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An Ounce of Prevention, Health Matters, Winter 2008


With an aging Baby Boomer population, longevity is at the forefront of everyone's mind. Yet chronic medical conditions such as obesity and diabetes make the enjoyment of those "Golden Years" difficult for some.

"Obesity is the hub of the wheel that creates so much chronic disease," says Dr. Lawrence Barcelo, a Family Practice physician with Santa Lucia Medical Group in Salinas. "And we seem to be losing the battle...."

With the arrival of the New Year, however, optimism abounds. Never before has "an ounce of prevention" been worth more, especially with health care guidelines designed to improve your chances of "aging gracefully."

With the assistance of a primary care provider, assessing your health risks can help you implement changes to improve your health forecast.

Cardiovascular Diseases are the number one cause of death for men and women and are responsible for almost twice as many deaths among women as all forms of cancer combined. Fortunately, most of the risk factors (please see sidebar) can be modified with lifestyle changes.

Most women don't need mammograms until they reach age 40. Breast Cancer screening for average-risk women ages 40 to 49 is recommended every one to two years. Mammograms should be performed annually for women 50 and older.

Colorectal Cancer screening with colonoscopy--the screening test of choice, says Dr. Barcelo--should begin at age 50 for the average-risk person. (Please see sidebar for alternative procedure options.)

Cervical Cancer screening with Pap smears should occur within three years of becoming sexually active, but no later than age 21. If a woman has had a hysterectomy for benign disease, a Pap smear should be offered every five years, Dr. Barcelo notes. "I'm much more aggressive" if the hysterectomy was performed as a treatment for cancer or pre-cancer.

Prostate Cancer screening with the prostate-specific antigen (PSA) blood test and a digital rectal examination should be offered to men annually, beginning at age 50 (American Cancer Society). This recommendation is met with significant controversy, however, due to the uncertain benefits and harms of early detection and treatment of prostate cancer.

Dr. Cassandra Ohlsen, an Internist who has practiced medicine in Monterey since 1994, advises her patients to obtain the test. "Even if it's within normal range, and it goes up significantly, I'll usually refer to urology and have them evaluate what's happened," she says.

While Dr. Barcelo believes that the PSA test has merit, he cautions that it does not have the sensitivity and specificity that the medical community would like.

"Despite a normal PSA you still have to remain vigilant," says Dr. Barcelo.

Given that one-half of all postmenopausal women will have an osteoporosis-related fracture, Dr. Ohlsen utilizes bone density testing after menopause as a preventative tool--"unless there's a predisposition when they're premenopausal."

Dr. Barcelo agrees that younger women who have gone through surgical menopause deserve a bone density study earlier than the average-risk woman.

So how often should you get a routine check-up? That depends. Both Dr.'s Ohlsen and Barcelo base their recommendation for a physical on the age and health status of their patients.

"I think it's a nice idea for women of the age where they need a Pap smear and a breast exam," says Dr. Ohlsen, "and for men when they need ... a prostate exam."

For those "who [have a normal blood pressure and cholesterol] and no risk factors," Dr. Barcelo says, "to drag them in and have them go through a physical every year is a little bit much. If someone is healthy, I think that every two years is really very appropriate."