December 12, 2024 • 39 mins
Centered on Health 12-12-24 - Health Screenings at every age with Dr. Conor O'Neill and Dr. Arayo Sokan
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Speaker 1 (00:01):
It's now time for Centered on Health with Baptis Help
on use Radio.
Speaker 2 (00:05):
Wait for each elbody y JS. Now here's doctor Jeff Tuban.
Speaker 3 (00:11):
Good evening, everyone, and welcome to tonight's episode of Centered
on Health with Factors Health, your call in medical show
here on News Radio eight forty whas. I am your host,
doctor Jeff Publin. We're joined by mister Jim Finn and
our studio waiting to take your calls to talk to
tonight's guests. Our phone number five oh two, five seven one,
(00:32):
eight four eight four if you want to call in
be a part of tonight's conversation and tonight we are
very fortunate to have not one, but two primary care
physicians today to talk to us about healthcare screenings at
any age. So, no matter who you are listening to
this show right now, there's going to be something in
this show that pertains to you. So I am I'm
(00:54):
hoping you're there, you're ready to call in and ask questions.
I want to introduce you to both doctor Connor O'Neill
and doctor Ario Chopan. Doctor O'Neill is a primary care
physician with Baptist Health Medical Group at Breckenridge a practice
that I am very familiar with. He's joined us from
as a graduate of the University of Kentucky Medical School,
(01:14):
and doctor Ariah Chopin also is a primary care physician
with Baptist Hospital Medical Group, receiving his MV from the
University of Kentucky Medical School as well.
Speaker 4 (01:24):
Both of them are here.
Speaker 3 (01:25):
They're new to our community over the last couple of
years and are filling an enormous gap in primary care.
Speaker 4 (01:33):
And we welcome you both to the show.
Speaker 2 (01:36):
Thank you, Thank you for having us, and we're glad
to be here.
Speaker 3 (01:39):
And we've got both of you on. Yeah, fantastic. So
you know, I'm really excited to have you both, And
I think the way I just kind of want to
introduce you to our listeners and to our audience is
maybe give you each, you know, just a little time
to tell us about your decision to become a primary
care physician and kind of what you what you think
(02:03):
about primary care and why you're attracted to it. So
maybe we'll start with doctor O'Neil, you can tell us
about you, and then doctor Choken we can hear about you.
Speaker 2 (02:13):
Yeah, thank you.
Speaker 1 (02:13):
So I had always kind of been interested in primary
here and it wasn't until I was in residency and
training that I wanted to pursue it. It really was
the aspect of just having continuity and you know, establishing
relationships with patients over years to decades that I really
(02:36):
enjoyed and looked forward to. So that was really the
main reason I wanted to pursue primary care. The other
reason was that I kind of liked I liked every
other specialty, but I didn't love any specialty. So primary
care kind of encapsulates all specialties in some way. So
that was a main reason that I wanted to pursue.
(02:58):
And it's it's been a good to say as an
ever since.
Speaker 4 (03:02):
Good talking in doctor shoken.
Speaker 5 (03:05):
Yeah, for sure. You know I can echo a lot
of what doctor O'Neal I had to say. You know,
for me, it's an interesting process, right. You know, my
father is also a primary care physician.
Speaker 4 (03:16):
Okay, in some way the kind.
Speaker 5 (03:18):
Of a family business. But you know, in truth, it's
not something that I really thought I was going to
end up in. Like when I started out in this
process so long ago, if you'd asked me if I
was gonna end up as a primary care position, I
would have told you. But you know, as I think,
the more time I spent working with patients and the
more time I spent, you know, studying medicine, I think
(03:42):
for me, the part that's always been important is it's
always been the people right, and the opportunity to serve
a community and a group of people for a long
period of time right and make a significant difference. I
don't think I'm alone and saying that's why I was
called to medicine, My suspicion is probably why most of
us were, you know. And I think for me, the
(04:02):
best way that I found to be able to do that,
to make a meaningful impact on a specific group of people,
it's through primary care. And you know, I agree with
the doctor O'Neil. There are a lot of things in
medicine that are super awesome and cool, and I'm so
happy we have wonderful people to do those things, you know,
But I think it's incumbent upon each of us in
(04:22):
medicine to find the area that best melds our skill
set and our interests in a way that can bestor
of our patient population. And I think for me, primary
care has been that, and it's challenging, it's it's different,
it's fast paced. Every single day is something new, every
single visit is something new, which is you know, had
(04:45):
its own unique challenges, But it's a it's great, it's fun,
it's it's a very cool thing to be a part
of right now. And getting to do it with such
a great group of people like we have over at
Saint Matt's, it's just such a unique opportunity. So I'm
really thankful, well.
Speaker 3 (05:00):
We are thankful that both of you are here for sure.
And I'm going to stick with you, doctor Chokin for
just a minute because I have a whole list of
things about primary care I wanted to talk to you
guys about. I'm gonna wait because I want to These
screenings are so important. I want to kind of get
right into it. But before we get with doctor O'Neil
and start with our first cancer screening, doctor Chokin, can
(05:24):
you just describe for our listeners what.
Speaker 4 (05:27):
Screening actually means?
Speaker 3 (05:29):
And I think you know, as one of the people
doing the screening for one area of this medical world,
sometimes I feel like people don't understand what the concept
of screening is versus a diagnostic KEP, could you tell
us a little bit about that for sure.
Speaker 5 (05:46):
You know, screenings in many ways, This is probably the
talk I give the most, but screening. What we're doing
with screening is we're really trying to identify problems that
might be coming down the road before they be issues
that are so significant that they require such a massive intervention.
Speaker 2 (06:04):
Right.
Speaker 5 (06:05):
So it's really about early identification, early diagnosis, and giving
ourselves the best chance to fight back against anything that
might be brewing. So, you know, many of these tests
that we're going to discuss our tests that you would
get while feeling healthy or relatively normal, routine tests that
we asked our patients to go through so that we
(06:28):
can evaluate for the things that don't typically develop in
a way that is very apparent to the people who
are experiencing them. Right. So, a lot of these tests
are specifically designed have high rates of positivity, right, So
they want to catch as many people as possible in
(06:48):
order to identify the people who need an additional step
of screening, a further step of testing. Right. So, some
of them are not the most specific tests that we have,
but they do a really great job of identifying the
individuals who have need for further screening. So as you,
as we go through this talk, I'm sure you'll see
that many of these tests are tests that lead to
(07:10):
further tests, and that's often a way I think about
screening is as an opportunity for us to take a
peek under the hood see what problems might be brewing
while we still have plenty of time to address and
impact those things.
Speaker 3 (07:24):
And and doctor o' neil, we're gonna switch over to
you another first thing we're going to talk about. We're
going to have you kind of focus on. But these
are it's important for our listeners and for patients and
our practices to realize that they don't have to have symptoms.
In fact, the screening really is intended to get things
before symptoms.
Speaker 4 (07:45):
Is that is that correct?
Speaker 1 (07:48):
Yes? And really I mean for screening. You know, that's
kind of the hard part about you know, screening tests
is that you don't don't feel any you know, you're
not having any symptoms, you're not feeling worse, and so
to go through a test, a lot of people don't
feel the value. But typically when you start to develop
(08:10):
symptoms of you know, the tests and diseases that we're
going to discuss, typically that is at a point, you
know where it's not too late, but it's later than
we could have addressed it before.
Speaker 2 (08:24):
And so that's why it's very important.
Speaker 1 (08:26):
To make sure we're doing all of the proper testing
at you know, the certain ages, the certain risk factors,
because we want to make sure that we can address
it before before it progresses to something that you know,
ultimately could you know, be inevitable. And so that's really
the most important part about screening is that you don't
(08:46):
feel any different. You know, you feel fine, but there
still could be something there that we can address before
it progresses.
Speaker 3 (08:54):
And I think we're gonna we're going to try. We're
going to try and cover quite quite a range of
screening today. We're going to try and hit at least
colon and prostrate and cervical and breath and we're going
to try and touch on all of those. But I
think we're going to start, and we're going to start
with you, doctor O'Neil, about colon cancer screening, which of
course to me is very near and dear to my heart.
(09:16):
But if you could just tell us briefly kind of
who when do you start calling cancer screening? And is
there a time when you stop calling cancer screening?
