Transcription:
Routine Medical Screenings - Why They Are Important

Melanie Cole (Host): During the pandemic, so many people put off visits to their doctors. And as a result, they may have missed routine medical screenings that could be life-saving. Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And joining me today is Dr. Anirudh Rai. He's a primary care physician at Henry Mayo Newhall Primary Care.

Dr. Rai, it is a pleasure to have you join us again today. Dr. Rai is a fan favorite here on it's Your Health Radio. And we're talking about the importance of routine medical screening. So Dr. Rai, as I said in my intro, during the pandemic, a lot of people put this stuff off. I know I did. And because we didn't want to go into the offices, some offices were closed, some people may or may not have done virtual visits. But now, that we're back kind of in the swing of things, I'd like you to tell us how important annual physical and wellness exams are for our overall health, because they're really one of the best ways to be proactive and be our own best health advocate, yes?

Dr Anirudh Rai: Yeah, that's correct actually. So, I'm glad you mentioned particularly the pandemic, which kind of slowed stuff down. In fact, from our current trajectory, our estimate at least is, at least in the next five to 10 years, we're going to see an increase in these things that we were supposed to screen for, like colorectal cancer, cholesterol, diabetes, Pap smears are being decreased. So, there's all this kind of ramifications that were projected to increase in the future, and I think it's very vital to take that initiative, go to your doctor and talk to them about these screenings.

But I guess the overall question is what does it really mean and why is screening so vital I think is, to start off, a good baseline. So, screening kind of just basically gives us an idea of certain populations, certain diseases that have a higher chance of causing these setbacks in the future. For example, with diabetes, if it's uncontrolled, it tends to be quite a bit of an effect in the patient just because they could lose legs. There's other things that could come of it. So, we do recommend going to a doctor for screening in general. But what does it mean, or what kind of things can we screen for is the next logical question.

So, to be a good screening condition, there must be a lot of things that it has to meet. One of the criteria, what we notify is that the disease has to have a high prevalent in the population, meaning that within the already set population, that current condition or disease has to be within a set number of people. I mean, a lot of people must have it essentially is the bottom line. And not only that, it must also cause what we say significant mortality and morbidity, meaning that that particular disease must have quite a bit of ramification in the future. The other thing is there must be an asymptomatic period where we could do treatment for it and where that treatment can be helpful. For instance, diabetes, we could treat for it early, and there's great data showing that you have decreased mortality and morbidity in the future.

The other thing is we must have tests that have high sensitivity and specificity, meaning tests that not only capture the disease, but also help rule out patients who may think they have the disease. So, that's also important just because many of these tests that we're going to talk about do tend to have what we call a false positive and false negative rate, meaning that even if you test for the disease, they may not really have it. And we're going to talk about each particular one as well. Not only that, that must be inexpensive, relatively cheap. That way, it's not a huge burden on the economic landscape, so to speak. Not only that, but there also has to be effective treatment for the disease if you find it.

So, there's a lot of criteria that we look for when it comes to screening, and there's many things we as primary care doctors or doctors generally do watch out for, the things I already kind of mentioned, diabetes, cholesterol, high blood pressure. And these particular conditions are highly prevalent in the population. To give you an example, about 45% to 41% of the people in the US in 2019 that noted have high blood pressure, and that's from all age groups. So, it's something that we definitely want to keep an eye on and treat if we see it come in our way. And the best way to do that is going to your doctor. And every time they go to your doctor, they check your blood pressure. And we do have a chart and certain criteria we look for if your blood pressure's in a certain range based on your age and other factors that go into play. We talk to you about it, "Hey, what ways can we help lower your blood pressure?" A lot of the studies, they recommend that diet is one of the best ways. Low salt, they tell you, but that can be quite difficult. But weight loss alone has been shown to decrease blood pressure by 20%. So, we talk to our patients about, "Hey, how could we get you in a good regimen to help with that?" And thankfully, blood pressure is one of the easiest thing we could screen for. Every time you go to a doctor's office, we look at it and we're like, "Okay, is it high? Is it low? Did we recheck it?" So, it's something very easy to do and unfortunately with the pandemic on board, no one was able to go to the office to have those. So, we're going to see a rise in high blood pressure in the future, is what we're thinking. But if you keep going to your doctor, I think it's a good way to offset that.

