JustCare

Tag: Colonoscopy

  • Coronavirus: Have you gotten your cancer screenings?

    Coronavirus: Have you gotten your cancer screenings?

    During this novel coronavirus pandemic, most of us have opted against visiting a doctor’s office or going to the hospital when we had the choice. Fortunately, now that we appear to be coming out of the pandemic, many people recognize the importance of cancer screenings. Health Care Dive reports that people are once against getting breast and colon cancer screenings as well as other important preventive care services.

    COVID-19 led millions of Americans to delay care. Preventive care was put on a back burner. The data show drops in cancer screenings of 95 percent or more.  And, many hospitals and outpatient clinics lost billions of dollars in  revenue.

    But, preventive care is important for detecting diseases early on and promoting good health outcomes. Time will tell the consequences for people of skipping cancer screenings and other important services. No one knows yet how many patients will find themselves with later-stage cancers that might have been avoided.

    If you haven’t yet scheduled cancer screenings, talk to your doctor about doing so. Medicare pays for an array of preventive care services in full, including:

    Medicare also covers 80 percent of the cost of screenings for glaucoma, trainings for diabetes self-management, barium enemas to detect colon cancer, and digital rectal exams to detect prostate cancer.

    Here’s more from Just Care:

  • When to avoid preventive care services

    When to avoid preventive care services

    Medicare covers a wide array of preventive care services, which can offer tremendous benefits. But, some preventive care services may cause more harm than good for people towards the end of life. Liz Szabo reports for Kaiser Health News on when to avoid preventive care services.

    Mammograms and cervical cancer screenings: Experts say that people with terminal cancers of the lung, colon and pancreas generally should not be getting a mammogram or cervical cancer screening. Similarly, people in their late eighties and older with multiple chronic conditions usually do not need these services. The risks of harm outweigh the benefits.

    Experts further say that people with severe dementia and other chronic conditions near the end of life also do not need mammograms. Not only will a mammogram not improve their quality of life, it may lead to unnecessary surgeries.  It may also lead to painful hormonal therapies that can increase risk of stroke. Moreover, a mammogram is unlikely to identify a deadly disease. The research shows that only one woman in a thousand who gets a mammogram over a lifetime does not die because the cancer was  detected before it spread.

    Prostate cancer screenings: Experts also say that older people who already have a deadly cancer or who are at grave risk of dying within ten years are not likely to be helped by prostate screenings, PSA tests. PSA tests tend to identify tumors that are extremely slow-growing and do not need to be treated. And more than two in three prostate cancer screenings find something that does not need to be found. The follow-up biopsy causes infections in about 6 percent of men, 1 percent of whom end up in the hospital. These screenings have been deemed “low value” in men 75 and older. Research shows that men who receive surgery or radiotherapy for prostate cancer are no more likely to live ten years than men who receive active monitoring.

    Colonoscopies: Colonoscopies can lead to intestinal tears. And, people 75 and older are more likely to get a tear than younger people. Colonoscopies can also lead to dehydration and fainting in older adults.

    Skin cancer removal: People in their late eighties and older also might want to avoid removing skin cancers that are not life threatening. Caring for the skin after the cancer is removed can be problematic. And wounds may not heal. More than 25 percent of people report problems with their wounds healing.

    In sum, if you are wondering why some people should avoid these “harmless” tests, it is that the tests can lead to false positives, stress, and unnecessary invasive procedures as well as medical complications.

    Here’s more from Just Care:

  • Health screenings may have risks

    Health screenings may have risks

    For a long time now, we’ve heard about the benefits of preventive care, including screenings.  And, preventive care can have many benefits. So, preventive care services are generally covered in full whether you have Medicare or are in a commercial health plan.  But, health care screenings, in particular, can have risks as well.  The U.S. Preventive Services Task Force grades different preventive care tests based on the degree of benefit they offer.

    The Task Force uses five different grades. An “A” grade means that there is a high likelihood that the net benefit of the test is substantial.  Services with a “B” grade are likely to have only a moderate benefit, but the Task Force still recommends them. A “C” grade means that the net benefit is likely to be small and the patient and provider should discuss the risks.  The Task Force discourages services with a “D” grade. An “I” grade means that there is not enough evidence to know whether there is a net benefit or a net risk to the service.

    In short, screenings may turn up issues that warrant addressing. But, the question is how. Doctors often don’t know whether there’s a problem that should lead to more tests or a surgery. For example, some tumors may never grow large or present a health risk. So, they do not need to be removed. Risk to the patient can come from removing a tumor that does not present a health risk.  Surgery involves its own set of risks, including bacterial infections.

    Screenings for prostate cancer get a “D” from the U.S. Preventive Services Task Force. (An update is in progress here.) They often lead to unnecessary treatments. The Prostate Cancer Foundation suggests that as many as two in five men treated for prostate cancer had tumors that would never have presented a health or life risk.  But, the radiation treatment many men opt for can cause incontinence and erectile dysfunction.  And, hormone therapy treatment can lead to depression and osteoporosis.

    Task Force grades for breast cancer screenings vary.  The Task Force gives breast self-exams a “D” and recommends against teaching breast self-exams.  And mammograms get a “C” for women under 50 and a B for women between 50 and 74. This information is in the midst of being updated. But, you can see the most updated information here.

    H. Gilbert Welch, a professor of medicine at Dartmouth College, explains these risks in his book “Should I be Tested for Cancer?“ His simple answer is the book’s subtitle: “Maybe not.”

    A good primary care doctor will talk to you about your care needs and help you decide which screenings to get and which to avoid.

  • Colonoscopy: Do you need one?

    Colonoscopy: Do you need one?

    If you take charge of your health, you can help prevent colon cancer.  Colon cancer is the third most common type of cancer in both men women.  And, 50,000 people die of colon cancer every year. The overwhelming majority of people with colon cancer are over 50.What can you do to minimize the risk of colon cancer significantly? Get a colonoscopy, which is a colon cancer screening that will identify cancer or precancerous polyps that need removing or monitoring.

    When should you get your first screening and how frequently should you get one?  It depends on your family history. Generally, without a family history, you should get your first colonoscopy at 50. After that, colon cancer screening frequency varies quite a bit from individual to individual and depends heavily on both the results of your screening and your medical and family history. Talk with your doctor about what is best for you.If your results are normal, with no evidence of growths and you don’t have a family history of colon cancer, you can wait ten years before getting another colonoscopy.  That’s because the data show that precancerous polyps take more than ten years to grow into a cancerous form.  If the test shows you have polyps (or growths) on your colon, the doctor will generally remove them.  When you have to be screened again will depend on the size and type of growth.

    The test itself is safe and is generally painless. However, it takes time and can be an inconvenience.  For example, you usually have to drink an enormous amount of liquid the night before the test in order to clean out your system. You are also limited in what you can eat and drink the day before and day of the test. And you might need someone to drive you to and from the appointment.

    Very rarely, a colonoscopy can cause infections, heavy bleeding or tears in your colon, so it is not completely risk free. However, as always you should weigh your history and risk with your doctor.