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Palm Beach State College Lunch and Learn Lecture Series September 18, 2012 Dudley Brown, Jr., MD, MBA BS in Psychology--University of Miami (Coral Gables) MD--University of Florida College of Medicine Residency in Obstetrics and Gynecology--Cook County Hospital, Chicago, IL (Chief Resident) Private Practice in Woodstock, IL for 8 yrs (Medical Director) MBA--Northern Illinois University Office locations: Forest Hill & N. Flagler Dr (by Good Samaritan Hospital) in WPB; University Dr in Jupiter Surgeries and Deliveries at Good Samaritan and St Mary’s Medical Centers in WPB (561)357-6277 www.tenetfloridaphysicianservices.com Cervix Breast Ovary Colorectal Prostate 2nd most common cancer in women ~500,000 new cases/ year ~275,000 deaths / year >70% decline in mortality last 60 years #13 in cancer deaths for women In 2010, ~12,200 new cases and ~4,200 deaths 50% of new cases are in unscreened women 10% had not had a screen in 5 years 30% due to system error (sampling, interpretation) Under 21 y/o, do not screen 21-29 y/o, Pap every 2 yrs 30 y/o and older, Pap every 3 yrs if 3 consecutive negative tests 65 y/o and older, stop if 3 consecutive negative tests & no abnormal tests in last 10yrs Any age after hysterectomy, stop if done for benign condition (e.g. fibroids, abnormal periods) and no h/o HG CIN Most common cancer in women #2 in cancer deaths in women 37% decline in mortality from 1997 to 2005 2010 estimates; ~207,000 new cases, ~40,000 deaths Ages 40-49, every 1-2 yrs (varies by organization) Ages 50-74, every 1-2 yrs (varies by organization) Age 75 and older, No recommendation for age to stop ACOG recommends clinical breast exam annually after 19 y/o “Self breast awareness” recommended 2nd most common Gyn Cancer #1 in Gyn cancer deaths 2010 estimates; ~21,800 new cases, ~13,800 deaths ~75% diagnosed at > stage 2 Nonspecific symptoms No proven screening test Recommended screening test is an annual pelvic exam CA 125 is not a recommended screening test High false positive rate leading to unnecessary surgery and increased cost Identifies late stage disease Research continues for an effective screening test #3 in cancer deaths in women & men (#2 for Hispanic men) 50% screening rate in US Average risk people should begin screening at 50 y/o Screening tests include; FOBT, Stool DNA test, Flexible Sigmoidoscopy, Colonoscopy Most common cancer in men Walnut-sized organ just below bladder and in front of rectum 200,000 men diagnosed annually and 25,000 deaths Risks factors: age > 50, African American, 1st degree relative with disease Difficulty in starting urination Weak or interrupted flow of urine Frequent urination, especially at night Difficulty in emptying the bladder completely Pain or burning during urination Blood in the urine or semen Pain in the back, hips, or pelvis that doesn't go away Painful ejaculation Some men do not have any symptoms Controversy exits regarding screening recommendations USPSTF recommends against PSA-based screening in men without symptoms Usual screening tests: Digital Rectal Exam (DRE) and Prostate Specific Antigen (PSA) Thyroid Diabetes Cholesterol Bone Density Recommendations vary per organization Start at 35 y/o and screen every 5 yrs with TSH blood test (American Thyroid Association) Screen at 50 y/o (American College of Physicians) Other organizations say only screen if someone in symptomatic Bottom line, discuss with your physician, especially if there is a family history of Thyroid disease Screen with blood test if BMI >25 and another risk factor present (e.g. Hypertension, age > 45, certain ethnic groups, habitual physical inactivity) American Diabetes Association Screen if BP consistently > 153/80 (treated or untreated) USPSTF Screen in pregnancy Bottom line, discuss with your physician, especially if there is a family history of Diabetes Osteoporosis is characterized by low bone mass (density) and architectural changes in the bone which increases the susceptibility to fracture Postmenopausal women age 65 and older Postmenopausal women younger than age 65 if risk factors are present (e.g. previous fracture as an adult, parents with h/o hip fracture, steroid therapy, low body weight, smoking) No screening for premenopausal women Start screening with a blood test at age 20 and every 5 yrs after that, NCEP III Start at age 20 for men or women risk factors for CHD, USPSTF Start at age 35 for men and age 45 for women if no risk factors for CHD, USPSTF Bottom line, speak with your doctor Lung (#2) Colorectal (#3) Diabetes Cholesterol Lifestyle changes (proper diet, regular exercise, no smoking, alcohol in moderation) Dr. Dudley Brown, Jr. Board Certified, Ob/ Gyn Offices in West Palm Beach and Jupiter (561)357-6277 Accepting New Patients