Diabetes is another one. To give you a good idea, about 11% of the population in 2019 have this condition. We're seeing it rise to 12% to 13% of the future as well. It's the ninth leading cause of death in the US. And thankfully enough, there's ways to screen for it. The test we use is something called the a1c, which is a blood test to kind of give us an average of how your sugars have been within the last three-month time span. The idea and the physiology behind this is basically that the red blood cells have 120-day lifespan. And if your sugars are really high, the sugar itself gets attached to the red blood cell. And what we test for when it comes to A1c is how much of your red blood cells with a certain concentration have been affected by the high sugars. And that gives us a good idea about if your blood sugar has been high in the last three months or so. And the certain number that we look for is 6.5. If it's that number or higher, then we definitely recommend getting treatment for it just because this has been shown by studies that early treatment for diabetes has been very effective at preventing kidney failure, preventing liver failure, preventing GI issues, preventing vascular issues at the leg, preventing infections. So, this is something that we definitely want to screen for whenever we come see patients. And if there's a family history of either of these conditions, we tend to keep an eye on it much more keenly.

There's many other things we screen for as well. Cholesterol is a very common one, and that's another one we want to keep an eye out for, because we've noted that patients who have high cholesterol for a long period of time tend to have higher rates of heart attacks, higher rates of stroke, and those are very debilitating conditions in general and life-threatening at times as well. So, that's something we definitely want to keep an eye out for. Dietary changes are the best way to help regulate that. And blood work, what we do is look for certain numbers. The LDL, which is the bad cholesterol, is something we look for. If it's above 190, then our studies have shown if you're in the age group between 40 and 75, you do benefit from medication to help with that. And definitely, all of these screening mechanisms and treatment have to be talked to your doctor to see which is best for you, just because there's not really one treatment that's good for all. It's individualized to see if you would benefit for certain medications, certain lifestyle, certain dietary changes, that's all something that should be talked to with your doctor in an individual basis.

So, these are the basic things we test for just on visits alone. But when it comes to stuff like cancer, colorectal cancer is one of the more keen ones out there. To give you a bit more of an idea, just because those conditions we tested for before, cholesterol, diabetes, high blood pressure, that's quite prevalent in the population, about 45% to 50% of the population has it in the US and that's quite a bit. But when it comes to something like cancer, colorectal cancer, prostate cancer, breast cancer, cervical cancer, there's very select minutia that kind of have it. To give you an idea, the prevalence or the amount of patients who have colorectal cancer in 2019 they measured was around 0.14%. It may not seem like a big number overall. But again, we have to keep in count if patients are coming to the office to get this tested. Many patients, when they think of these tests like colonoscopies or stool tests, do have a bit of a pugnacity toward it just because no one wants to look at stool, no one wants to get a colonoscopy. So, something that we as doctors always try to comfort saying, these are quite important tests, just because finding a cancer before it gets throughout the body is one of the best ways to help you live a better life, have a higher quality of life in general when it comes to something like this.

Melanie Cole (Host): And I'm going to interject here because I want the listeners to just hear what you just said, because colonoscopies are easy, they're a piece of cake. The prep may not be the most pleasant experience. But you'll lose a pound or two, it's kind of nice. You know you're nice and clean. And before you know it, you've had a nice nap and you've gotten your nice little pictures. So, don't put off your colonoscopies, people. And, you know, while this podcast doesn't necessarily, you know, every single guideline, but I would like you, Dr. Rai, to, as you're telling us all of these things, give us the quick guidelines on when the first colonoscopy, when the first mammogram. So, as you're going through the PSA and colonoscopy and mammograms for us, please just add in when is that first colonoscopy?