Speaker 1 (09:29):
Yes, so it actually I think it changed in twenty
twenty one, and you correct me if that it says
right around the year. But it was fifty years old
that we would get, you know, that would be the
age that we would scream for colling cancer. But they
had looked at the data and sold that, you know,
they were there were a lot more people who were
being diagnosed younger, and so they actually changed it in
(09:52):
twenty twenty one to age forty five. So that is
the age of age that we typically will screen for
people who are average risks and then after and then
we screened until seventy five years old. Now you can
you know, be screened after year seventy five and you
won't have It's really a shared decision making with you know,
(10:14):
the patient and the position if they want to pursue that.
There are certain individuals who may be at higher risk
of needing earlier screening, and some of those include if
you have a family history, which typically includes if you
have a first degree relative that was diagnosed and going cancer.
(10:36):
Typically we would die or we would start screening ten
years before that first degree relative age of when they
were diagnosed. If they were diagnosed later than you know fifty,
then we typically would start at age forty because you
are at a higher risk of developing coaling cancer if
(10:56):
you do have family history. The other ones would be
if you haven't flammatory val disease typically like ultra drive
colitis or chron disease. We typically would start colonoscopy about
eight years after they were diagnosed initially of disease on set,
and then we would kind of pursue colonoscopies or in
(11:16):
a screening method for colon cancer every three to five
years because those patients are at a higher risk of
developing colon cancer as well.
Speaker 2 (11:25):
And we're gonna, I guess this go ahead.
Speaker 3 (11:28):
I was just gonna say, we're gonna we'll get into
how we're gonna do that screening. We're gonna have to
take a quick break here and then we're going to
continue with you, doctor O'Neil. You are listening to doctor
Connor O'Neill and doctor Ario Chopin talking to us about
screening at any aid. This is centered on health with
Baptist Help here on news radio eight forty w a
as I'm your host, doctor Jeff Publin, And if you
(11:49):
want to call in and ask questions about screening for
any type of cancer. Five oh two, five seven one,
eight four eight four producers.
Speaker 5 (11:57):
Contents on call to take your calling.
Speaker 3 (11:59):
We'll be right back. Welcome back to send it on
health with Baptist Help here on news radio eight forty WAKS.
(12:19):
I'm your host, doctor Jeff Calvin. We're talking tonight to
primary care physicians Connor O'Neill and a Ryo Chopan, both
at the Baptist Hospital Medical Group, and teaching us tonight
about screenings at any age. Right before the break, we
started talking about colon cancer screening and doctor O'Neill. By
the time patients get to me, they're getting a callonoscopy
(12:39):
as their choice for callon cancer screening, but you have
to have the conversation with them about what that means
and what other options are. So tell us about your
approach and what tests you offer to people for coll
and campus screens.
Speaker 1 (12:55):
Yeah, so there's a variety there's of tests for screening
for colon cancer.
Speaker 2 (13:04):
The first one.
Speaker 1 (13:05):
And really the gold standard that we typically recommend is
the colonoscopy. And the reason this is the gold standard
and probably one of the best screening cancer screening tests
that we have is that you're able to get direct
visualization of the colon and if there's any specific leasions
(13:26):
that are concerning for cancer, and you can actually remove
those during the tests. So it's really one of one
of a kind to where you can do a screening
test and then also treat it with removing part of
that pole up, assuming that they're able to get the whole,
the whole complete set. So that is typically we typically
(13:47):
will start again at age forty five if you're at
average risk and assuming that you you know, if you
have no polyups or nothing that is concerned on the colonoscopy,
you don't have to get another one for until ten
years after that, so that is a very Again there's
very few screening tests that have that duration of not
(14:09):
needing another one for ten years.
Speaker 2 (14:11):
Now, there are certain poll ups that can.
Speaker 1 (14:14):
Specifically if you do have those and they remove them,
they recommend sooner surveillance with another colonoscope. Typically it would
be three to five years, and and there's a number
of different poll ups that can indicate which year you
would do, but we'll get into the details of that,
but that is typically what we would do is ten
(14:36):
years or three or five years if you do have
evidence of poll ups. The next one that again i'll
keep with the most common ones, is a school test
that we.
Speaker 2 (14:48):
It's called the color guard often at REMART test, and so.
Speaker 1 (14:51):
That is one that you are able to get a
sample of your soool. Usually you'll get since the material
to do that and you'll you'll obtain a sample of
your stool. Then you will send it back to this
facility that where they will test it for certain markers
(15:12):
and they can detect DNA mutations that are associated with
colorectal cancer or pre cancer as poly ups. Now, if
you do test positive, or if the coal of guard
ultimately does so positive, then you do have to proceed
to get into colonoscopy to further evaluate that. The good
part about that color guard is that it's obviously non invasive,
(15:35):
which is an ideal situation for a lot of patients. However,
you know, again it's not as ideal for treating if
you do have polyps as a colonoscopy. And so those
are really the two main ones. There's a couple, there's
a few other ones. Two other kind of direct visualization.
(15:55):
One is a flex flexible sigmoidoscopy that is typically every
five years, and that just specifically we'll look at kind
of the lower part of the colon where most cancers
do present, and it is a little less invasive the colonoscopy.
And then the other one is a CKE colonograph. And
(16:15):
I'll be honest, I haven't really had many patients perform
this or even before.
Speaker 2 (16:20):
Uh, and so that I think is every five years. Now.
Speaker 1 (16:24):
Again, I recommend strongly when I talked about patients that
colonoscopy is the most ideal. And again you can get
that if you don't have any findings, then you can
go for ten years and you don't.
Speaker 2 (16:35):
Have to worry about it necessarily.
Speaker 3 (16:38):
Well, and you know, I appreciate that approach, and you
know what's really nice for those listening is that, of course,
you know, we strongly recommend the colonoscopy, but the important
part is to be screened. Unfortunately there are some other
options for some reason. Colonoxopy isn't isn't right for you,
but do get screened. And thank you so much doctor
O'Neil for for explaining all that to us. We're gonna
(17:00):
shift gears a little doctor soapin We're going to move
into the area of prostate cancer screening, which is also
another another important screening cancer to look for. What is
your approach and what do we need to know about
prostate cancer screening.
Speaker 5 (17:16):
Yeah, absolutely, let's get into it. Pro State cancer. You know,
prossate cancer is actually the most common non skin cancer
in men in the United States. It's the fourth most
common tumor that is diagnosed worldwide. So for men in
the United States, about one in eight will be diagnosed
with prostate cancer at some point in their life. Those
numbers are slightly higher if like me, you're a man
(17:36):
of color. For African American men, it's about one in
six of us will develop PROC high. Yeah, that's remarkably high. Yeah,
it's very, very high. You know, it's when you start
to look at the statistics, it's really easy to understand
why the screening is so important, you know. You know,
and this year alone, the American Eurologic Eucologication is estimating
(18:01):
more than two hundred ninety nine thousand men will be
diagnosed with prostate cancer and over thirty five thousand people
will die from the So, you know, it's a very
significant thing that's impacting a bunch of members of our community.
So let's talk about it. You know, it's interestingly prostate
cancer is not one of the cancers for which the
United States Preventitive Services Task Force recommends that we do
(18:24):
routine screening and all of our patients. But you know,
this is a really unique opportunity for your primary care
provider to get a practice from shared decision making. You know,
prostate cancer screening is really an individualized decision. It's something
that each primary care physician would talk to each of
their patients about. Well, the patients for whom it's applicable,
which just male patients is only men have process at
(18:49):
this point. You know, for me, at least, my approach
is I start to look at the risk factors. You know,
for me, men of color something we should be discussing. Right,
we know that there's a signal, nificant increase in incidents
and men of color in this country. We've got to
talk about these things. Other than that any any individual
with a first agree relative with the history of prostate cancer,
(19:12):
individuals who are currently smoking, these are all the kinds
of people for whom there's an increased risk, right, we
should have at least the conversation about whether or not
this is something that we should pursue right now. I
will also say that because of the nature of prostate
cancer as a disease, there are a significant percentage of
(19:32):
people for whom screening is not really warranted.
Speaker 2 (19:36):
Right.
Speaker 5 (19:37):
You know, we know that this is a slowly progressive cancer,
and we know that this is a cancer that it's
fairly treatable and in many cases does not require urgent intervention. Right.
