I saved a life last week. I encouraged Mel to do a bowel cancer test and she rolled her eyes. “It sounds awful and anyway, I don’t have any symptoms.” I convinced Mel that the idea of a preventive health screen is to detect a cancer before it causes symptoms and that taking such a test (a FIT or faecal immunochemical test in New Zealand) is very straightforward.
When her results came back positive, I was shocked. Mel is 46 with two primary school-aged children. She did have haemorrhoids during her pregnancies, and I wondered if this was the cause of her positive test. I contacted her and referred her for a colonoscopy. We were both shocked to learn that she had an adenocarcinoma of the bowel.
This was a sober reminder that preventive medicine is at the heart of my job as a GP. The problem is that there are so many competing demands on my time that it can be challenging to squeeze preventive screening and routine examinations in.
The 15-minute consultation is woefully inadequate when dealing with something as important as people’s physical and mental wellbeing.
Why testing is vital
Celia presented to me after a long absence. She was unwell with a cough and a fever and just wanted a quick consultation to get a sickness certificate for work. When I asked her how she was, I learned that she had moved after a difficult separation from her husband and now lived with her two children much further from the surgery.
Such a lot had happened since I’d last seen Celia, I let her talk. The pandemic had been a particularly challenging time as she worked long hours as a nurse in one of our major hospitals, while her husband was retrenched and found himself at home managing the household and home schooling. A marriage that was already under strain cracked under the pressure and Celia and her husband are now separated with plans to divorce.
I had a quick scroll through her file and noticed she was overdue for her cervical screening test, routine bloods and her mammogram. She agreed to have these done and to come back in a couple of weeks.
I was floored by the call from the radiologist advising me that she had breast cancer. It was late Friday afternoon and I wondered whether to call her immediately or give her one final weekend of blissful ignorance. I called her Monday morning with the news, having arranged an appointment with a breast surgeon who agreed to see Celia later that week. Like many people, life got in the way of routine medical tests. The pandemic was particularly challenging as many routine services closed. When life gets busy or stressful, those life-saving tests like a mammogram, routine blood tests and skin checks are neglected, and for some, the consequences prove to be life-threatening.
The Royal Australian College of General Practice recently released its latest copy of The Red Book, a guide to routine preventive practices that if consistently implemented, would have profound positive impacts on every sector of the health system and on overall wellbeing.
Some recommendations like regular blood pressure checks are quick and easy to implement and easily incorporated into a consultation. Screening for mental health issues or asking a woman in her late forties about menopause is like opening a Pandora’s box and impossible to accomplish in 15 minutes when a patient has presented for an unrelated issue.
Mel was booked in for surgery the week of her diagnosis and lost a segment of her bowel. She was very fortunate that the cancer was detected early. There were no lymph nodes involved and no metastases. Her prognosis is excellent. Her brush with cancer has had a positive ripple effect amongst her friends and family with all of them lining up for routine preventive screening with their own family doctors.
Celia is doing well. She had a mastectomy and opted for a reconstruction and further radiation therapy.
She is back at work and slowly rebuilding her life with support from her sister and good friends. I have seen Celia’s sister and a couple of her friends for a full women’s health check. She is not considered in remission until she is cancer-free for five years, but I am optimistic.
Check in with your GP
There are excellent screening programs in New Zealand and Australia for breast cancer, bowel cancer as well as cervical screening for cervical cancer. Vaccinations are recorded in a national immunisation register, making it easy to track if you are up to date. Most general practices have robust recall systems in place to track when blood tests, diabetes screening, skin checks and a range of other blood tests are due, but despite this, uptake is far from perfect.
While screening for breast cancer and bowel cancer can be accessed without attending a GP surgery, the uptake is much higher when I encourage patients to do the screening and go through the process with them. One of the greatest barriers to practising preventive medicine is that most patients only present when they are unwell. Having high blood pressure, high cholesterol or low bone density is asymptomatic. Many cancers like Mel’s are asymptomatic and once they do cause symptoms, are invasive with lower survival rates and more aggressive treatments required. It can be challenging to convince someone to comply with treatment to prevent catastrophic outcomes in 10 or more years in the future.
Even though we know that prevention of a heart attack or fractured hip is more cost-effective and associated with better outcomes, it is more difficult to measure and elicits less enthusiasm than the latest high-tech life-saving procedure or device.
I encourage everyone to present for an annual health check which differs depending on your age. Present when you are well, armed with a family history of significant illness and any personal health concerns. In between those assessments, do keep a check on your weight, eat good food in moderation, add in some regular exercise and recreation.
Longer life, better life
Indulge in a little creativity to keep your brain active and excited about life, wear sunblock, aim for two alcohol-free days each week and stick to a maximum of two standard drinks on the other days.
Smile more, get enough sleep, keep in touch with friends and spend time with your loved ones as loneliness is as toxic to your health as smoking 15 cigarettes per day.
Our life expectancy has increased, but there is little point in living longer if poor health impairs our ability to do the things that we love.
If you do develop a new unexplained symptom or have any concerns, do check in with your GP and book an appropriate time slot. Ask for more time if you have multiple or complex issues. It means that your GP can give your concerns the attention they deserve. Prevention and early intervention are what we GPs do best.
Health Checklist
Many screenings are based on family history, risk factors and specific conditions. See your GP who will do age appropriate screenings. This is a general list only, as guidelines vary depending on different factors.
For Adults 18-39: Regular health check with focus on health maintenance with good lifestyle (diet, exercise), mental health checks, skin checks.
For Adults 40-59: Increased screening for cancers, heart disease (blood pressure, cholesterol), diabetes, mental health, and skin checks. For women, consider menopause-related health issues eg. osteoporosis.
For Adults 60+: More regular health checks to keep chronic illness in check, manage bone density issues, mental health including loneliness, nutritional status, and muscle strength. Ongoing review of heart disease, diabetes and skin check.
PREVENTIVE HEALTH CARE
BREAST
Every two years – from 40-74 years.
If you have a family history or develop a breast lump/symptoms, see your GP.
CERVICAL
Every five years from 25-74.
BOWEL
Every two years – recommended from 45-74 years. If you have bleeding/a change in bowel habits or a relative gets bowel cancer, see your GP.
SKIN CHECK
Annual full skin check. Minimise sun exposure. If you have skin changes or a freckle changes shape, see your GP.
CARDIOVASCULAR HEALTH CHECK
Blood pressure check from age 16 every two years. Risk assessment from 45 years (earlier if high risk).
OSTEOPOROSIS
Bone density for women starting at menopause (earlier if there is a history of smoking, heavy drinking, being underweight, overactive thyroid, coeliac disease or taking steroid medications.
PRECONCEPTION
See a GP for a full health check to discuss prenatal screening and supplements.
