February 4 is World Cancer Day! It was established at the World Summit Against Cancer for the New Millennium in Paris on February 4, 2000. The aim of World Cancer Day is to promote research for curing and preventing cancer and mobilize the global community to talk about cancer prevention. It’s also a great opportunity to talk about the importance of preventive medicine and cancer prevention.
Preventive medicine: A doctor’s perspective
As a physician, talking to my patients about preventive care was one of my favorite things to do when I was in practice; it was also one of the most challenging. In our culture we see our physicians as healers, someone we turn to when we are sick. But did you also know the word doctor comes from the Latin word docere, to teach? So physicians are not only healers but teachers, as well. This not only involves educating and encouraging patients recovering from illnesses, it also involves teaching people who are well how to prevent illnesses!
Getting past excuses
The challenge for all of us is to do something to protect our health when we don’t feel sick. When recommending a mammogram, I would often hear, “Well, I don’t have a history of breast cancer in my family.” When discussing colon cancer screening, patients would ask, “Why would I do that? I don’t feel sick.”
It is amazing what humans will do to avoid a small amount of discomfort, particularly when they have no pressing urgency (“I can’t imagine drinking that liquid to clean out my bowels for a colonoscopy!”). It’s also amazing the dramatic lengths to which people will go to treat a serious illness, even doing things that are tremendously painful and distressing, such as chemotherapy.
Understanding preventive medicine
Believe it or not, modern medicine’s approach to “preventive medicine” is a relatively new concept. This is not to say that humans haven’t always wondered about how to protect themselves from getting sick and dying. However, for the most part, doctors, and insurers, didn’t spend much time actually trying to prevent disease or illness until the 20th century.
If we look back at the beginning of the 20th century, medicine and health looked very different. For example, in 1900 the top three causes of death in the United States were all infections: tuberculosis, pneumonia (including influenza), and infectious diarrhea. Fast-forward to 2015 and those infections, due to better public health measures and antibiotics, have been replaced by chronic diseases: heart disease, cancer, and chronic obstructive pulmonary disease (COPD), with stroke a close fourth.
The three levels of preventive care
One important thing to keep in mind is that screening for cancers is what we call secondary screening, which implies we are hunting for the disease, trying to find it early so it is more easily treated and cured. We think about preventive medicine on multiple levels:
- Primary prevention is when we are trying to prevent an illness or disease from actually starting. An example of this would be vaccinations of any type to prevent infections. We even have one to prevent cervical cancer since it is known to be caused by a virus. We give this before women have developed the cancer so as to prevent it.
- Secondary prevention is when we go looking for the disease so as to find it EARLY and thus treat and potentially cure, instead of waiting until it is quite advanced. This includes many cancer prevention interventions: for example, mammograms, colonoscopies, prostate checks, Pap smears.
- Tertiary prevention interventions aim to soften the impact of a chronic illness that has already been diagnosed and may have lasting effects in order to improve as much as possible on patients’ ability to function, their quality of life, and their life expectancy. Some folks just call this good disease management. For example, making sure a stroke victim has good rehab and appropriate assistive devices to help them, or urging a diabetic patient to have eye exams, kidney monitoring, and good foot care. In terms of cancer it can involve things like providing support groups.
How should Medicare beneficiaries approach preventive cancer screening?
- Talk with your doctor. There are many organizations that give medical professionals’ guidelines as to when and how often we should do screenings, such as the American Cancer Society, the American Geriatrics Society, and the United States Preventive Services Task Force.
- Know what Medicare covers for preventive services. The good news: beneficiaries usually have no coinsurance or copay and deductibles for preventive services. For cancer screening these include: Lung cancer screening in certain conditions, cervical cancer with human papilloma virus testing, breast cancer screening, colorectal cancer screening, and prostate cancer screening.
- Visit the World Cancer website and learn about cancer prevention.
Hopefully, the next time your doctor says, “When was the last time you had your mammogram?” or “Looks like you’re due for a colonoscopy,” you’ll be prepared to have a meaningful discussion about the screenings that are best for you.