Dr Lisly Chéry (Host): Lisly Chéry, M.D., Associate Professor, Urology Hi, I'm Dr. Lisly Chéry, associate professor of Urology at UT MD Anderson. I'm joined today by Dr. Amy Hassan, chair of General Oncology at UT MD Anderson. And this is the Cancerwise podcast. Dr. Hassan, thank you so very much for joining us today.

Amy Hassan, M.D., Chair, General Oncology It's my pleasure.

Dr Lisly Chéry (Host): So, something that I've noticed in my practice, and that's also backed up by research, is that men are more reluctant to go to the doctor and sometimes just don't want to go to the doctor. So, today we're going to talk about how to get your father, brother, spouse, friend or loved one to address their symptoms and to get serious about their cancer screenings.

Dr Amy Hassan: Chair, General Oncology Yeah, I think there may be a number of reasons, but, you know, I think a big one is that unlike women, who tend to need to seek care for reproductive needs earlier in their life, men don't really have another reason to need to go to the doctor, right? If they're feeling well, they don't really think about needing to go to the doctor. With women, once they're there already for their other reproductive needs, they're kind of a captive audience, and the doctor can, you know, address other things that they may need, like screenings. But men don't have that same reason to go.

Dr Lisly Chéry (Host): Professor, Urology That is so true. I think particularly for young men, they really never think of going to the doctor unless something is wrong. You know, kind of the mentality of it's, you know, if it's not broke, don't fix it. I think a lot of men also have the idea that they have to tough through things, you know, like just, you know, be a man and tough it out. So, if it's not really bothering them a lot, they're not going to take the time to get it addressed. So, I think a lot of the mentalities or conceptions that we have of things that we associate with being a man, kind of get in the way of seeking the care that is needed to keep us healthy.

Dr Amy Hassan: Hassan, M.D., Chair, General Oncology I think that's a really good point, and maybe something we need to try to change the conversation around. Maybe it's helpful for people to know what might be some of the risks of not seeking care early and, you know, not getting regular screenings or ignoring symptoms if they occur.

Dr Lisly Chéry (Host): M.D., Associate Professor, Urology That is the biggest thing that I try to convey. Like almost anything, it's easier to tackle or address something when it's smaller than when it's a much bigger issue. So, you know, going for regular checks allows you to, you know, stay on top of things. It allows you to know if there is something wrong, get it addressed a whole lot earlier when it's, you know, easier to do, it's often cheaper to do, the therapies or remedies aren't as intensive than kind of waiting until the last minute. For, for a lot of men, you know, it's something you can compare to, you know, maintenance for a car, for instance. You know, there are things that you do all the time for your car. You want to get new tires, get your tires rotated, get your oil changed, all these things that you do as maintenance to keep the car running well, you don't want to wait until there's smoke coming out from under the hood to say, you know, now's the time that I want to go into the shop because, you know, then you're maybe looking at a new car, and we only have one body, so we can't change, change things out. So, that's one of the things that I like to compare it to.

Dr Amy Hassan: General Oncology Yeah, that's really a great analogy. And when we, you know, as obviously physicians to treat cancer also know that, you know, certainly the treatments can be even more successful, obviously, when something is caught very early and sometimes even, you know, preventing things, that's always the way to go.

Dr Lisly Chéry (Host): M.D., Associate Professor, Urology Yeah, yeah, that's so true. It is. You know, if we identify cancer early, you know, oftentimes we're talking about, OK, this is what we're going to do to to get this cured and get it beat and to put this behind you. And you know, when something's a lot more severe, if it's stage 4, then we're having a completely different conversation. And, you know, sometimes cure is not on the table anymore. So, you know, getting that identified so much earlier, it's such a much better idea.

Dr Amy Hassan: Amy Hassan, M.D., Chair, General Oncology Yeah, absolutely. Very, very important. While we're on that topic, like, perhaps we can maybe talk about like, what are some of the main types of screenings that men should be undergoing on a regular basis?

Dr Lisly Chéry (Host): Lisly Chéry, M.D., Associate Professor, Urology We should definitely talk about that from the cancer screening perspective. The big one that I deal with often is prostate cancer. So, prostate cancer, very common cancer for many in the United States. In terms of the screening recommendations, the earlier you screen the better. So, around age 45 is what we recommend. A lot of men have apprehension about prostate cancer screening, particularly because I'd say traditionally it involves a feeling the prostate, or a physical exam or rectal exam that universally men do not want to to have in any way, shape or form. But the good news that I would say is that we've shifted to screening for prostate cancer, for the most part, now is a blood test. So, for that initial screening you're talking about at age 45, getting your PSA checked, which is just a blood test, they don't have to worry about the digital rectal exam for screening, so they don't have to worry about that aspect of things. We came to that as a way to help get more men to come, because a lot of men weren't seeking care because they fear that more than they fear the cancer. So, now it's a simple blood test that gets checked essentially once a year. And if that initial screen shows up as positive, then there are other tests that we get along the way to to further figure out what's going on. The other very common cancer for men, and just in the United States in general is colorectal cancer. And that goes hand in hand -- the ages are similar. Colorectal cancer screening now is recommended at age 45 for colonoscopy. And that is a somewhat recent change. Before people thought of it is, you know, something that used to start when you're in your 50s or older. But now the recommendation is the first age is 45. If you have a strong family history, that can be shifted even earlier, but for the average adult male, it would be 45 to get that first screening colonoscopy, and then after that, it kind of depends what they find on that initial colonoscopy. And that can be successful in terms of identifying colon cancer for those screenings and for finding a prostate cancer very early when our success rates of getting get treated are very, very high. Those are the two that I think about the most. What other screenings are there that men need to think about?