Dr Anirudh Rai: So according to our guidelines, what they recommend is they have lowered the age from 50, which was prior, to around 45. So, they do recommend screening for colorectal cancer in adults who are age 45 to 49. So, they've dropped down the age just because they've noted the sooner we find it, the better off we'll be. And honestly, talking to your doctor about different methods is important. Colonoscopy is one of the great methods to find this type of cancer. The other method is if you don't feel like colonoscopy is good for you, you don't like it, we do have something called a fecal immunochemical test, which is something we could give in the office and have you take back home. And it is a great way to of see, "Okay. Would colonoscopy be something that you could need in the future?" The way this works is to test your blood via immunochemistry to see if you have any blood in your stool. And if they find any trace of it, then a colonoscopy would be highly recommended because that is unusual to have even a little bit of blood in your stool. It's quite sensitive and specific. In fact, it's about 88% to 93% when it comes to sensitivity and specificity. So, it's a really good test, very cost effective if you're worried about a colonoscopy. But again, you have to go to your doctor and talk to them about the best sort of method to monitor for these conditions, because these are very preventable conditions. And it'd be a loss, honestly, if we don't tell you that, yeah, you'll benefit from either colonoscopy, you'll benefit from a FIT test, which is cost effective and simple to do, FIT tests in particular.

The other thing, as you mentioned, is lung cancer screening, and there's particular guidelines for that as well. They noted that in the past, in the '70s and '80s, they would test for this kind of cancer via x-rays. And now, we're doing low-dose CTs, which have been shown to actually be quite effective in preventing this kind of cancer. The reason for this particular one is usually when we find the cancer, it tends to be spread and very hard to treat it. And mortality with lung cancer is quite high if it's been caught late, so this is one of the best things we do. And according to our guidelines, we do recommend that anyone who has been a smoker or smoking history of 30-pack years or so, or quit in the last 15 years. They have to be in the age of 55 and 80. And we do recommend screening yearly for these kind of lung cancers just because these are very preventable. And studies have shown that people do much better if you find this particular type of cancer, like colon cancer, a bit early. So, definitely, talk to your doctor if you've been a smoker for a long time to get these routine screenings.

Breast cancer is the other one you did mention. To give you an idea of prevalence in the patient population, when it comes to breast and prostate, it's a bit more complicated too, I'll be honest, just because the mathematics and statistics behind them tend to be in a very select minutia. So, for instance, breast cancer has a certain population that's adhered to prostate cancer, again, the same thing. So when it comes to what we're learning about it, and we're still learning more about it as we speak, is the recommendations currently is that we do screen for anyone age of 50 to 74 for any sort of breast cancer concerns. And when it comes to any lumps or bumps, we definitely take that very seriously just because when it comes to the mindset of the patient, anything like that is a concern. And thankfully enough, mammograms do help to at least keep some at bay.

And the reason why it's a bit trickier when I say with breast and prostate is since it's a more of a newer sort of subset, we're still learning to see what are the benefits for the future, just because it's, again, a select minutia, since it's 0.65% of the population has that, it's about half of the population, which is 50%, and then 0.65% of that is a relatively good amount. So when it comes to mathematics, it's a bit difficult to say exactly, "Yeah. This is something that you may or may not need, but it's something that we do recommend if you are a select group in that patient population." For instance, if you have a family history of breast cancer, you may benefit greatly to just kind of keep an eye on yearly, to do mammograms yearly, just to make sure that we're not missing a beat if you have a family history of that.

