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“The Talk” that can be more Embarrassing than the “Birds & The Bees”

A board-certified hematologist/oncologist explains how to open up the dialogue to get your loved ones screened for cancer

I see several patients on a daily basis with cancer.  Some days can be tough, but nothing compares to what they are going through.  I know that.  The physical anguish and toll that chemotherapy, radiation, and surgery can take on the body.  The burden that the disease can take on the mind and the soul.  It’s devastating and almost always life-changing.  What makes things harder though is when a patient did not go to have one of their screening tests done “because they didn’t want to” or “because they didn’t think it was necessary”. 

I have a family history of cancer.  My father is a physician.  I am an oncologist.  He has read and studied the data, yet even I had to convince him.  Imagine talking to your father and trying to convince him that he not only should, but that he needs to put a long camera in his rear end (colonoscopy) to screen for colon cancer.  Not exactly easy or comfortable.  Well, I guess that can be said about both scenarios I just described. 

When I was sitting there talking to my parents about the screening tests that they needed to complete, I could imagine what they must have felt like deciding which one was going to teach me about “the birds and the bees”.  I felt uneasy and almost a little embarrassed.  I quickly got over that, because that feeling was not worth possibly seeing one of my parents as a patient some day. 

The American cancer society did a survey a few years ago that showed that nearly all unscreened people knew that they should be screened. There are several common “reasons” that that are consistently used by people.  One of the top reasons for delaying screening though has to do with being embarrassed to discuss these tests with family or physicians.  Other reasons include but are not limited to patients not having a family history, not being familiar with the different screening methods, concern about cost of the test, and worrying about taking time off of work. 

Below I have set out a guide for how you can approach your discussion for discussing cancer screening tests for patients at various ages and which of some of the more common screening tests are appropriate for various age groups.  Not all cancer is preventable, but several are, and what better time to have the discussion than in February during National Cancer Prevention Month.

  1. Tell them that you love them – that’s ultimately why you’re talking about it 
  2. Find out how they feel about the test 
  3. Ask them what their concerns may be 
  4. Offer to help take them to the test 
  5. Be supportive 

It may be a tough conversation, but it may be the one that will save their life.  Below are some of the common screening tests and recommendations.  Each of these may differ on an individual basis and these guidelines below are the ones set out by The U.S Preventive Services Task force.  

Colonoscopy – An average risk individual (no family history, genetic disorders, or bowel disorders that predispose you to colorectal cancers) should start with screening at age 50 or 10 years prior to the youngest age at which a family member was diagnosed with colorectal cancer. 

Mammography – Every 1 -2 years for women between the ages of 40 – 74.  Randomized clinical trials have shown that mammography can reduce the number of deaths from breast cancer among ages 40 – 74.  This may differ with a family history and an MRI of the breast may be used in certain situations.  

PAP Test and HPV – These test can be used alone or in conjunction with one another to help find abnormal cells before they become cervical cancer.  Generally, testing is recommended to start at the age of 21 and can be stopped at age 65.  This is typically is not at high risk for cervical cancer and has had prior screening. 

Low dose Helical Chest CT Scan – The national lung cancer screening trial has recently shown to reduce the risk of heavy smokers (30 pack-years of smoking) ages 55 – 74 compared to X-ray.  Various lung cancers were detected at an earlier stage and patients had approximately a 15 to 20 percent lower risk of mortality from lung cancer than patients that received a chest X-ray.  

Physical Exam and Lab Work– Seems simple right?  Many patients skip their yearly physical for the reasons described above.  A physical exam, including a skin exam, as well as basic labs, can be the first sign that something is wrong and lead to further work up.   

So, while this this conversation may be as tough or as the dreaded as “the birds and the bees” that your parents once had with you, embarrassment is not worth death, especially when the life of a loved one could be saved. 

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