And so for people who have significant medical comorbidities, you know,
or life expectancies that are are of a sort that
means that they are more likely to have other issues
(20:00):
rise prior to this becoming the significant problem in their life,
it may not be reasonable to pursue this, you know,
the screening strategy for them. So I think this is
a really great opportunity for us to compare and contrast,
you know, the way we talk about colon cancer screening
and the way we talk about prostate cancer. Colon cancer
screening every patient, we've got to do it. Prostate cancer screening.
(20:21):
This is a more tailored approach, a more personalized approach
per patient. You know, the general logic, go ahead.
Speaker 3 (20:31):
I was gonna say, the screening is it? The digital
rectal exam is it A, is it the p S A?
Speaker 5 (20:36):
What?
Speaker 3 (20:36):
What is your the current guideline of what to use
to screen for sure?
Speaker 5 (20:41):
For sure?
Speaker 3 (20:42):
You know.
Speaker 5 (20:42):
Fortunately, I think for for both clinicians and patients, we've
moved away from the digital firstal examine the first line
of testing for screening for prostate cancer. I think many
of our nations are very happy about that.
Speaker 3 (20:54):
Yeah, you know.
Speaker 5 (20:55):
The prostate specific antigen is a blood test that we
can and getting our patients. It's recommended by the Urologic Association.
Is the first screening test with a level A recommendation
for evidence. So this is for us, the first test
that I would reach for in patients for whom this
is something that they want to be a part of
(21:17):
their care plan for some or for someone who has
significant risk factors. The recommendation is to discuss this with
your patients every two to four years, and patients who
have a prostate age between fifteen and sixty nine. But
the discretion and frequency of rescreening is left to each individual,
to each individual patient and their provider to determine based
(21:40):
on each individual's unique circumstances.
Speaker 3 (21:45):
Well, we are learning a lot about taking good care
of ourselves, so we are hearing from doctor Connor O'Neal
and doctor Arroya Royal Chokran about calling cancer screening, prostate screening.
We've got others coming up. Please stay on the line, listen,
call in, ask questions. This is Centered on Health with
Baptist Health here on news Radio eight forty. I'm your host,
(22:06):
doctor Jeff Publin. Five oh two, five seven one, eight
four eight four. If you want to call in and
ask the question, We've got a lot more to cover.
We'll be back right after this. Welcome back to center
(22:27):
it on Health with Baptist Health here on news radio
eight forty w h as. I am your host, doctor
Jeff Publin, and we're talking tonight about screening at any
age and for all sorts of cancers. And we're talking
with primary care physicians, doctor Connor O'Neill and doctor Ario Chopin.
Speaker 4 (22:45):
We're gonna switch gears a little bit.
Speaker 3 (22:47):
We've talked about colon cancer, We've talked about cost stake cancer.
Speaker 4 (22:51):
We're going to switch and talk doctor O'Neil about cervical.
Speaker 3 (22:54):
Cancer, which is it is very important obviously in women
with cervixes, but there is some implications for young men
and HPV, and I think this is a topic we
need to hear about. So tell us a little bit
about cervical cancer screening.
Speaker 1 (23:13):
Yeah, So typically when we screen for cervical cancer, the
age that we will plan to start at is twenty
one and we go up until sixty five.
Speaker 2 (23:26):
From twenty one to twenty nine, we typically.
Speaker 1 (23:30):
Will do a PAP smear and if that is normal negative,
then we would just do that every three years. Once
we reach age thirty, we can either do the regular
PAP smear, but we can also screen for HPV, which
is what you mentioned before, which can cause cervical cancer
that we know of, and so.
Speaker 2 (23:51):
We will depending on which tests you get.
Speaker 1 (23:54):
If you get a pat SERF, we do a PAS
smeere and HPV testing with that PAS smear and that's
negat know we go every five years. We don't have
to go any sooner. If we just do a PAP smear,
we don't test for HPV.
Speaker 2 (24:07):
That every three years.
Speaker 1 (24:08):
But like you mentioned before, we had we know that
certain viruses, specifically the human papaloma virus can cause UH
cervical cancer, and so we have we do have a
vaccine which is beneficial and we're strongly recommending that to
our patients to prevent cervical cancer and the spread of
(24:32):
that and reduce the risk of and so we will
recommend HPV vaccines if you haven't received it from as
a as a child typically is recommended first from age
starting at age eleven. You can get it up to
age twenty six, and it's two doses as a child
if you get it, but typically it'll be three doses
(24:54):
by the time they get to us. And that's again
up to twenty six. You can get it over twenty
six twenty six years of age, but that's kind of
a more you know, shared decision making depending on your
risk factors, if your immuno compromise and have anything specifically,
so again like I said, we will it's usually every
(25:15):
three to five years after you turn sixty five, and
you you know, you haven't had any history or issues
of positive PAP smears going forward, then we typically wouldn't
recommend screening.
Speaker 2 (25:28):
However, again, if you had either a positive PAP smear
in the past or any.
Speaker 1 (25:35):
Increased risk factors, then we would consider going forward and
continuing PAP smear testing and screening for cervical cancer.
Speaker 4 (25:44):
You know, and I think it's really fascinating when you
think about it.
Speaker 3 (25:47):
The fact that there is a linkage between an infection
and cancer and we have a vaccine that prevents it.
Speaker 4 (25:55):
Tell us about like who are the targets for the
HPV that and at what age is.
Speaker 5 (26:02):
Yeah, so the game really recommended for both the male
and females.
Speaker 2 (26:08):
So we get for pretty much everyone.
Speaker 1 (26:12):
It's to start if we can get it earlier from
age eleven to twelve. And specifically, you know, there's two
kind of subtypes of this virus that they have found
that kind of cause.
Speaker 2 (26:24):
Cervical cancer, and so.
Speaker 1 (26:27):
You can get the two doses as a child, but
again you can also get three doses. But the most
important part is that this is going to prevent you know,
getting cervical cancer if you're a woman, but also if
you're a male and you get this HTV, you can
prevent the spread of that, which is really probably very
unique in the cancer field that we know that a virus.
Speaker 2 (26:50):
Cancer.
Speaker 1 (26:50):
So that's another thing that's very unique with this kind
of cancer and screening for it, is that we can
almost prevent it with just you know, two shots initially essentially,
So that's a very you know unique thing and beneficial
thing if we can address it sooner.
Speaker 3 (27:08):
Amazing when you think about what we're what we're able
to prevent there, Doctor Show, can you know obviously we
could do an entire hour, two hours, three hours on
the topic of breast cancer screening, but in the context
of a general overview of screening recommendation for those listening,
tell us about where we are, what the recommendations are
(27:30):
for breast cancer screening, how is it, how is it done,
and who is it recommended?
Speaker 5 (27:33):
For sure, absolutely, just a little bit of background again,
breast cancer rights in the United States is roughly one
in eight women lifetime risk, which is again substantial twenty
twenty four estimates, or three hundred and ten thousand new
cases with forty two thousand new women unfortunately passing from
(27:54):
breast cancer. You know, we think about breast cancer typically
as a condition that effects women, but it can affect men,
although they are very significantly a significantly smaller percentage of
the patient population. So when we talk about screening, we're
going to focus primarily on women for this particular type
of cancer. The median age at the time of breast
(28:16):
cancer diagnosis is sixty two, so that's going to inform
us about how old we are going to start the
screening and how long we're going to continue it for.
So currently, the United States Preventative Service Task Force recommends
by any o, which is one of my favorite, unnecessarily
difficult word by the word yeah.
Speaker 4 (28:34):
Yeah, it's a good word.
Speaker 5 (28:37):
For as all women age fifty to seventy four years.
For some women, it's reasonable to start before fifty. But again,
shared decision making, I think we've beaten guys over that
with what that means at this point. So for some people,
depending on your independent risk factors, we may choose to
pursue it earlier. But even in most of those patients,
(28:58):
I've very rarely seen it before the age of four.
Speaker 4 (29:01):
And for women that are sorry, go ahead, no, go ahead,
go ahead, okay.
Speaker 5 (29:07):
For women who are at average risk of breast cancer,
the most common type of breast cancer screening is a mammogram,
and that demonstrates the most significant benefit for patients between
the ages of fifty to seventy four, specifically sixty or
sixty nine. That is where we see the most significant
mortality benefits through mammography. So let's talk about what is mammography.
Speaker 2 (29:29):
What is.
