1. Palm Beach State College Lunch and Learn Lecture Series September 18, 2012 Dudley Brown, Jr., MD, MBA

2.  BS in Psychology--University of Miami (Coral Gables)  MD--University of Florida College of Medicine  Residency in Obstetrics and Gynecology--Cook County Hospital, Chicago, IL (Chief Resident)  Private Practice in Woodstock, IL for 8 yrs (Medical Director)  MBA--Northern Illinois University  Office locations: Forest Hill & N. Flagler Dr (by Good Samaritan Hospital) in WPB; University Dr in Jupiter  Surgeries and Deliveries at Good Samaritan and St Mary’s Medical Centers in WPB  (561)357-6277  www.tenetfloridaphysicianservices.com

3.  Cervix  Breast  Ovary  Colorectal  Prostate

4.  2nd most common cancer in women  ~500,000 new cases/ year  ~275,000 deaths / year

5.  >70% decline in mortality last 60 years  #13 in cancer deaths for women  In 2010, ~12,200 new cases and ~4,200 deaths

6.  50% of new cases are in unscreened women  10% had not had a screen in 5 years  30% due to system error (sampling, interpretation)

7.  Under 21 y/o, do not screen  21-29 y/o, Pap every 2 yrs  30 y/o and older, Pap every 3 yrs if 3 consecutive negative tests  65 y/o and older, stop if 3 consecutive negative tests & no abnormal tests in last 10yrs  Any age after hysterectomy, stop if done for benign condition (e.g. fibroids, abnormal periods) and no h/o HG CIN

8.  Most common cancer in women  #2 in cancer deaths in women  37% decline in mortality from 1997 to 2005  2010 estimates; ~207,000 new cases, ~40,000 deaths

9.  Ages 40-49, every 1-2 yrs (varies by organization)  Ages 50-74, every 1-2 yrs (varies by organization)  Age 75 and older, No recommendation for age to stop  ACOG recommends clinical breast exam annually after 19 y/o  “Self breast awareness” recommended

10.  2 nd most common Gyn Cancer  #1 in Gyn cancer deaths  2010 estimates; ~21,800 new cases, ~13,800 deaths

11.  ~75% diagnosed at > stage 2  Nonspecific symptoms  No proven screening test  Recommended screening test is an annual pelvic exam  CA 125 is not a recommended screening test

12.  High false positive rate leading to unnecessary surgery and increased cost  Identifies late stage disease  Research continues for an effective screening test

13.  #3 in cancer deaths in women & men (#2 for Hispanic men)  50% screening rate in US  Average risk people should begin screening at 50 y/o  Screening tests include; FOBT, Stool DNA test, Flexible Sigmoidoscopy, Colonoscopy

14.  Most common cancer in men  Walnut-sized organ just below bladder and in front of rectum  200,000 men diagnosed annually and 25,000 deaths  Risks factors: age > 50, African American, 1st degree relative with disease

15.  Difficulty in starting urination  Weak or interrupted flow of urine  Frequent urination, especially at night  Difficulty in emptying the bladder completely  Pain or burning during urination  Blood in the urine or semen  Pain in the back, hips, or pelvis that doesn't go away  Painful ejaculation  Some men do not have any symptoms

16.  Controversy exits regarding screening recommendations  USPSTF recommends against PSA-based screening in men without symptoms  Usual screening tests: Digital Rectal Exam (DRE) and Prostate Specific Antigen (PSA)

17.  Thyroid  Diabetes  Cholesterol  Bone Density

18.  Recommendations vary per organization  Start at 35 y/o and screen every 5 yrs with TSH blood test (American Thyroid Association)  Screen at 50 y/o (American College of Physicians)  Other organizations say only screen if someone in symptomatic  Bottom line, discuss with your physician, especially if there is a family history of Thyroid disease

19.  Screen with blood test if BMI >25 and another risk factor present (e.g. Hypertension, age > 45, certain ethnic groups, habitual physical inactivity) American Diabetes Association  Screen if BP consistently > 153/80 (treated or untreated) USPSTF  Screen in pregnancy  Bottom line, discuss with your physician, especially if there is a family history of Diabetes

20.  Osteoporosis is characterized by low bone mass (density) and architectural changes in the bone which increases the susceptibility to fracture

21.  Postmenopausal women age 65 and older  Postmenopausal women younger than age 65 if risk factors are present (e.g. previous fracture as an adult, parents with h/o hip fracture, steroid therapy, low body weight, smoking)  No screening for premenopausal women

22.  Start screening with a blood test at age 20 and every 5 yrs after that, NCEP III  Start at age 20 for men or women risk factors for CHD, USPSTF  Start at age 35 for men and age 45 for women if no risk factors for CHD, USPSTF  Bottom line, speak with your doctor

23.  Lung (#2)  Colorectal (#3)  Diabetes  Cholesterol Lifestyle changes (proper diet, regular exercise, no smoking, alcohol in moderation)

24.  Dr. Dudley Brown, Jr.  Board Certified, Ob/ Gyn  Offices in West Palm Beach and Jupiter  (561)357-6277  Accepting New Patients