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Preventive medicine is widely applicable, relatively easy, and much more affordable than individual treatments, which tend to be complicated, often unaffordable, and frequently limited to the privileged few. The following is a continuation of a previous article which talks on ways to prevent some of the serious diseases.

7- Ovarian cancer is a major killer but, unfortunately, remains undetectable in its early stages.  Pelvic examination, pelvic ultrasound, pap smears, and the CEA blood test do not find it early enough to save lives.  The CEA blood test is especially inadequate because it has too many false positives and false negatives and should not be utilized for early detection because it causes nothing but confusion and worry.  Even surgical removal of the ovaries does not totally prevent ovarian cancer.  Unless a test is developed that can detect ovarian cancer in its early stages, this disease will remain largely unpreventable.

8- Breast cancer is relatively preventable with mammography but only between the ages of 50 and 65.  We are not sure that mammography done between the ages of 30 and 50 or after 65 saves enough lives to make it mandatory.  Breast self examination is largely unreliable or, if it finds the cancers, finds them too late.  These rules may not apply to women with a strong family history of breast cancer.  Certain blood tests that detect these breast cancer genes may guide such women to have their breasts removed as a preventive measure, even though such surgery may not give perfect results.

9- Cervical cancer is readily preventable with Pap smears that are done during pelvic examinations.  It is a sexually transmitted disease caused by certain strains of the HP virus.  A Pap smear is not necessary in women who have never had sex or in those who have had a hysterectomy (surgical removal of the uterus) because they no longer have a cervix.

10- Lung cancer is common in smokers and is seldom detected at the stage when it is curable.  Chest x-rays, which were thought to be sensitive detectors, have proven inadequate.  Scientific studies have shown that doing annual chest x-rays on smokers does not detect lung cancers early enough to save or prolong lives and seems to do more harm than good.  Hence, a chest x-ray should only be done for symptoms and not for prevention.  Other more sensitive tests such as CT scans are under study but the results are not out yet.  At present, the most important preventive measure against lung cancer is to stop smoking.  Stopping smoking also reduces cancers of the mouth, larynx, esophagus, stomach, kidneys, and urinary bladder.  Moreover, it also reduces the incidence of heart attacks, strokes, aneurisms, pneumonias, asthma, and progressive lung damage.

11- Osteoporosis, the leading cause of vertebral, hip, and other arm-and-leg fractures is easily preventable.  In women it begins after menopause and in men, after age 65.  Vitamin D deficiency is a common cause and so is sedentary life (i.e. not taking daily walks) and inadequate intake of calcium.  A bone density is diagnostic and therapy is quite effective.  An adequate intake of calcium (1000 mg/day), vitamin D (1000 u/day), and daily one-hour walks are essential for those at risk.  Specific medications are available that can reverse osteoporosis but their use in the pre-osteoporosis stage (i.e. osteopenia) has not been shown to reduce fractures and is not universally recommended.

12- Vaccines have great preventive powers and all modern vaccines are safe, effective, and should be given as recommended to both children and adults.  There are no scientifically rational arguments against vaccines and those who refuse them do so because of imaginary fears.  The one annual vaccine that everyone should take is Influenza because epidemics occur annually and cause a pronounced rise in mortality and morbidity worldwide.  The myth that the Influenza vaccine can cause Influenza is unfounded because the vaccine does not contain any living virus.  Patients who say that every time they are vaccinated they get influenza should be educated that the vaccine takes 3-4 weeks to become effective and that, during that vulnerable period, they may actually succumb to other viral illnesses including Influenza, especially if they were late in taking their flu vaccine.  Moreover, many patients think that every viral infection is the flu.  In fact, the flu only refers to Influenza, which is a severe illness marked by very high fever, severe chills, severe body aches, and a slow, protracted recovery.  Most patients who assume that they have had the flu will have actually had one of the lesser, seasonal respiratory viral infections.  On the other hand, patients who have had the real flu (i.e. Influenza), never forget their horrible experience as long as they live.

To conclude, while medical treatments help individuals, preventive treatments save millions of lives and are epidemiologically crucial for the health of nations.  Like unhealthy individuals, unhealthy nations slowly die, and history abounds with such examples.  Moreover, with modern advances in technology, global health has become inseparable from national health and, therefore, if we allow entire nations to succumb to preventable diseases, planet earth will be our next victim.  

2008 - ISSUE 73