Speaker 5 (29:31):
The current discussion around it, and what are the new
things that might be coming down the pipeline in the
next five to ten years that we might see as
novel ways that we can evaluate and screen for these
conditions that might give us some opportunities to evaluate patients
who might not fit into the box of the mammogram. So,
(29:51):
a screening mammogram one of the most common ways we
screen for breast cancer in the United States. It's a
test where we use X ray pictures, typically from two
different angles to get a good characterization of the tissue
of the breast.
Speaker 1 (30:05):
Right.
Speaker 5 (30:06):
If we see something significant on a screening mammogram, typically
we reach for a follow up from mammogram which looks
at several different angles extra views, and that's what we
would call a diagnostic mammogram. Typically that's the path that
one would follow if that's where you were headed. But
there's some other tests that you might hear that might
(30:28):
be used in this process for screening, or if you
have some specific characteristics about your specific breast tissue, for example,
if you have more dense breast tissue, we might reach
for one of these alternate modalities. Right. So, one of
the other common ways that we screen, although it's not
typically our first test is it would be breast ultrasound. Specifically,
(30:50):
I reach for breast ultrasound in my patients who have
a more dense breast tissue. That dense tissue can be
just more difficult to characterize on mammogram. It also can
help us get you know, better pictures of suspicious areas
that we might have seen on a screening mammogram as well.
Ultrasound is nice because it helps us distinguish between like
(31:11):
a fluid filled mass, which like a cyst. Those things
are much less likely to be a cancer than a
solid mass, which would mean you know, advanced testing for
their imaging depending on what the characteristics of that mass
might be. There are a couple of newer modalities coming
down the pipeline. I just want to mention these briefly.
(31:32):
We don't have to get into it. I just think
they're super cool. So one, there is a new sequencing,
a new structure of MRI called abbreviated breast MRI or
fast breast MRI, which is a more rapid sequencing MRI
that gets another opportunity to evaluate breast tissue, specifically in
people who have more dense breasts for whom mammogram may
(31:53):
not be the best modality in that same patient population.
We can also pursue contrast enhance mirmography, which is another
new form of screening where we're using contrast injections to
enhance the baseline functionality of the mammogram technique that we've
been using. So if you hear either of these two
new modalities, I think these are the two for which
(32:16):
there's the best buzz as far as new testing strategies
that might be coming down the pipeline. But in truth,
I'd be pretty surprised if, say, if they are outpaced
the screening mammogram, which has been a stall wark really
for us for quite some time.
Speaker 3 (32:32):
Well, I think for anybody listening, it's very obvious why
we need young educated primary care physicians in our workforce
to teach us and keep up with all of these things.
I mean, this is just the amount of information you
carry around with you guys all day long. It's just unbelievable.
We're going to take our final break here and we're
going to come back and talk about a couple more things.
(32:54):
You're listening to Center on Health with Baptist Health here
on News Radio eight forty whas our guest tonight, doctor
Connor O'Neill and doctor Rio.
Speaker 4 (33:02):
Show Can talking to us tonight about.
Speaker 3 (33:05):
Screening modalities and different types of screening at any age.
Speaker 4 (33:09):
If you miss any of tonight's show, download the iHeartRadio app.
It's free, it's easy to use. We'll be right back.
Welcome back to center It on Hew with them miel
(33:30):
Beer on New Radio A forty WHS.
Speaker 3 (33:34):
I'm your host, doctor Jeff Publin, and we're talking tonight
with primary care physicians Connor O'Neill and Orio show Can
talking us tonight about screening for cancers at any age.
Remember to download the iHeartRadio app so we listen to
this or any of our previous segments and have access
to all the other features the app has to offer,
you know, doctor Onneil, One of the things that I
(33:54):
think that people may not think about is that we actually.
Speaker 4 (33:58):
Have the ability to screen for lung cancer.
Speaker 3 (34:01):
And I know that we live in a state that
has you know, significant risk factors for this. So talk
to us, what talk to us about screening for lung
cancer and how are we doing as a community and
getting that done.
Speaker 2 (34:15):
Yeah, so this is.
Speaker 1 (34:16):
Obviously very important for our state, the state of Kentucky,
and we have a very high lung cancer diagnosis and
lung cancer patient population, so we typically will we will
get the screening method for lung cancer is a CT scan,
and so it's it's specifically a low dose one, so
(34:37):
it's not high end radiation, and we start at age
fifty and patients who have what we call a twenty
pack here smoking history, which pack here essentially means how
many packs over a certain amount of years that they've smoking.
So if you smoked one pack a day for twenty years,
(34:57):
that would be a twenty pack year. If you smoke
two packs a day for ten years, that would be
a twenty pack year essentially, So it depends on how
much and how long you smoke, and so we would
typically get the CT scan once a year, starting at
age fifty up until you're eighty years old. If you
continue to smoke, if you have quit within the past
(35:19):
fifteen years, then typically we would stop because your likelihood
of having lung cancer if you've quit and you don't
have any essentially nodules that are concerning for lung cancer
is much lower. And so again we do that once
a year, but really the most important part of lung
cancer is smoking cessation and minimize it and stopping smoking.
(35:43):
And so there's a lot of you know, different modalities
that we can do to produce that, and we really
try to advocate for that instead of obviously having to
screen with a CT scan every year, and.
Speaker 3 (35:57):
We certainly want to you know, reinforce that this is again,
this is screening. We you know, especially with something like
lung cancer, we want if we're able to catch this
really early, then that's obviously ideal. So to any stigmata
around you know, feeling uncomfortable talking about that you're smoking
with your provider, we hope that you'll that you'll do
that shifting gears a little bit out of the cancer
(36:22):
realm per se, but screening as a primary care physician,
doctor Sho, can you talk to us. We have a
couple of minutes left about depression. I mean that that
is such an important thing and and I think people
go to their primary care and is this something you
find people bring up to you.
Speaker 4 (36:39):
Do you find you have to be proactive in assessing
this and how do you do that?
Speaker 5 (36:45):
Yeah? Absolutely, you know this is in many ways, this
is the silent part of almost every visit that I have, Right,
this is some ways of silent screening, because especially in
the last four years, I guess we're the last four
years more or less, we're seeing significant increases in depression
(37:05):
in every demographic right, every age group across the board.
And so you know, as a primary care physician, I
think it's really incumbent upon us, and in truth really
for many of our specialists as well, to be evaluating
this to some degree in almost every patient visit. You know,
from a primary care standpoint, we have a more structured approach,
(37:26):
there is a recommendation for us to do routine screening
either with typically with one of several questionnaires that we
might use that can help identify patients that might be
at risk. However, really I think at this point it's
(37:46):
a conversation that I'm having with almost every patient, right,
how are you feeling? How do you feel that you're adjusting?
You know, it's a crazy world that we're living in.
I think that's being clear And I was telling someone
the other day, I'm really ready for some precedented times.
You know, we're all adjusting to this. What is the
(38:08):
next ten years going to look like? How are we
going to move forward and whatever this new world is
going to look like. So I think a lot of
primary care physicians are taking this time to really just
make sure that we're checking in on each other. And
whether that's using a validated questionnaire like the PhD nine series,
(38:28):
or whether that's you know, taking a more patient by
patient approach. I just you know, I think it's it's
going to be more and more important, and as we
move into the future, I think it's going to be
one of the cornerstones of primary care.
Speaker 1 (38:42):
Well.
Speaker 3 (38:43):
I know I can already tell just by talking to
both of you that you provide an environment for your
patients to have those conversations with you about all of these.
Speaker 4 (38:51):
Screenings, so we appreciate everything you're doing.
Speaker 3 (38:54):
That wraps it up for another segment of Centered on
Health as Aptics Health. I'm your host, doctor Jeff Publin.
I want to thank our guests, doctor Connor O'Neil and
doctor Arioshocran for sharing with us screening.
Speaker 4 (39:06):
And I know we have much more we could talk about.
We'll just have to have you back.
Speaker 3 (39:09):
So I want to thank our producer mister Jim Ben
and you the listener. Join us every Thursday night for
another episode and I.
Speaker 4 (39:16):
Hope you have a great week. We'll see you next week.
Speaker 1 (39:23):
This program is for informational purposes only and should not
be relied upon as medical advice.
Speaker 2 (39:28):
The content of this program is not intended to be
a substitute for professional medical advice, diagnosis, or treatment.
Speaker 1 (39:35):
This show is not designed to replace a physician's medical
assessment and medical judgment. Always seek the advice of your
physician with any questions or concerns you may have related
to your personal health or regarding specific medical conditions.
