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Prakash Chandran (Host): Cancer screening can help doctors detect abnormal tissue or cancer early before they cause symptoms. Knowing what cancers to screen for and when to screen, could help save your life. We're going to talk about it today with Audrea Williams, Physician Assistant in Oncology-Hematology for Aspirus Health. This is the Aspirus Health Talk, the podcast from Aspirus Health. I'm Prakash Chandran. So, Audrea, it's great to have you here today. Let's just start with a basic question here. Why exactly is cancer screening so important?

Audrea Williams, PA-C (Guest): I think you said it perfectly, it saves lives. Done early enough, it can save your life. And even if it's caught late, there's something that can be done about it. There have been so many technological findings and improvements in cancer care, cancer treatment that there are options. And I don't think people realize that.

Host: Yeah, I don't think they realize that either. But one of the things that I wanted to unpack a little bit more before we get into it, is we're talking about cancer screening. What types of cancer can you get screened for? And when should you start?

Audrea: So, let me start with saying this, the various associations, meaning gastroenterology, gynecology, all of those different associations, they have special criteria that usually your Primary Care will go over with you when you have your annual exam, or if you're establishing with a new provider. So, there's colon cancer, breast cancer, pancreatic, the skin for melanoma; all of these cancers have different criteria. For breasts, it usually changes. There's probably like three different societies or associations that guide you to when you should get your first screening. Some it's 40 some it's 45, some it's talk to your doctor. Some is if you have a family history. All of these have different levels of criteria when you should get your first screening.

Host: I see. So, it's probably best to talk to your Primary Care Physician who has a more comprehensive view your health and your family history, to really get an accurate picture of when you should start. Is that correct?

Audrea: Absolutely. And I will say just to not put you on the spot, since I'm a PA, I have to say this, not just your Family Physician, but your Nurse Practitioner, your Physician Assistant, or your MD, or DO can answer that question for you.

Host: Okay, thank you for that clarification.

When we talk about cancer screening, I know you mentioned obviously, there's different criteria for what type of cancer gets screened, but is all cancer screened for the same? Is the process the same? Maybe talk about that.

Audrea: That is a mis conception with people, is that they think okay, you do this test. It screens for all cancers. And it doesn't. Of course, breast cancer screenings are a mammogram, colon cancer is a colonoscopy. Prostate cancer is actually a blood test. You do the blood test called a PSA. If your doctor feels that it's too high, then he may refer you to a urologist who would then do another test or take a biopsy. Like I said, the different criteria, calls for different testing, some blood and some might be imaging.

Host: Understood. So, in order to be proactive about cancer screening, because as we talked about at the top of the episode, it's really important to do obviously, because we can catch things early. What would you recommend the best way to do that is because I only ask that because sometimes when I go, for example, to my doctor, for my annual, I don't even know that cancer is brought up and maybe that's because, there's no indicators or markers to say that I'm at risk, but I'm one of those people that I want to be proactive. So, how might I do that?

Audrea: Before I started working in Oncology-Hematology, I also worked in Primary Care or Family Medicine or General Medicine. What started happening probably oh, a few years ago, when you go see your provider, there's usually a pop-up or there's usually something that alerts them that they need to ask you for what's called health maintenance. Your health maintenance at a certain age, it will alert the provider that, okay, this person is 50. They are due for a colonoscopy, or this person is 45 or 40, whatever is set in that system, that health system's charting; it'll say this person is due for a mammogram. So, you have these pop-ups and I think it's extremely valuable to a provider that it will pop up and it'll say this person needs a pap smear, a colonoscopy at this age. It kind of keeps track of it as your birthday comes along in your chart, in your Epic chart or in your electronic medical record. If you are 20, that won't pop up. There's nothing that's going to pop up for the provider to alert to. If you have a family history of something, I've had people come to me and they say, my mom had this, or my grandmother has this; can I be screened for this? Depending on your age, yes and no, because insurance may not pay for it at 20.

