In part 1, screenings to prevent cardiovascular disease were discussed. These included screening for hypertension, and for abnormal blood glucose. Next, we’re going to talk about two medications that are recommended by the task force for people with elevated risk for heart disease. But before we address the medications, we first have to talk about a concept called the “10-year risk for atherosclerotic cardiovascular disease”, as defined by the American Heart Association and the American College of Cardiologists. This calculation uses age, gender, race, blood pressure, cholesterol numbers, diabetes history, and smoking history to estimate an individual's “10-year risk” for heart attack and stroke.¹ This was based off of a review of large cohort studies that looked for correlation between risk factors and disease in tens of thousands of people.¹ Now, this is a very imperfect estimate,² but it is helpful in identifying individuals who are at greater risk,...

Cardiovascular disease is the #1 cause of death in the US, at about 655,000 deaths/year.¹ Even more importantly, it is estimated that nearly of deaths from cardiovascular disease are preventable.²

For this reason, the United States Preventive Services Task Force has made six separate recommendations for clinical preventive services. Two of these recommendations are screenings for risk factors of cardiovascular disease, two are for medications that decrease cardiovascular risk, and then the final two are about behavioral counseling and interventions that also reduce risk.

Let’s start with the two screening recommendations. The first of these is to screen any adult, (any person over the age of 18), for high blood pressure (also known as “hypertension”).³ This condition is very common, with approximately 45% of American adults affected.⁴ It’s also a very sneaky condition, as most of the time hypertension doesn’t cause any symptoms. It is...

Skin cancers are the most common types of cancer in the United States, at over 3 million new cases per year.¹ Fortunately, most of these cancers are nonmelanoma skin cancers like basal cell and squamous cell carcinoma. These types are much more common, but far less deadly than melanoma. Invasive melanoma represents only about 2% of all skin cancer cases, but it is responsible for 80% of the deaths from skin cancer.¹ 

The major risk factor for skin cancer is exposure to ultraviolet or “UV” radiation.² UV exposure causes skin cancer by damaging the DNA of skin cells.³ Most UV radiation exposure is from the sun, but people who use tanning beds are also exposed to this risk.⁴  

It is believed that exposure to UV radiation as a child or adolescent represents the strongest connection to skin cancer.⁵ Also, people with fair skin types are at an increased risk.⁶ This means having pale skin, freckles, light hair color or eye color, or just being a person that...

Of all cancer screenings, cervical cancer screening is arguably the greatest success story. Screening for cervical cancer has been largely responsible for decreasing deaths from cervical cancer in American women by more than 80% between 1930 and 2012.¹ Not only that, the number of new cases of cervical cancer have been almost cut in half since 1975.²

Cervical cancer is caused by the human papilloma virus, or HPV, in over 99% of cases.³ There are many strains of HPV, some of which are dangerous and can cause cervical cancer, while some are not very dangerous and only cause warts. These lower-risk strains are more of a nuisance than a major public health risk. Of the high-risk strains of HPV, types 16 and 18 are responsible for 70% of all cervical cancers.⁴ The human papilloma virus is a sexually-transmitted disease, so unsurprisingly, the risk factors for contracting this virus are early onset of sexual activity and having multiple sexual partners. Other risk factors include low...

Let’s start out by just saying that being screened for breast cancer is important. The reason that it’s important is because appropriate screening can decrease your risk of dying from breast cancer by up to 20%.¹ Over 40,000 women die of breast cancer every year, which is second only to lung cancer in the number of cancer deaths in women.² But in addition to the lives lost, breast cancer affects our society in many different ways. Here are some other statistics: 

• Close to a quarter of a million women are diagnosed with breast cancer every year in the United States. 
• It is the most common cancer to be diagnosed in women, excluding skin cancers. 
• Approximately one out of every eight women will be diagnosed with breast cancer sometime during their life.²

Most of us know someone close to us who has had breast cancer. This disease burdens many patients and their families, and has a devastating impact.