Speaker 5 (39:48):
To find a Baptist health provider, please visit Baptist Health
dot com.
It's now time for Centered on Health with Baptis Help
on use Radio.
Speaker 2 (00:05):
Wait for each elbody y JS. Now here's doctor Jeff Tuban.
Speaker 3 (00:11):
Good evening, everyone, and welcome to tonight's episode of Centered
on Health with Factors Health, your call in medical show
here on News Radio eight forty whas. I am your host,
doctor Jeff Publin. We're joined by mister Jim Finn and
our studio waiting to take your calls to talk to
tonight's guests. Our phone number five oh two, five seven one,
(00:32):
eight four eight four if you want to call in
be a part of tonight's conversation and tonight we are
very fortunate to have not one, but two primary care
physicians today to talk to us about healthcare screenings at
any age. So, no matter who you are listening to
this show right now, there's going to be something in
this show that pertains to you. So I am I'm
(00:54):
hoping you're there, you're ready to call in and ask questions.
I want to introduce you to both doctor Connor O'Neill
and doctor Ario Chopan. Doctor O'Neill is a primary care
physician with Baptist Health Medical Group at Breckenridge a practice
that I am very familiar with. He's joined us from
as a graduate of the University of Kentucky Medical School,
(01:14):
and doctor Ariah Chopin also is a primary care physician
with Baptist Hospital Medical Group, receiving his MV from the
University of Kentucky Medical School as well.
Speaker 4 (01:24):
Both of them are here.
Speaker 3 (01:25):
They're new to our community over the last couple of
years and are filling an enormous gap in primary care.
Speaker 4 (01:33):
And we welcome you both to the show.
Speaker 2 (01:36):
Thank you, Thank you for having us, and we're glad
to be here.
Speaker 3 (01:39):
And we've got both of you on. Yeah, fantastic. So
you know, I'm really excited to have you both, And
I think the way I just kind of want to
introduce you to our listeners and to our audience is
maybe give you each, you know, just a little time
to tell us about your decision to become a primary
care physician and kind of what you what you think
(02:03):
about primary care and why you're attracted to it. So
maybe we'll start with doctor O'Neil, you can tell us
about you, and then doctor Choken we can hear about you.
Speaker 2 (02:13):
Yeah, thank you.
Speaker 1 (02:13):
So I had always kind of been interested in primary
here and it wasn't until I was in residency and
training that I wanted to pursue it. It really was
the aspect of just having continuity and you know, establishing
relationships with patients over years to decades that I really
(02:36):
enjoyed and looked forward to. So that was really the
main reason I wanted to pursue primary care. The other
reason was that I kind of liked I liked every
other specialty, but I didn't love any specialty. So primary
care kind of encapsulates all specialties in some way. So
that was a main reason that I wanted to pursue.
(02:58):
And it's it's been a good to say as an
ever since.
Speaker 4 (03:02):
Good talking in doctor shoken.
Speaker 5 (03:05):
Yeah, for sure. You know I can echo a lot
of what doctor O'Neal I had to say. You know,
for me, it's an interesting process, right. You know, my
father is also a primary care physician.
Speaker 4 (03:16):
Okay, in some way the kind.
Speaker 5 (03:18):
Of a family business. But you know, in truth, it's
not something that I really thought I was going to
end up in. Like when I started out in this
process so long ago, if you'd asked me if I
was gonna end up as a primary care position, I
would have told you. But you know, as I think,
the more time I spent working with patients and the
more time I spent, you know, studying medicine, I think
(03:42):
for me, the part that's always been important is it's
always been the people right, and the opportunity to serve
a community and a group of people for a long
period of time right and make a significant difference. I
don't think I'm alone and saying that's why I was
called to medicine, My suspicion is probably why most of
us were, you know. And I think for me, the
(04:02):
best way that I found to be able to do that,
to make a meaningful impact on a specific group of people,
it's through primary care. And you know, I agree with
the doctor O'Neil. There are a lot of things in
medicine that are super awesome and cool, and I'm so
happy we have wonderful people to do those things, you know,
But I think it's incumbent upon each of us in
(04:22):
medicine to find the area that best melds our skill
set and our interests in a way that can bestor
of our patient population. And I think for me, primary
care has been that, and it's challenging, it's it's different,
it's fast paced. Every single day is something new, every
single visit is something new, which is you know, had
(04:45):
its own unique challenges, But it's a it's great, it's fun,
it's it's a very cool thing to be a part
of right now. And getting to do it with such
a great group of people like we have over at
Saint Matt's, it's just such a unique opportunity. So I'm
really thankful, well.
Speaker 3 (05:00):
We are thankful that both of you are here for sure.
And I'm going to stick with you, doctor Chokin for
just a minute because I have a whole list of
things about primary care I wanted to talk to you
guys about. I'm gonna wait because I want to These
screenings are so important. I want to kind of get
right into it. But before we get with doctor O'Neil
and start with our first cancer screening, doctor Chokin, can
(05:24):
you just describe for our listeners what.
Speaker 4 (05:27):
Screening actually means?
Speaker 3 (05:29):
And I think you know, as one of the people
doing the screening for one area of this medical world,
sometimes I feel like people don't understand what the concept
of screening is versus a diagnostic KEP, could you tell
us a little bit about that for sure.
Speaker 5 (05:46):
You know, screenings in many ways, This is probably the
talk I give the most, but screening. What we're doing
with screening is we're really trying to identify problems that
might be coming down the road before they be issues
that are so significant that they require such a massive intervention.
Speaker 2 (06:04):
Right.
Speaker 5 (06:05):
So it's really about early identification, early diagnosis, and giving
ourselves the best chance to fight back against anything that
might be brewing. So, you know, many of these tests
that we're going to discuss our tests that you would
get while feeling healthy or relatively normal, routine tests that
we asked our patients to go through so that we
(06:28):
can evaluate for the things that don't typically develop in
a way that is very apparent to the people who
are experiencing them. Right. So, a lot of these tests
are specifically designed have high rates of positivity, right, So
they want to catch as many people as possible in
(06:48):
order to identify the people who need an additional step
of screening, a further step of testing. Right. So, some
of them are not the most specific tests that we have,
but they do a really great job of identifying the
individuals who have need for further screening. So as you,
as we go through this talk, I'm sure you'll see
that many of these tests are tests that lead to
(07:10):
further tests, and that's often a way I think about
screening is as an opportunity for us to take a
peek under the hood see what problems might be brewing
while we still have plenty of time to address and
impact those things.
Speaker 3 (07:24):
And and doctor o' neil, we're gonna switch over to
you another first thing we're going to talk about. We're
going to have you kind of focus on. But these
are it's important for our listeners and for patients and
our practices to realize that they don't have to have symptoms.
In fact, the screening really is intended to get things
before symptoms.
Speaker 4 (07:45):
Is that is that correct?
Speaker 1 (07:48):
Yes? And really I mean for screening. You know, that's
kind of the hard part about you know, screening tests
is that you don't don't feel any you know, you're
not having any symptoms, you're not feeling worse, and so
to go through a test, a lot of people don't
feel the value. But typically when you start to develop
(08:10):
symptoms of you know, the tests and diseases that we're
going to discuss, typically that is at a point, you
know where it's not too late, but it's later than
we could have addressed it before.
Speaker 2 (08:24):
And so that's why it's very important.
Speaker 1 (08:26):
To make sure we're doing all of the proper testing
at you know, the certain ages, the certain risk factors,
because we want to make sure that we can address
it before before it progresses to something that you know,
ultimately could you know, be inevitable. And so that's really
the most important part about screening is that you don't
(08:46):
feel any different. You know, you feel fine, but there
still could be something there that we can address before
it progresses.
Speaker 3 (08:54):
And I think we're gonna we're going to try. We're
going to try and cover quite quite a range of
screening today. We're going to try and hit at least
colon and prostrate and cervical and breath and we're going
to try and touch on all of those. But I
think we're going to start, and we're going to start
with you, doctor O'Neil, about colon cancer screening, which of
course to me is very near and dear to my heart.
(09:16):
But if you could just tell us briefly kind of
who when do you start calling cancer screening? And is
there a time when you stop calling cancer screening?