Host: I see. Okay. That's really helpful to know. There is, I think as long as you are being consistent with your visits, they're going to have that comprehensive view. There's going to be a notification on the provider and lets them know, hey, it's time to get screened. So, just on the patient side, because I also like to be a good patient here; what's one thing that you wish more patients did to be more proactive or is there nothing at all and you just want them to come in consistently? What are your thoughts on that?

Audrea: I will say, anytime a provider goes into a patient chart, if it's an electronic medical record, I used to have people come in for sore throat and my nurse would room them and they'd say oh, we haven't asked you this question about are you ready for your colonoscopy or something like that? There's checks and balances in that patient's chart through electronic medical record, that kind of cues you to ask this question or this hasn't been done. What I would like for patients to do to answer your question is, it's kind of like fear of the unknown. You do have people who know that they have a family history of something. And in a strong family history, you have some that want to know early, right away, and you have some that do not want to know at all. What I want patients to know is be proactive. If we do say, you're this age, you haven't gotten this screening, know that we're not asking you that because we're trying to bug you or we're trying to get you to spend more money or believe it or not, patients do believe that. We're asking you that so we can catch it early. If there is something, we can catch it early and we can do something about it. And that's what I want patients to understand.

I know there's fear. I know you may have seen somebody have cancer, go through the treatments and the strain that it caused or the pain or the suffering or whatever. But I just urge patients to find out early. Follow your health maintenance and be proactive and allow the provider to help you step by step get to that point where if there is bad news, we can do something about it.

Host: That is fantastic advice, Audrea, truly. One of the things that I wanted to ask you about that I'm sure people are thinking about is, what causes cancer. And I know that there are so many different types of cancer here, but as far as I know, for example, smoking a lot and not taking care of yourself and managing your weight. Those are all contributing factors that are direct line correlation to cancer, but are there other things that people should be aware of outside of screening that they can be proactive about to avoid the chance of getting cancer?

Audrea: Yes, smoking is huge. Smoking affects lungs. It affects other viable tissues that you have in your body. Smoking makes it hard for you to heal, whether it's inside or out. The other thing is family history, that's why I say talk to your family, ask questions, pay attention to, uncle so-and-so or aunt so-and-so. Patients tell me that their family told them early, hey, so-and-so had this, when you get this age, make sure you're screened.

So, I think communication and conversation is extremely important. Prolonged long-term sun exposure is another one. And I know living in the UP, we don't get a lot of sun. So when, we do, I do see a lot of people laying out in the sun that we only get for what, three or four months out of the year. So, think just being careful and when you're young, who's thinking about skin cancer, right?

Host: Yeah, I know. And as far as I've heard, these things accumulate over time, so you may be 20 or your early twenties laying out in the sun every single day, or whenever you can get access to it, but those have long-term and potentially lasting effects for later in your life.

Audrea: Absolutely. I have so many stories about people who for instance, really quick, I did my dermatology rotation in Nampa, Idaho, and we had I would say 80 year olds, 70 year olds who worked in the farm all their life as young boys and young girls. And at 80 that's, when we were doing procedures to cut out skin cancers from their scalps, their ears, their nose. So, you're right. You can be 20 or 30 and be fine, 80 and you've got skin cancer.

Host: I guess it is true what they say. Just, I think the theme of this conversation is that the price of peace is eternal vigilance. You have to be proactive. You have to mind your health. You have to stop smoking if you're smoking already. So, Audrea, just as we close here today, is there anything else that you would like our audience to take away from this conversation?

Audrea: I would say that your provider is not your enemy. Your provider is only looking out for your health and your wellbeing. Fear, I understand it, but there's so many new developments in cancer. It's come a long way. Whatever you witnessed in the seventies, eighties, nineties, even early two thousands. There is new research. There are new developments in cancer, daily, weekly, monthly. Pay attention, be proactive, be friends with your provider because we're there to help you not to hurt you or not to harm you.

Host: I think that is the perfect place to end Audrea. I really appreciate your time today. Super informative conversation. That's Audrea Williams, Physician Assistant in Oncology- Hematology for Aspirus Health. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks for checking out this episode of Aspirus Health Talk. Thanks, and we will talk next time.