An Ounce of Prevention is Worth a Pound of Cure

By Tasanee Rungteranoont, M.D., and Sarah Spelsberg, M.D.

Tasanee Rungteranoont, M.D.	Sarah Spelsberg, M.D.

Some of the deadliest diseases are colon cancer, cervical cancer, breast cancer, prostate cancer, heart disease and diabetes which kill almost 1 million people in the US alone. These often begin silently. We recommend routine screening because treatment is most effective when we find these diseases early. If a patient ignores getting a colonoscopy or stool analysis at 45 and ends up with Stage 4 cancer three years later, an initially treatable condition (often a polyp removal done during the colonoscopy itself) becomes life-threatening. When these conditions are discovered early through routine screening, simple interventions can be lifesaving.

Routine screening is part of preventive care. These are healthcare measures focused on prevention and early detection rather than waiting for symptoms. Early detection leads to better outcomes, less invasive treatments, lower healthcare costs, and improved quality of life. It is important to recognize that most conditions are asymptomatic in their early stages. High blood pressure, diabetes, and high cholesterol often cause no symptoms until major damage has been done.

For Everyone

Routine bloodwork is like the “check engine” light of the body. This is our early warning. This includes cholesterol, blood glucose, kidney function, liver function, thyroid testing, PSA for men to check for prostate cancer, and blood counts to check for anemia, infection and certain cancers. Some of these tests are done every 5 years or so and some should be done annually. Discuss your schedule with your physician.

Colonoscopies can both detect and prevent/treat cancer by removing precancerous polyps during the procedure. The current recommendations are to begin at age 45 for average-risk adults. If the initial exam is normal, you may end up repeating it every 5-10 years. If higher risk, such as those with inflammatory bowel disease, colonoscopies are performed every 1-2 years. There are also stool-based screening tests. These do not replace colonoscopy in all patients but are acceptable as an initial screening tool in average risk patients. Or if a patient does not want to get a colonoscopy, sending a stool sample is a better screening measure than doing nothing.

Blood pressure monitoring and heart disease screening are very important. Hypertension is known as the “silent killer.” Uncontrolled blood pressure is a major contributor to strokes, heart attacks, and kidney disease. Blood pressure should be checked at least yearly in adults and much more frequently if elevated.

Vaccines have unfortunately been vilified without evidence in the political news a lot lately. It is the concensus of the medical community that vaccines are safe, effective, preventive medicine and they save lives. As physicians, we have received all vaccines, including annual influenza and covid vaccines. My children are up to date on all vaccines as well. We would not ask you to do anything that we did not believe is safe and important. Diseases like measles can be life threatening even a decade or more after recovery with spontaneous inflammation in the brain. They also wipe out your ability to fight off other infections causing “immune amnesia”. The original American Academy of Pediatrics Vaccination schedule is safe. For adults we recommend a yearly influenza vaccine, a tetanus booster every ten years, shingles vaccination at age 50 and pneumonia vaccination at age 65 in average risk patients. Higher risk patients should get some of these vaccinations earlier. Please discuss vaccination schedules with your physician! Vaccines protect not only individuals but vulnerable communities.

For Women

Mammograms matter because early-stage breast cancer is far more treatable. Mammograms can detect cancer before it can be felt. Most women of average risk should begin mammograms at age 40 and repeat every 1-2 years. Higher risk patients may need earlier screening. Your physician can also teach you to do a monthly breast self-exam in addition to your annual exam.

For women, it is important to get their pap smear done starting the age of 21. It is not recommended for anyone under the age of 21years old, even if you are sexually active. Pap smear is part of your routine screening and is helpful to detect the development of cervical cancer. Current guidelines suggest pap smear should be done between the age of 21 to 65. For average-risk patients between the ages of 21 and 29, screening should be done every 3 years. From age 30 to 65, you should also have it done every 3 years, with the addition of co-testing with the HPV test. As young people get vaccinated against the HPV virus, we expect to see less cervical cancer.

For Men

The PSA or prostate-specific antigen blood test helps evaluate prostate cancer risk in men. Men should discuss PSA screening with their physician. Screening decisions should be individualized because PSA testing has both benefits and limitations. Trauma, infections, and cancer can elevate your PSA level. This is usually done between the ages of 55 and 69.

The Importance of Prevention

As emergency physicians, we often see these conditions when it is nearly too late.  It is heartbreaking to know it could have been treated with some simple preventive care and screening.

A few examples

A heartbreaking example is a 55-year-old father of four who didn’t want to get a colonoscopy because he thought it was “gross” who comes to the emergency department with abdominal pain and is found to have advanced colon cancer.

Another is the 46-year-old mother of three who “just never got around to” getting mammograms who now has advanced breast cancer.

Last example, a 36-year-old man who has been having uncontrolled hypertension, symptoms initially only right foot pain. He developed an aortic dissection that required going into surgery for repair.

Advanced cancers diagnosed after symptoms become severe have a much more difficult treatment course. Uncontrolled diabetes or hypertension leading to kidney disease, heart failure, strokes and heart attacks are preventable when caught early. Sometimes these patients “just don’t like doctors” (no offense taken) and “feel fine” and they simply have not had routine medical care in years.

Preventive care is not about searching for illness! It is about protecting the years of healthy life ahead so you can enjoy your life and be active as long as possible.

We encourage patients to:    

• Schedule annual wellness visits    
• Stay current on vaccines
• Know their family history
• Talk with their physician about age-appropriate screenings
• Do not skip colonoscopies, mammograms, or other preventive screenings (these are not done in the Emergency Department, they are done with your primary care provider).

If you need a primary care physician, UNC Health Southeastern Family Medicine at The Oaks and UNC Health Southeastern Internal Medicine at Tanglewood are accepting new patients. To learn more, visit UNCHealthSE.org.

Tasanee Rungteranoont, M.D., and Sarah Spelsberg, M.D., are Emergency Medicine Residents at UNC Health Southeastern. In addition to offering services you’d expect from a community healthcare system, UNC Health Southeastern provides a number of specialized services that are unique to our system and not available anywhere else in the region. To schedule an appointment, call our referral line at 984-974-CARE.

Sarah Spelsberg, M.D.