Speaker 1 (09:29):
Yes, so it actually I think it changed in twenty
twenty one, and you correct me if that it says
right around the year. But it was fifty years old
that we would get, you know, that would be the
age that we would scream for colling cancer. But they
had looked at the data and sold that, you know,
they were there were a lot more people who were
being diagnosed younger, and so they actually changed it in
(09:52):
twenty twenty one to age forty five. So that is
the age of age that we typically will screen for
people who are average risks and then after and then
we screened until seventy five years old. Now you can
you know, be screened after year seventy five and you
won't have It's really a shared decision making with you know,
(10:14):
the patient and the position if they want to pursue that.
There are certain individuals who may be at higher risk
of needing earlier screening, and some of those include if
you have a family history, which typically includes if you
have a first degree relative that was diagnosed and going cancer.
(10:36):
Typically we would die or we would start screening ten
years before that first degree relative age of when they
were diagnosed. If they were diagnosed later than you know fifty,
then we typically would start at age forty because you
are at a higher risk of developing coaling cancer if
(10:56):
you do have family history. The other ones would be
if you haven't flammatory val disease typically like ultra drive
colitis or chron disease. We typically would start colonoscopy about
eight years after they were diagnosed initially of disease on set,
and then we would kind of pursue colonoscopies or in
(11:16):
a screening method for colon cancer every three to five
years because those patients are at a higher risk of
developing colon cancer as well.
Speaker 2 (11:25):
And we're gonna, I guess this go ahead.
Speaker 3 (11:28):
I was just gonna say, we're gonna we'll get into
how we're gonna do that screening. We're gonna have to
take a quick break here and then we're going to
continue with you, doctor O'Neil. You are listening to doctor
Connor O'Neill and doctor Ario Chopin talking to us about
screening at any aid. This is centered on health with
Baptist Help here on news radio eight forty w a
as I'm your host, doctor Jeff Publin, And if you
(11:49):
want to call in and ask questions about screening for
any type of cancer. Five oh two, five seven one,
eight four eight four producers.
Speaker 5 (11:57):
Contents on call to take your calling.
Speaker 3 (11:59):
We'll be right back. Welcome back to send it on
health with Baptist Help here on news radio eight forty WAKS.
(12:19):
I'm your host, doctor Jeff Calvin. We're talking tonight to
primary care physicians Connor O'Neill and a Ryo Chopan, both
at the Baptist Hospital Medical Group, and teaching us tonight
about screenings at any age. Right before the break, we
started talking about colon cancer screening and doctor O'Neill. By
the time patients get to me, they're getting a callonoscopy
(12:39):
as their choice for callon cancer screening, but you have
to have the conversation with them about what that means
and what other options are. So tell us about your
approach and what tests you offer to people for coll
and campus screens.
Speaker 1 (12:55):
Yeah, so there's a variety there's of tests for screening
for colon cancer.
Speaker 2 (13:04):
The first one.
Speaker 1 (13:05):
And really the gold standard that we typically recommend is
the colonoscopy. And the reason this is the gold standard
and probably one of the best screening cancer screening tests
that we have is that you're able to get direct
visualization of the colon and if there's any specific leasions
(13:26):
that are concerning for cancer, and you can actually remove
those during the tests. So it's really one of one
of a kind to where you can do a screening
test and then also treat it with removing part of
that pole up, assuming that they're able to get the whole,
the whole complete set. So that is typically we typically
(13:47):
will start again at age forty five if you're at
average risk and assuming that you you know, if you
have no polyups or nothing that is concerned on the colonoscopy,
you don't have to get another one for until ten
years after that, so that is a very Again there's
very few screening tests that have that duration of not
(14:09):
needing another one for ten years.
Speaker 2 (14:11):
Now, there are certain poll ups that can.
Speaker 1 (14:14):
Specifically if you do have those and they remove them,
they recommend sooner surveillance with another colonoscope. Typically it would
be three to five years, and and there's a number
of different poll ups that can indicate which year you
would do, but we'll get into the details of that,
but that is typically what we would do is ten
(14:36):
years or three or five years if you do have
evidence of poll ups. The next one that again i'll
keep with the most common ones, is a school test
that we.
Speaker 2 (14:48):
It's called the color guard often at REMART test, and so.
Speaker 1 (14:51):
That is one that you are able to get a
sample of your soool. Usually you'll get since the material
to do that and you'll you'll obtain a sample of
your stool. Then you will send it back to this
facility that where they will test it for certain markers
(15:12):
and they can detect DNA mutations that are associated with
colorectal cancer or pre cancer as poly ups. Now, if
you do test positive, or if the coal of guard
ultimately does so positive, then you do have to proceed
to get into colonoscopy to further evaluate that. The good
part about that color guard is that it's obviously non invasive,
(15:35):
which is an ideal situation for a lot of patients. However,
you know, again it's not as ideal for treating if
you do have polyps as a colonoscopy. And so those
are really the two main ones. There's a couple, there's
a few other ones. Two other kind of direct visualization.
(15:55):
One is a flex flexible sigmoidoscopy that is typically every
five years, and that just specifically we'll look at kind
of the lower part of the colon where most cancers
do present, and it is a little less invasive the colonoscopy.
And then the other one is a CKE colonograph. And
(16:15):
I'll be honest, I haven't really had many patients perform
this or even before.
Speaker 2 (16:20):
Uh, and so that I think is every five years. Now.
Speaker 1 (16:24):
Again, I recommend strongly when I talked about patients that
colonoscopy is the most ideal. And again you can get
that if you don't have any findings, then you can
go for ten years and you don't.
Speaker 2 (16:35):
Have to worry about it necessarily.
Speaker 3 (16:38):
Well, and you know, I appreciate that approach, and you
know what's really nice for those listening is that, of course,
you know, we strongly recommend the colonoscopy, but the important
part is to be screened. Unfortunately there are some other
options for some reason. Colonoxopy isn't isn't right for you,
but do get screened. And thank you so much doctor
O'Neil for for explaining all that to us. We're gonna
(17:00):
shift gears a little doctor soapin We're going to move
into the area of prostate cancer screening, which is also
another another important screening cancer to look for. What is
your approach and what do we need to know about
prostate cancer screening.
Speaker 5 (17:16):
Yeah, absolutely, let's get into it. Pro State cancer. You know,
prossate cancer is actually the most common non skin cancer
in men in the United States. It's the fourth most
common tumor that is diagnosed worldwide. So for men in
the United States, about one in eight will be diagnosed
with prostate cancer at some point in their life. Those
numbers are slightly higher if like me, you're a man
(17:36):
of color. For African American men, it's about one in
six of us will develop PROC high. Yeah, that's remarkably high. Yeah,
it's very, very high. You know, it's when you start
to look at the statistics, it's really easy to understand
why the screening is so important, you know. You know,
and this year alone, the American Eurologic Eucologication is estimating
(18:01):
more than two hundred ninety nine thousand men will be
diagnosed with prostate cancer and over thirty five thousand people
will die from the So, you know, it's a very
significant thing that's impacting a bunch of members of our community.
So let's talk about it. You know, it's interestingly prostate
cancer is not one of the cancers for which the
United States Preventitive Services Task Force recommends that we do
(18:24):
routine screening and all of our patients. But you know,
this is a really unique opportunity for your primary care
provider to get a practice from shared decision making. You know,
prostate cancer screening is really an individualized decision. It's something
that each primary care physician would talk to each of
their patients about. Well, the patients for whom it's applicable,
which just male patients is only men have process at
(18:49):
this point. You know, for me, at least, my approach
is I start to look at the risk factors. You know,
for me, men of color something we should be discussing. Right,
we know that there's a signal, nificant increase in incidents
and men of color in this country. We've got to
talk about these things. Other than that any any individual
with a first agree relative with the history of prostate cancer,
(19:12):
individuals who are currently smoking, these are all the kinds
of people for whom there's an increased risk, right, we
should have at least the conversation about whether or not
this is something that we should pursue right now. I
will also say that because of the nature of prostate
cancer as a disease, there are a significant percentage of
(19:32):
people for whom screening is not really warranted.
Speaker 2 (19:36):
Right.
Speaker 5 (19:37):
You know, we know that this is a slowly progressive cancer,
and we know that this is a cancer that it's
fairly treatable and in many cases does not require urgent intervention. Right.
And so for people who have significant medical comorbidities, you know,
or life expectancies that are are of a sort that
means that they are more likely to have other issues
(20:00):
rise prior to this becoming the significant problem in their life,
it may not be reasonable to pursue this, you know,
the screening strategy for them. So I think this is
a really great opportunity for us to compare and contrast,
you know, the way we talk about colon cancer screening
and the way we talk about prostate cancer. Colon cancer
screening every patient, we've got to do it. Prostate cancer screening.
