What can the patient expect at their first meeting with your department to discuss cancer prevention? What topics are typically covered?
What can the patient expect at their first meeting with your department to discuss cancer prevention? What topics are typically covered?
Answer by Dr. Therese Bevers, professor of Clinical Cancer Prevention and the medical director of the Cancer Prevention Center and prevention outreach programs at M. D. Anderson Cancer Center.
A: Up to two-thirds of all cancers may be prevented by avoiding tobacco and adopting healthy lifestyle habits. Regular screening exams can help detect many cancers in the earliest stages, when they can be treated successfully. MD Anderson was among the first comprehensive cancer centers to develop a clinical program emphasizing cancer prevention.
The Cancer Prevention Center offers a comprehensive cancer prevention program that includes cancer risk assessment, screening exams based on cancer risk, age and gender as well as personalized risk reduction strategies. It also provides the infrastructure and support for clinical and translational cancer prevention research. Services that are offered include:
Site-Specific Cancer Screening
Cancer risk assessment, counseling and screening for the most common types of cancer in adults without symptoms:
· Breast cancer: clinical breast exam and screening mammogram
· Gynecologic cancer: Pap and HPV testing
· Prostate cancer: digital rectal exam and prostate specific antigen blood test
· Skin cancer: skin exam
· Colorectal cancer: convention or virtual colonoscopy
· Lung cancer screening: low-dose CT scan
Risk Assessment and Risk Reduction
· Genetic Testing and Risk Counseling: for individuals at increased cancer risk due to a family history of disease; services include counseling, testing and risk management.
· Chemoprevention: drug therapy to reduce cancer risk in high-risk patients; research studies are underway for patients at risk for oral, prostate, cervical, lung, colorectal and breast cancers.
· Nutrition Counseling: a dietary evaluation with personalized counseling for cancer risk reduction
· Tobacco cessation services for current smokers desiring to quit or recent quitters desiring assistance with relapse prevention.
Diagnostic Evaluation Services
· Undiagnosed Breast Clinic: comprehensive clinical and diagnostic evaluation of breast abnormalities, including a lump, other breast changes and abnormal mammograms
· Undiagnosed Dermatology Clinic: diagnostic evaluation of skin abnormalities, including a change in a mole or freckle or other skin changes
· Undiagnosed Gynecology: diagnostic evaluation of abnormal Pap smear or abnormal uterine bleeding
What can patients do to make the most of their time with doctor visits? What questions should they be asking?
Answer by Evan Falchuk, President of BestDoctors.com
What can patients do to make the most of their time with doctor visits? What questions should they be asking?
There is no question that when physicians have more in-depth, personalized discussions with their patients and encourage them to take an active role in their health, both doctor and patient feel more confident that they have reached a correct diagnosis and a good treatment path.
A doctor’s approach to the patient is key. Taking the time to examine every piece of a person’s medical history, and then applying his/her expertise to the patient’s particular condition is critical to making the correct diagnosis.
The first piece of advice I would offer a patient is to ask questions, and to keep asking until they’re satisfied with the answers. It’s all too easy to be referred to a specialist and start treatment without having all of your questions answered, or having your doctor ask – and answer – the right questions in the first place.
For example, if you have a test, don’t assume that no news is good news. Ask about your results. Also, treatment recommendations based on the latest scientific evidence are available from the National Guidelines Clearinghouse™ at www.guideline.gov. Ask the doctor if your treatment is based on the latest evidence.
A recent study in Israel (http://tinyurl.com/3wehvcw) determined that examining patients and taking a medical history are more useful to hospital doctors in diagnosing patients than high-tech scans. The study showed that patient history alone or history plus a physical exam were most important to a doctor’s correct diagnosis in almost 60 percent of cases. When basic tests were included, they were the basis of more than 90 percent of correct diagnoses along with history and exams.
According to Dr. Jerome Groopman, one of the world’s foremost researchers on how doctors think (he’s written the definitive book on it http://tinyurl.com/28pom7), doctors desperately need patients and their families and friends to help them think. Asking questions won’t just make the patient comfortable – it can disrupt a doctor’s thought process and make him think about a case in a way that may save a life.
While we urge patients to be their own advocate, it’s also smart to have a family member or friend with you at doctor’s visits, someone who can help get things done and speak up for you if you can’t.
Also, I can’t stress enough the importance of researching and compiling a family medical history. BreastCancer.org reports that a woman’s risk of breast cancer approximately doubles if she has a first-degree relative (mother, sister, or daughter) who has been diagnosed with the same, and about 20-30 percent of women diagnosed with breast cancer have a family history of it. A Cleveland Clinic study (http://tinyurl.com/25azwa8) shows that a family history may be a better predictor of disease than even genetic testing. Find out about your family’s medical history, write it down (the Surgeon General has a good on-line tool to help you do thishttp://tinyurl.com/a675nl), and make sure your doctor knows about it.
Even if you do have charts dating back to childhood, however, don’t assume your physician has digested or will remember everything. Adam Dickler, M.D., a radiation oncologist in Evergreen, Ill., says,”There really isn’t enough time. If your doctor flips open your file while entering the exam room, it may be the first time she’s looking at it, so be ready with a recap. A full recap.”