Dr Amy Hassan: General Oncology Yeah, yeah, those are definitely ones that, you know, apply to really all men. So, those are really our top ones for sure. In particular, I know colon cancer, you know, we are seeing it being diagnosed at younger ages these days. And hence the reason that they decided to lower that age at initial screening to 45. So, it's really, really important to think about that. And as you mentioned, those cancers, you know, can be much more successfully treated when they're caught early. So, there are a few others that men may consider just kind of depending on their risk factors. So, one of those would be lung cancer. We do have screening recommendations for people who are smokers or have had a significant smoking history in the past. Those recommendations do vary a little bit, kind of depending on which guidelines you're looking at. But in general, it's typically around the ages of about 50 to 80 for men that have had a at least a 20 pack-year history of smoking. So, for instance, if you had smoked one pack a day for 20 years, that's considered a 20 pack-year history or two packs a day for ten years would also give you a 20 pack-year history. So, anything more than that. And if you are either currently smoking or have quit within less than 15 years, then you can consider screening for lung cancer. And that is done with low dose CT scans typically once a year for people in that category. So, that's one definitely for folks to consider. And then another one is skin cancer screening. Skin cancers, of course, are very common. And particularly, there are certain individuals who may be at higher risk for developing skin cancer. Those include people who are very sun sensitive. So, we think about people, for instance, with, you know, red hair or blond hair, sometimes, too, pale skin, and, you know, typically the kind of lighter colored eyes like blue or green eyes as well. Those individuals just tend to be more sensitive to the sun in general, and definitely should use some protection, but should really be considering annual skin exams for screening for skin cancers, including melanoma. Melanoma, of course, being the most serious skin cancer that we know of. And again, just like these other cancers that we talked about, if you can diagnose it early, you know, treatment is much more successful. So, those individuals certainly, and if you have a family history of melanoma would be another, you know, reason to be considered, sort of, in that higher risk cancer category for skin cancer or folks also that have a lot of of nevi or what we call moles, colloquially, if you have a lot of those, then, you know, you need to to have those monitored. So, those are the groups of individuals that definitely should consider annual skin screening. And for others, you definitely want to be very aware of any changes in any skin lesions. So, those are really kind of the main things that men should be considering in terms of cancer screenings. But you know, as always, you want to, you know, talk with your doctor about what's most appropriate for you, right? So, obviously hence the importance of, of going to see the doctor and just having those, you know, routine visits.

Dr Lisly Chéry (Host): Yeah, yeah, very true. And you know outside the realm of cancer there's high blood pressure, you know, diabetes, cholesterol, obesity -- these are all things that get screened, and oftentimes at even younger ages than people in their 40s. You know, high blood pressure screening starts in the 20s to try to get a handle on it. So, all great reasons to go to the doctor, you know, early and often and establish that relationship with a with a primary care provider. So, if someone is watching or listening to this and they have a loved one who still may be reluctant after all the good reasons that that we gave them, what are some, you know, tips or suggestions that you can give to a loved one or a, you know, a caring family member or friend of a man who is still reluctant to want to go to the doctor.

Dr Amy Hassan: Chair, General Oncology Yeah. I mean, I think that the first thing is always just, you know, don't be afraid to open up that conversation, right? You know, you're not going to get anywhere if you don't start talking about it. You know, so, if you have men in your life that are not going to see the doctor, just, you know, talk with them about it. Is there some reason that they're, you know, hesitant to go to the doctor? Maybe you can, you know, help come up with some help for them, you know, for those particular reasons that they might be hesitant. And, you know, sometimes even considering, you know, "Oh, well, how about if I come with you to the doctor?" Maybe that helps to make it feel a little bit less intimidating to have, you know, a loved one, or a friend or whoever accompanying you to the visit. So, I think that those are some good ways to just try to

prompt the visits or even offering to say, you know, "Hey, I could, I can make the appointment for you if that would be easier for you. If you feel you're very busy and don't have time to do it."

Dr Lisly Chéry (Host): Yeah.

Dr Amy Hassan: So, those are some things, I would think.