So, with this in mind, let it sink in that very few women...

Colorectal cancer, or cancer of the large intestine, is a common and deadly cancer. It is the third most common cancer in both men and women. In the United States, there are around 140,000 new cases of colorectal cancer per year, and more than a third of these people will die from the illness within five years.¹ So, it is prevalent, and deadly.

Fortunately, the number of new cases and death rates for colorectal cancer have been steadily decreasing over the past twenty years.² Part of this is due to increasingly effective treatment options for colorectal cancer, and part is thanks to increased awareness and increased screening. In fact, one study showed that 53% of the reduction in deaths from colorectal cancer could be directly attributed to screening.³ Additionally, the CISNET models estimate that over the course of a lifetime, with screening between ages of 50 to 75, approximately 20 to 24 lives per 1000 could be saved just by screening.⁴ The USPSTF gives their recommendation in...

Prostate cancer screening is a fairly controversial topic for public health and the medical community. When looking at the balance between the benefits and the risks, the evidence shows it is heavier on the side of risks. In short, prostate cancer screening is not very effective at saving lives, but is unfortunately quite effective at causing harms. More on this a little later. 

First, let's have just a short discussion on the burden of the disease. Other than minor skin cancers, prostate cancer is the most common type of cancer diagnosed in men, with around 170,000 being diagnosed with prostate cancer each year.¹ This number is pretty high, but lower than the actual number of men who develop the disease. There are many men who develop prostate cancer and never know it; as up to 70% of men over 80 years old who died of other causes were found to have prostate cancer on autopsy.² Just under 30,000 men in the United States die of prostate cancer per year, making this...

Lung cancer is by far the most deadly type of cancer in the United States. Over 150,000 men and women die from lung cancer per year, easily making it the leading cause of cancer death in the country.¹ There are over 210,000 newly diagnosed cases of lung cancer in the United States each year.¹ Rates of lung cancer have been decreasing recently due to a decline in smoking, but it is obviously still a major public health problem. In 2013, the United States Preventive Services Task Force (USPSTF) published recommendations for lung cancer screening, which will be the focus of this article.

First, let’s talk about the risk factors for lung cancer. By far, the most significant risk is smoking. Smoking is responsible for 80% to 90% of all lung cancers.² Secondhand exposure to tobacco smoke is another big risk factor, and the younger the age of exposure, the higher the risk of developing lung cancer. Smaller, less important risk factors include exposure to environmental toxins such as...

For starters, let’s discuss preventive medicine. The main purposes of preventive medicine are the following:

1. Try to prevent diseases from occurring in the first place (primary prevention). An example of this is vaccination.
2. Detect diseases early and treat them (secondary prevention). A good example of this is screening for cancer, which has the goal of detecting precursors to cancer or early cancer. This can improve the prognosis.
3. Prevent progression of the disease once it is established (tertiary prevention). An example of this would be taking certain medications after a heart attack, to prevent complications that can happen afterwards.

"A little understanding goes a long way, and the more informed patients are about their screening options, the better."

For the purposes of this article, we will be focusing on screening tests. When patients want to know about the best way to screen for diseases such as cancer, many would like a “black and white“...

When it comes to smoking, we have both some good news and some bad news to discuss. 

Let’s start with the bad news: 42.1 million Americans still smoke regularly.¹ Tobacco use remains the largest preventable cause of disease, disability, and death in the United States, and there are over 480,000 premature deaths annually that are related to tobacco use. This means that around one out of every five deaths that occur each year in the United States is related to smoking._²

Now for some good news: people are smoking less and less all the time. Between 2005 and 2016, the percentage of US adults who smoke has decreased from 20.9% to 15.5%.³ In adults who have ever used cigarettes, 59% have quit as of 2016, which has increased from 50.8% in 2005. Going back even further in time, there were more than twice as many smokers (as a percentage) in 1965 compared to today.³

Although the change is happening gradually and slowly, this is a war that we appear to be...