When it comes to men’s health, the first recommendation is deceptively simple: go see a doctor.
It may sound obvious, but a Cleveland Clinic study published last September found that 55% of men do not get regular health screenings. The reasons for this can vary, but the fact remains that regular doctor visits and diagnostic screenings can be an invaluable tool for detecting potential medical problems.
Dr. Richard Strongwater, a family medicine practitioner at White Plains Hospital Physician Associates of Pleasantville, provides further details.
Q: Why do so many men apparently avoid going to the doctor?
A: According to the CDC, women are 33% more likely to visit their doctor than are men — and women are 100% more likely to maintain their screenings and medical care. We believe that much of this is because men believe they are “too busy.” Some men may also be deterred by the fear of finding out something is seriously wrong.
Q: How often should a man see his primary care physician?
A: While opinions vary, routine physical exams are generally recommended once a year if you are 50 years or older, and once every three years if you’re younger than 50 and in good health. If you have a chronic disease or other ongoing health issues, you should see your doctor more regularly, no matter how old you are. Your doctor will discuss with you how often that should be.
Q: What kinds of things do you look for when examining a male patient?
A: Prostate cancer is at the top of the list. It is the second-most common cancer in men, after skin cancer. Last year, 34,000 men in the United States died from prostate cancer. The good news is that if caught early and treated, the 10- year survival rate is 98%.
However, the decision to screen asymptomatic individuals for prostate cancer is a complex issue. In asymptomatic men aged 50 to 69, shared decision-making is recommended before conducting a PSA (prostate-specific antigen) test to allow men to make an informed decision on how they want to proceed. I routinely check PSAs yearly in men 50 and older.
Due to the slow-growing nature of most prostate cancers and autopsy evidence of incidental prostate cancer found in 36% to 51% of men in their 70s, the recommendation is not to do PSA screening in asymptomatic men over the age of 70. However, this should be a decision made between the patient and their physician.
A digital rectal exam may also be helpful as a screen for prostate cancer especially if positive for a mass. There are other reasons to do a rectal exam in an annual physical, such as finding rectal carcinoma or occult bleeding from a gastrointestinal cancer.
Q: Colon cancer seems to be a prevalent risk. What should men do to screen for colon cancer?
A: A rectal exam and a stool check are the first steps. Because colon cancer is on the rise, with a recent spike in cases for men under the age of 50, the recommended age for colonoscopy has been lowered from 50 to 45. Average-risk adults, aged 45-75, whose colonoscopy has normal results typically won’t need another colonoscopy for seven to 10 years. Of course, if a colonoscopy reveals something that is concerning or alarming, the whole process changes. Men who are 75 and older should check with their primary care doctor about whether or not to continue colonoscopy exams. Colonoscopies are not recommended for those over the age of 85.
Q: Any other common cancers men should be concerned about?
A: Lung cancer is also something to look for, especially — but not only — for men who are current or former smokers. It’s the third-most common cancer in the U.S. and has the highest mortality rate of any cancer, with 90% of all lung cancer deaths related to smoking. Low-dose CT scanning, rather than just a chest X-ray, can reduce the mortality rate by 20% for those who have at least a 20-pack-year smoking history.
Q: Smoking tends to increase your chances of developing a host of other problems as well, doesn’t it?
A: Absolutely. Cigarette smoking has proven to play a major role in heart disease, stroke, and certain cancers like bladder, mouth, and throat cancer.
Q: The same is true for high blood pressure?
A: Yes. You may need to take medications to control your blood pressure as well, but diet and exercise are key. Hypertension, or high blood pressure, is a leading cause of stroke and other heart issues. Cholesterol levels should be checked at least one time, by age 35, unless they are high risk, such as having a family history. Then we recommend getting checked at age 20.
Q: What about diabetes?
A: We like to test for diabetes at least every three years starting at age 45 and sooner and more often if there are certain risk factors. Type 2 diabetes can be reversed by losing weight and making dietary and lifestyle changes. Some people are even able to wean off diabetes medication thanks to these changes.
Q: What about erectile dysfunction (ED)?
A: Erectile dysfunction affects about 30 million men in the United States. Although it is very common, it is not a normal part of aging, so you should talk with your healthcare professional about treatment. Usually this is something that the patient comes in to ask about, not something that a doctor screens for, though some urologists will run tests if a case of ED is suspected. Again, hypertension, high cholesterol, and diabetes can all make ED worse.
Obviously diet and exercise, giving up smoking, and at the very least reducing your consumption of alcohol, can play a part in nearly all of these situations, although a family history will in some cases prove to be a significant factor. Keeping on top of your health is really one of the most important things a person — man or woman — can do to ensure they have a long and enjoyable life.
Dr. Richard Strongwater is a family medicine practitioner at White Plains Hospital Physician Associates of Pleasantville. To make an appointment, call 914-849-4100.