(20:21):
This is a more tailored approach, a more personalized approach
per patient. You know, the general logic, go ahead.
Speaker 3 (20:31):
I was gonna say, the screening is it? The digital
rectal exam is it A, is it the p S A?
Speaker 5 (20:36):
What?
Speaker 3 (20:36):
What is your the current guideline of what to use
to screen for sure?
Speaker 5 (20:41):
For sure?
Speaker 3 (20:42):
You know.
Speaker 5 (20:42):
Fortunately, I think for for both clinicians and patients, we've
moved away from the digital firstal examine the first line
of testing for screening for prostate cancer. I think many
of our nations are very happy about that.
Speaker 3 (20:54):
Yeah, you know.
Speaker 5 (20:55):
The prostate specific antigen is a blood test that we
can and getting our patients. It's recommended by the Urologic Association.
Is the first screening test with a level A recommendation
for evidence. So this is for us, the first test
that I would reach for in patients for whom this
is something that they want to be a part of
(21:17):
their care plan for some or for someone who has
significant risk factors. The recommendation is to discuss this with
your patients every two to four years, and patients who
have a prostate age between fifteen and sixty nine. But
the discretion and frequency of rescreening is left to each individual,
to each individual patient and their provider to determine based
(21:40):
on each individual's unique circumstances.
Speaker 3 (21:45):
Well, we are learning a lot about taking good care
of ourselves, so we are hearing from doctor Connor O'Neal
and doctor Arroya Royal Chokran about calling cancer screening, prostate screening.
We've got others coming up. Please stay on the line, listen,
call in, ask questions. This is Centered on Health with
Baptist Health here on news Radio eight forty. I'm your host,
(22:06):
doctor Jeff Publin. Five oh two, five seven one, eight
four eight four. If you want to call in and
ask the question, We've got a lot more to cover.
We'll be back right after this. Welcome back to center
(22:27):
it on Health with Baptist Health here on news radio
eight forty w h as. I am your host, doctor
Jeff Publin, and we're talking tonight about screening at any
age and for all sorts of cancers. And we're talking
with primary care physicians, doctor Connor O'Neill and doctor Ario Chopin.
Speaker 4 (22:45):
We're gonna switch gears a little bit.
Speaker 3 (22:47):
We've talked about colon cancer, We've talked about cost stake cancer.
Speaker 4 (22:51):
We're going to switch and talk doctor O'Neil about cervical.
Speaker 3 (22:54):
Cancer, which is it is very important obviously in women
with cervixes, but there is some implications for young men
and HPV, and I think this is a topic we
need to hear about. So tell us a little bit
about cervical cancer screening.
Speaker 1 (23:13):
Yeah, So typically when we screen for cervical cancer, the
age that we will plan to start at is twenty
one and we go up until sixty five.
Speaker 2 (23:26):
From twenty one to twenty nine, we typically.
Speaker 1 (23:30):
Will do a PAP smear and if that is normal negative,
then we would just do that every three years. Once
we reach age thirty, we can either do the regular
PAP smear, but we can also screen for HPV, which
is what you mentioned before, which can cause cervical cancer
that we know of, and so.
Speaker 2 (23:51):
We will depending on which tests you get.
Speaker 1 (23:54):
If you get a pat SERF, we do a PAS
smeere and HPV testing with that PAS smear and that's
negat know we go every five years. We don't have
to go any sooner. If we just do a PAP smear,
we don't test for HPV.
Speaker 2 (24:07):
That every three years.
Speaker 1 (24:08):
But like you mentioned before, we had we know that
certain viruses, specifically the human papaloma virus can cause UH
cervical cancer, and so we have we do have a
vaccine which is beneficial and we're strongly recommending that to
our patients to prevent cervical cancer and the spread of
(24:32):
that and reduce the risk of and so we will
recommend HPV vaccines if you haven't received it from as
a as a child typically is recommended first from age
starting at age eleven. You can get it up to
age twenty six, and it's two doses as a child
if you get it, but typically it'll be three doses
(24:54):
by the time they get to us. And that's again
up to twenty six. You can get it over twenty
six twenty six years of age, but that's kind of
a more you know, shared decision making depending on your
risk factors, if your immuno compromise and have anything specifically,
so again like I said, we will it's usually every
(25:15):
three to five years after you turn sixty five, and
you you know, you haven't had any history or issues
of positive PAP smears going forward, then we typically wouldn't
recommend screening.
Speaker 2 (25:28):
However, again, if you had either a positive PAP smear
in the past or any.
Speaker 1 (25:35):
Increased risk factors, then we would consider going forward and
continuing PAP smear testing and screening for cervical cancer.
Speaker 4 (25:44):
You know, and I think it's really fascinating when you
think about it.
Speaker 3 (25:47):
The fact that there is a linkage between an infection
and cancer and we have a vaccine that prevents it.
Speaker 4 (25:55):
Tell us about like who are the targets for the
HPV that and at what age is.
Speaker 5 (26:02):
Yeah, so the game really recommended for both the male
and females.
Speaker 2 (26:08):
So we get for pretty much everyone.
Speaker 1 (26:12):
It's to start if we can get it earlier from
age eleven to twelve. And specifically, you know, there's two
kind of subtypes of this virus that they have found
that kind of cause.
Speaker 2 (26:24):
Cervical cancer, and so.
Speaker 1 (26:27):
You can get the two doses as a child, but
again you can also get three doses. But the most
important part is that this is going to prevent you know,
getting cervical cancer if you're a woman, but also if
you're a male and you get this HTV, you can
prevent the spread of that, which is really probably very
unique in the cancer field that we know that a virus.
Speaker 2 (26:50):
Cancer.
Speaker 1 (26:50):
So that's another thing that's very unique with this kind
of cancer and screening for it, is that we can
almost prevent it with just you know, two shots initially essentially,
So that's a very you know unique thing and beneficial
thing if we can address it sooner.
Speaker 3 (27:08):
Amazing when you think about what we're what we're able
to prevent there, Doctor Show, can you know obviously we
could do an entire hour, two hours, three hours on
the topic of breast cancer screening, but in the context
of a general overview of screening recommendation for those listening,
tell us about where we are, what the recommendations are
(27:30):
for breast cancer screening, how is it, how is it done,
and who is it recommended?
Speaker 5 (27:33):
For sure, absolutely, just a little bit of background again,
breast cancer rights in the United States is roughly one
in eight women lifetime risk, which is again substantial twenty
twenty four estimates, or three hundred and ten thousand new
cases with forty two thousand new women unfortunately passing from
(27:54):
breast cancer. You know, we think about breast cancer typically
as a condition that effects women, but it can affect men,
although they are very significantly a significantly smaller percentage of
the patient population. So when we talk about screening, we're
going to focus primarily on women for this particular type
of cancer. The median age at the time of breast
(28:16):
cancer diagnosis is sixty two, so that's going to inform
us about how old we are going to start the
screening and how long we're going to continue it for.
So currently, the United States Preventative Service Task Force recommends
by any o, which is one of my favorite, unnecessarily
difficult word by the word yeah.
Speaker 4 (28:34):
Yeah, it's a good word.
Speaker 5 (28:37):
For as all women age fifty to seventy four years.
For some women, it's reasonable to start before fifty. But again,
shared decision making, I think we've beaten guys over that
with what that means at this point. So for some people,
depending on your independent risk factors, we may choose to
pursue it earlier. But even in most of those patients,
(28:58):
I've very rarely seen it before the age of four.
Speaker 4 (29:01):
And for women that are sorry, go ahead, no, go ahead,
go ahead, okay.
Speaker 5 (29:07):
For women who are at average risk of breast cancer,
the most common type of breast cancer screening is a mammogram,
and that demonstrates the most significant benefit for patients between
the ages of fifty to seventy four, specifically sixty or
sixty nine. That is where we see the most significant
mortality benefits through mammography. So let's talk about what is mammography.
Speaker 2 (29:29):
What is.
Speaker 5 (29:31):
The current discussion around it, and what are the new
things that might be coming down the pipeline in the
next five to ten years that we might see as
novel ways that we can evaluate and screen for these
conditions that might give us some opportunities to evaluate patients
who might not fit into the box of the mammogram. So,
(29:51):
a screening mammogram one of the most common ways we
screen for breast cancer in the United States. It's a
test where we use X ray pictures, typically from two
different angles to get a good characterization of the tissue
of the breast.