But the other offset is these type of screening modalities do come with a lot of caveats. For instance, if we do screen you for something, we find something, that could be quite upsetting. And if we do more invasive tests and we find out it's nothing, that's again something that, if anything, cause a little bit of harm to you just because you've had the psychological damage that you may have had something. So, it's something we definitely want to talk to each patient about individually and to tell them exactly what these tests partake in and what the ramifications of each test is, just because these particular tests of breast and prostate ones do come with quite a bit of a caveat because we have noted, at least, from our current population, that people have been harmed from it just because of their psychological health, unnecessary procedures. So, something we do recommend you get if you talk to your doctor to see if you're part of that patient population that will benefit from it.

Melanie Cole (Host): Dr. Rai, that is such a comprehensive list. And you know, listeners, you can listen to it again to hear all of the great information that he gave today. And one of the things we didn't discuss, and I'd like you to just briefly cover some of the things that are addressed at that annual well-visit, like mental health screening, depression screening. We're an anxious country right now, so that's a big thing. And then also, especially for women, but for men as well, we are looking at bone health. So Dr. Rai, before we wrap up, I'd like you to just discuss depression screening, mental health screening, and then bone density, because that's something that's really important. And as you are telling us about these things we're bringing into, because both of these things have to do with lifestyle and exercise and healthy diet and good nutrition and self-care. Really important is self-care as we are advocating to be our own best health advocate.

Dr Anirudh Rai: Absolutely. Depression, anxiety is one of the most prevalent things, at least in our population. It's something we always do screen for every time you come for a visit. And it is something that we could help you with too, just because of the pandemic and how things are in the world tend to play a role in how your mental health is and how your mental health in general plays a role in the rest of your body. So, it's very important to remember that psychological and physiological mindset can be quite connected and any sort of terminals you face in your mind will be reflected in your body. So, we do recommend you address those when you can in every bit of it. And we do screen for that as well.

When it comes to the DEXA scans or the bone density scans, we do have our recommendations for women who are above 65, just because at that point the estrogen doesn't have the protective effects. But again, we do talk to each individual patient basis and just to determine if this is a good screening test for you as well, just because we want to make sure you're satisfied with the type of advocacy that you're given as well.

Melanie Cole (Host): Dr. Rai, you're such a wealth of information and such an excellent guest. As we finish up this podcast, please tell the listeners what you want them to know about taking care of themselves, about that self-care, and especially for the women out there. Because if we don't put our own mask on, not being ironic at this point, we cannot take care of the ones that we love. So, we always have to care for ourselves, then we can take care of the other people in our lives. So, please reiterate for us and briefly summarize the importance of these medical screenings and why they're so important, because as we just look at the people that we love, we really do first have to look to ourselves and make sure that we are okay, so that then we can spread that love all around.

Dr Anirudh Rai: That's absolutely correct. So, I think it's great that we have these tools to tell you that. There's ways we could do to help you out, to help your quality of life, that you have control of your own health. Nothing is random for your own health. There's something you could do to improve your own health. So, I think that's a great tool and extremely good armamentarium that every individual has in themself to kind of keep themselves healthy to take care of themselves. In that sense, eating healthy, exercising, washing your hands, all these things and many more. We do recommend you continue to adhere to this to a certain extent. Always talk to your doctor about it. But just remember that your health is always going to be in your own hands when it comes to the mental and the physiological. And doctors are there to help you understand that no matter what circumstances you may go through, there's many aspects of your own health and life that you have control over, and we offer that in our screening every single time you come into our office.

Melanie Cole (Host): Yes, you do. And what a great guest you are, Dr. Rai. Thank you again for joining us. And for more information about important medical screenings and when you should have them done, please visit the cancer care section of henrymayo.com.

And that concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. You can also visit the free health information library at library.henrymayo.com because there's so much great information and you know that you can trust the experts and specialists at Henry Mayo Newhall Hospital. They are here and we are all learning together. So, please remember to subscribe, rate, and review this podcast and all the other interesting podcasts in our Henry Mayo New Hall Hospital Library. I'm Melanie Cole. Thanks so much for listening,