think heart disease doesn’t seem as scary as colon cancer. But in terms of recommended screening for cancer and other diseases, you only have a colonoscopy to look forward to. Sad, I know. As always, final decisions about your personal care should be made after a conversation between you and your physician. Not after a quick perusal of the internet. 1. Colorectal Cancer Screening What is it? Most people associate colorectal cancer screening with colonoscopies — a multipurpose test that can screen for colorectal cancer, ulcers, polyps, and bleeding. There are actually a few methods of testing for colorectal cancer, each with a different screening recommendation. The unique advantage of the colonoscopy is that it visualizes the entire colon and allows for tissue sampling and removal of polyps as appropriate. There are also several screening tests that look for blood in the stool, a possible sign of colon cancer. What does it feel like? I had to outsource this question. For the colonoscopy and sigmoidoscopy prep, the almost universal responses were either “I don’t want to talk about it. There’s just so much poop.” For the colonoscopy itself, most people are sedated so you will have no memory of the experience. Because the sigmoidoscope does not travel as far up the digestive tract, patients are awake through the procedure. This was described “like someone is snaking a pipe...only it’s your rectum.” For the fecal occult blood screening test (FOBT), your doctor will insert one lubricated, gloved finger into your rectum and test for blood (a digital rectal exam). This feels exactly as it sounds. For the fecal immunochemical test (FIT), you will collect samples of your own stool. This is painless, but kind of gross. When Should I Get It? The American Cancer Society (ACS) recommends four screening options for low risk men. In all cases, if a test is positive, further exam via colonoscopy is required. Doctors recommend screening beginning at age 50 or age 45 for African Americans. Patients can choose between a colonoscopy every 10 years, a flexible sigmoidoscopy every 5-10 years, CT colonography every 5 years, or double contrast barium enema every 5 years. The American College of Gastroenterology (ACG) emphasizes that their preferred screening test for polyps and cancer is a colonoscopy. For detection of cancer, ACS recommends either a Guaiac based fecal occult blood test or fecal immunochemical test test every year or a stool DNA test every 3 years. They do not consider tests done based on in office digital rectal exams to be a sufficient means of screening for cancer. Based on research suggesting FIT to be a superior test, it was adopted as the preferred cancer detection test by the ACG. 2. Prostate Cancer Screening What is it? Traditionally, men would regularly receive a digital rectal exam (DRE) and Prostate Specific Antigen (PSA) test to screen for prostate cancer in patients without symptoms. During the DRE, the doctor inserts a gloved, lubricated finger into your rectum to feel for growths or bumps. The PSA is a blood test that looks for a protein produced by the prostate that may be elevated in cases of cancer. What does it feel like? The doctor will typically have you bend over the table (there are other possible positions if you are are unable to stand that way) and insert their gloved finger into your rectum, probing around for any masses or anything out of the ordinary. The test will usually last under a minute — you may feel some mild discomfort but there shouldn’t be any pain. Awkward small talk may be involved. While they’re up there, many doctors will follow the exam with a FOBT to look for blood in your stool (a possible signifier of other, non prostate cancer, problems) The PSA is a blood test, so that feels like a finger prick. When Should I Get It? Previously, PSAs were recommended yearly after 50 years of age, earlier for African American men and those with a family history of cancer. More recently, experts have recognized that the harms of this testing may outweigh the benefits. The PSA test may deliver falsely positive results (level elevated but no cancer)., leading to unnecessary anxiety and additional testing. A positive PSA test may also find small tumors that are not causing symptoms, but this may not reduce the chances of dying from prostate cancer. The resulting overtreatment, which may include surgery or radiation, can result in potential harmful side effects and complications. The American Academy of Family Physicians (AAFP) and ACS oth recommend that physicians discuss the possible risks and benefits of testing with patients, before making any decisions on testing. The discussion should start at age 50 for men of average risk, age 45 for men of high risk, and age 40 for those of very high risk. Screening is repeated annually or every 2 years, depending on the results. Testing for men with a less than 10 year life expectancy is not recommended by ACS. The USPTF recommends against PSA testing for prostate cancer (these guidelines are currently being updated). For men who continue to request screening, they recommend doctors fully relay the risks and benefits of the procedure. 3. Penile Cancer Prevention This last one is prevention rather than screening, but many men don’t realize that they are eligible for the HPV vaccine so I want to mention it here. It also protects against other forms of cancer,including anus, mouth, and throat. “Penile cancer” just seemed like the most eye-catching header to go with here. There are vaccines — Gardasil and Cervarix — that protect against the cancer and genital wart causing strains of HPV. While earlier vaccination is ideal (it is recommended after age 11), the vaccine is recommended for women through the age of 26. This is a vaccine that prevents cancer. Man, woman, boy, girl — if you’re eligible and don’t have it, go get it. Regular screening and early treatment of common medical conditions remains your best bet for reaching (or outliving!) the average American lifespan of 78.74 years (if you don’t live in the US, your average life expectancy can be found here). Insurance coverage in the US is higher than ever, but many still have limited or no access to this kind of preventative care. If you do not have a regular physician or are uninsured, there are programs that can help: Planned Parenthood offers STI testing for men. Some clinics also offer the HPV vaccine for free — in other cases they may be able to refer you elsewhere for the shots. The Colorectal Cancer Control Program offers colonoscopies for the underinsured. If there is no program near you, try reaching out to the American Cancer Society at 1-800-ACS-2345. The National Association of Free and Charitable Clinics, FreeClinics.com, and the Free Clinic Directory all order listings of nationwide clinics that offer adult primary care either complementary or on a sliding scale. You can also call your local health department for suggestions. Beyond these, talk to your primary care physician or health care provider. There may be local or community programs that can help find affordable or free resources for these screenings as well. Source