Speaker 1 (30:05):
Right.
Speaker 5 (30:06):
If we see something significant on a screening mammogram, typically
we reach for a follow up from mammogram which looks
at several different angles extra views, and that's what we
would call a diagnostic mammogram. Typically that's the path that
one would follow if that's where you were headed. But
there's some other tests that you might hear that might
(30:28):
be used in this process for screening, or if you
have some specific characteristics about your specific breast tissue, for example,
if you have more dense breast tissue, we might reach
for one of these alternate modalities. Right. So, one of
the other common ways that we screen, although it's not
typically our first test is it would be breast ultrasound. Specifically,
(30:50):
I reach for breast ultrasound in my patients who have
a more dense breast tissue. That dense tissue can be
just more difficult to characterize on mammogram. It also can
help us get you know, better pictures of suspicious areas
that we might have seen on a screening mammogram as well.
Ultrasound is nice because it helps us distinguish between like
(31:11):
a fluid filled mass, which like a cyst. Those things
are much less likely to be a cancer than a
solid mass, which would mean you know, advanced testing for
their imaging depending on what the characteristics of that mass
might be. There are a couple of newer modalities coming
down the pipeline. I just want to mention these briefly.
(31:32):
We don't have to get into it. I just think
they're super cool. So one, there is a new sequencing,
a new structure of MRI called abbreviated breast MRI or
fast breast MRI, which is a more rapid sequencing MRI
that gets another opportunity to evaluate breast tissue, specifically in
people who have more dense breasts for whom mammogram may
(31:53):
not be the best modality in that same patient population.
We can also pursue contrast enhance mirmography, which is another
new form of screening where we're using contrast injections to
enhance the baseline functionality of the mammogram technique that we've
been using. So if you hear either of these two
new modalities, I think these are the two for which
(32:16):
there's the best buzz as far as new testing strategies
that might be coming down the pipeline. But in truth,
I'd be pretty surprised if, say, if they are outpaced
the screening mammogram, which has been a stall wark really
for us for quite some time.
Speaker 3 (32:32):
Well, I think for anybody listening, it's very obvious why
we need young educated primary care physicians in our workforce
to teach us and keep up with all of these things.
I mean, this is just the amount of information you
carry around with you guys all day long. It's just unbelievable.
We're going to take our final break here and we're
going to come back and talk about a couple more things.
(32:54):
You're listening to Center on Health with Baptist Health here
on News Radio eight forty whas our guest tonight, doctor
Connor O'Neill and doctor Rio.
Speaker 4 (33:02):
Show Can talking to us tonight about.
Speaker 3 (33:05):
Screening modalities and different types of screening at any age.
Speaker 4 (33:09):
If you miss any of tonight's show, download the iHeartRadio app.
It's free, it's easy to use. We'll be right back.
Welcome back to center It on Hew with them miel
(33:30):
Beer on New Radio A forty WHS.
Speaker 3 (33:34):
I'm your host, doctor Jeff Publin, and we're talking tonight
with primary care physicians Connor O'Neill and Orio show Can
talking us tonight about screening for cancers at any age.
Remember to download the iHeartRadio app so we listen to
this or any of our previous segments and have access
to all the other features the app has to offer,
you know, doctor Onneil, One of the things that I
(33:54):
think that people may not think about is that we actually.
Speaker 4 (33:58):
Have the ability to screen for lung cancer.
Speaker 3 (34:01):
And I know that we live in a state that
has you know, significant risk factors for this. So talk
to us, what talk to us about screening for lung
cancer and how are we doing as a community and
getting that done.
Speaker 2 (34:15):
Yeah, so this is.
Speaker 1 (34:16):
Obviously very important for our state, the state of Kentucky,
and we have a very high lung cancer diagnosis and
lung cancer patient population, so we typically will we will
get the screening method for lung cancer is a CT scan,
and so it's it's specifically a low dose one, so
(34:37):
it's not high end radiation, and we start at age
fifty and patients who have what we call a twenty
pack here smoking history, which pack here essentially means how
many packs over a certain amount of years that they've smoking.
So if you smoked one pack a day for twenty years,
(34:57):
that would be a twenty pack year. If you smoke
two packs a day for ten years, that would be
a twenty pack year essentially, So it depends on how
much and how long you smoke, and so we would
typically get the CT scan once a year, starting at
age fifty up until you're eighty years old. If you
continue to smoke, if you have quit within the past
(35:19):
fifteen years, then typically we would stop because your likelihood
of having lung cancer if you've quit and you don't
have any essentially nodules that are concerning for lung cancer
is much lower. And so again we do that once
a year, but really the most important part of lung
cancer is smoking cessation and minimize it and stopping smoking.
(35:43):
And so there's a lot of you know, different modalities
that we can do to produce that, and we really
try to advocate for that instead of obviously having to
screen with a CT scan every year, and.
Speaker 3 (35:57):
We certainly want to you know, reinforce that this is again,
this is screening. We you know, especially with something like
lung cancer, we want if we're able to catch this
really early, then that's obviously ideal. So to any stigmata
around you know, feeling uncomfortable talking about that you're smoking
with your provider, we hope that you'll that you'll do
that shifting gears a little bit out of the cancer
(36:22):
realm per se, but screening as a primary care physician,
doctor Sho, can you talk to us. We have a
couple of minutes left about depression. I mean that that
is such an important thing and and I think people
go to their primary care and is this something you
find people bring up to you.
Speaker 4 (36:39):
Do you find you have to be proactive in assessing
this and how do you do that?
Speaker 5 (36:45):
Yeah? Absolutely, you know this is in many ways, this
is the silent part of almost every visit that I have, Right,
this is some ways of silent screening, because especially in
the last four years, I guess we're the last four
years more or less, we're seeing significant increases in depression
(37:05):
in every demographic right, every age group across the board.
And so you know, as a primary care physician, I
think it's really incumbent upon us, and in truth really
for many of our specialists as well, to be evaluating
this to some degree in almost every patient visit. You know,
from a primary care standpoint, we have a more structured approach,
(37:26):
there is a recommendation for us to do routine screening
either with typically with one of several questionnaires that we
might use that can help identify patients that might be
at risk. However, really I think at this point it's
(37:46):
a conversation that I'm having with almost every patient, right,
how are you feeling? How do you feel that you're adjusting?
You know, it's a crazy world that we're living in.
I think that's being clear And I was telling someone
the other day, I'm really ready for some precedented times.
You know, we're all adjusting to this. What is the
(38:08):
next ten years going to look like? How are we
going to move forward and whatever this new world is
going to look like. So I think a lot of
primary care physicians are taking this time to really just
make sure that we're checking in on each other. And
whether that's using a validated questionnaire like the PhD nine series,
(38:28):
or whether that's you know, taking a more patient by
patient approach. I just you know, I think it's it's
going to be more and more important, and as we
move into the future, I think it's going to be
one of the cornerstones of primary care.
Speaker 1 (38:42):
Well.
Speaker 3 (38:43):
I know I can already tell just by talking to
both of you that you provide an environment for your
patients to have those conversations with you about all of these.
Speaker 4 (38:51):
Screenings, so we appreciate everything you're doing.
Speaker 3 (38:54):
That wraps it up for another segment of Centered on
Health as Aptics Health. I'm your host, doctor Jeff Publin.
I want to thank our guests, doctor Connor O'Neil and
doctor Arioshocran for sharing with us screening.
Speaker 4 (39:06):
And I know we have much more we could talk about.
We'll just have to have you back.
Speaker 3 (39:09):
So I want to thank our producer mister Jim Ben
and you the listener. Join us every Thursday night for
another episode and I.
Speaker 4 (39:16):
Hope you have a great week. We'll see you next week.
Speaker 1 (39:23):
This program is for informational purposes only and should not
be relied upon as medical advice.
Speaker 2 (39:28):
The content of this program is not intended to be
a substitute for professional medical advice, diagnosis, or treatment.
Speaker 1 (39:35):
This show is not designed to replace a physician's medical
assessment and medical judgment. Always seek the advice of your
physician with any questions or concerns you may have related
to your personal health or regarding specific medical conditions.
Speaker 5 (39:48):
To find a Baptist health provider, please visit Baptist Health
dot com.
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