Dr Lisly Chéry (Host): Yeah, yeah, those are all excellent. You know, some tips I've gotten from when a man comes to see me and they're coming in with, you know, a family member or spouse, daughter, sister, they'll often say, a lot of men have a, you know, a negative view of the doctor or it's something that is, you know, something that's not necessarily a waste of time, but something that detracts from what they want to do. So, they'll pair it with doing something that they enjoy afterwards. You know, a lot of times they say, "Am I, you know, am I good to leave? We're going to go, you know, catch lunch." Or do something that they enjoy as kind of a counterbalance to the idea that the doctor is not something that they really want to do. So. So, that's another tactic. You know, being persistent, as you said, bringing it up. But knowing that the first time you bring it up may not necessarily be successful in getting them to to go. So, just bring it up. Staying positive. If you're someone that goes to the doctor often bringing up the benefits that you feel that you get from going to the doctor, that you get from that relationship. A lot of men also talk about the time that it takes, you know, going to the doctor, you know, takes time out of the day. They have to travel there or wait in the waiting room, then see the doctor. With the increase in telehealth and virtual visits, that can be a nice first step to get them to go. It usually takes less time from the patient perspective. You know, they don't have to go or wait in the waiting room. And they can get that first visit with a provider to talk about things and open up with their doctor about it. I've seen that utilized. More and more commonly I'm getting more request for virtual visits and patients seem to like it. So, that's something to try if someone's reluctant to actually physically go to, to seek medical attention. And then the other thing is just, you know, pushing on that thought that they have about being there and being there for the family. Explain to them why you want them to go to the doctor. Why do you think it's beneficial? Really just staying positive about the scenario. And I think that they usually over time are able to come around.

Dr Amy Hassan: Chair, General Oncology Yeah. No, I think that's incredibly important. I think that it can often be, as you mentioned, to emphasize the positive that we want to keep you healthy. We want you to be around for a long time, you know, to be with the family. So, absolutely, I think those are great suggestions. And I totally agree with you about the the telehealth option being convenient often for people who are very busy, of course, so, at least as a first visit.

Dr Lisly Chéry (Host): M.D., Associate Professor, Urology Right. Yeah, exactly. And the other thing that, that sometimes I will get are, you know, if someone has a bad interaction with a provider or something like that, it will turn them off from, you know, medicine in general. And I'll say, you know, "Just because you go to a bad restaurant, you never say, 'I'm never going to go eat again.' You're going to say, 'I'm just going to try it in a restaurant.' So, you know, if there's a provider that for some reason didn't see eye-to-eye with, you're selling yourself short by not going to the doctor ever again. Just find a provider that works for you. Because it should be a relationship. It should be a back-and-forth. There should be a lot of dialogue and decisions that are made together. So, if you find a provider that doesn't work for you, you know, find another one that does work. Don't deprive yourself of that because you're only doing yourself the disservice." So that's something else that I try to bring up and I've also heard other family members and support people talk about with patients.

Dr Amy Hassan: M.D., Chair, General Oncology Yeah, yeah, a really good point. It's always helpful to sort of draw parallels between other parts of your life, for sure. And, yeah, while

we're talking about it, so, about how frequently should we be recommending men to go to the doctor typically?

Dr Lisly Chéry (Host): Chéry, M.D., Associate Professor, Urology Oh, OK, I think a good rhythm is about once a year initially, particularly when, you know, you're just doing the screenings and everything is going well, once a year usually works for just checking in. Some people do it around the time of their birthday. They know my birthday month, I'm going to go to the doctor every month of my birthday month. Some people are used to it from, like, you know, school physicals. I know I have to take my kids to the doctor kind of in the summer or fall. And then it's just the time where everyone's going to go get their kind of annual check -in or appointment. Anything that you do over and over again kind of becomes a habit at the same time of year. So, usually it is it is once a year. And then I know sometimes I can change depending on what's going on. What do you think?

Dr Amy Hassan: Chair, General Oncology Yeah for sure. Annually is definitely recommended. You know, you want to get you know, those various different screenings including, like you mentioned, checking, you know, blood pressure and cholesterol and things like that to make sure those are in order. And it's a good time for the physician to be able to check and see what, you know, cancer screenings, for instance, might you be due for, you know, kind of on that kind of a cadence. But yeah, obviously it will then depend on if you're having any other issues or on medications, then you might need to be seen more frequently than that, but certainly at least annually I agree.

Dr Lisly Chéry (Host): Professor, Urology Dr. Hassan, thank you so very much for joining me today.

Dr Amy Hassan: Oncology Yeah, this was great.

Dr Lisly Chéry (Host): Professor, Urology If you enjoyed this episode, don't forget to follow or subscribe on Apple Podcasts, Spotify, YouTube or wherever you get podcasts. And be sure to comment or review. For more information or to request an appointment at UT MD Anderson, call 1-877-632-6789 or visit MDAnderson.org. Thank you for listening to the Cancerwise podcast from UT MD Anderson.