BELAJAR TENTANG PEMERIKSAAN RUTIN DAN MANFAATNYA TERHADAP PENCEGAHAN PENYAKIT KANKER, DIABETES, KERAPUHAN TULANG, HIV DAN SEBAGAINYA

Berikut merupakan kutipan ilmiah kedokteran yang sangat bermanfaat sehingga disusun dan digunakan sebagai referensi pribadi.

Perpustakaan keluarga : 

Helmut Todo Tua Simamora dan dr. Olga Y.V Hutapea

Why Screening Tests Are Important

Remember that old saying, "An ounce of prevention is worth a pound of cure"? Getting checked early can help you stop diseases like cancer, diabetes, and osteoporosis in the very beginning, when they’re easier to treat. Screening tests can spot illnesses even before you have symptoms. Which screening tests you need depends on your age, family history, your own health history, and other risk factors.

Breast Cancer

The earlier you find breast cancer, the better your chance of a cure. Small breast-cancers are less likely to spread to lymph nodes and vital organs like the lungs and brain. If you’re in your 20s or 30s, your health care provider should perform a breast exam as part of your regular check-up every one to three years. You may need more frequent screenings if you have any extra risk factors.

Screening With Mammography

Mammograms are low-dose X-rays that can often find a lump before you ever feel it, though normal results don’t completely rule out cancer. While you’re in your 40s, you should have a mammogram every year. Then between ages 50 and 74, switch to every other year. Of course, your doctor may recommend more frequent screenings if you’re at higher risk.

Cervical Cancer

With regular Pap smears, cervical cancer (pictured) is easy to prevent. The cervix is a narrow passageway between the uterus (where a baby grows) and the vagina (the birth canal). Pap smears find abnormal cells on the cervix, which can be removed before they ever turn into cancer. The main cause of cervical cancer is the human papillomavirus (HPV), a type of STD.

Screening for Cervical Cancer

During a Pap smear, your doctor scrapes some cells off your cervix and sends them to a lab for analysis. A common recommendation is that you should get your first Pap smear by age 21, and every two years after that. If you're 30 or older, you can get HPV tests, too, and wait a little longer between Pap smears. Both screenings are very effective in finding cervical cancer early enough to cure it.

Vaccines for Cervical Cancer

Two vaccines, Gardasil and Cervarix, can protect women under 26 from several strains of HPV. The vaccines don't protect against all the cancer-causing strains of HPV, however. So routine Pap smears are still important. What’s more, not all cervical cancers start with HPV.

Osteoporosis and Fractured Bones

Osteoporosis is a state when a person’s bones are weak and fragile. After menopause, women start to lose more bone mass, but men get osteoporosis, too. The first symptom is often a painful break after even a minor fall, blow, or sudden twist. In Americans age 50 and over, the disease contributes to about half the breaks in women and 1 in 4 among men. Fortunately, you can prevent and treat osteoporosis.

Osteoporosis Screening Tests

A special type of X-ray called dual energy X-ray absorptiometry (DXA) can measure bone strength and find osteoporosis before breaks happen. It can also help predict the risk of future breaks. This screening is recommended for all women age 65 and above. If you have risk factors for osteoporosis, you may need to start sooner.

 

Skin Cancer

There are several kinds of skin cancer, and early treatment can be effective for them all. The most dangerous is melanoma (shown here), which affects the cells that produce a person’s skin coloring. Sometimes people have an inherited risk for this type of cancer, which may increase with overexposure to the sun. Basal cell and squamous cell are common non-melanoma skin cancers.

Screening for Skin Cancer

Watch for any changes in your skin markings, including moles and freckles. Pay attention to changes in their shape, color, and size. You should also get your skin checked by a dermatologist or other health professional during your regular physicals.

High Blood Pressure

As you get older, your risk of high blood pressure increases, especially if you are overweight or have certain bad health habits. High blood pressure can cause life-threatening heart attacks or strokes without any warning. So working with your doctor to control it can save your life. Lowering your blood pressure can also prevent long-term dangers like heart disease and kidney failure.

Screening for High Blood Pressure

Blood pressure readings include two numbers. The first (systolic) is the pressure of your blood when your heart beats. The second (diastolic) is the pressure between beats. Normal adult blood pressure is below 120/80. High blood pressure, also called hypertension, is 140/90 or above. In between is prehypertension, a sort of early warning stage. Ask your doctor how often to have your blood pressure checked.

Cholesterol Levels

High cholesterol can cause plaque to clog your arteries (seen here in orange). Plaque can build up for many years without symptoms, eventually causing a heart attack or stroke. High blood pressure, diabetes, and smoking can all cause plaque to build up, too. It's a condition called hardening of the arteries or atherosclerosis. Lifestyle changes and medications can lower your risk.

Checking Your Cholesterol

To get your cholesterol checked, you’ll need to fast for 12 hours. Then you’ll take a blood test that measures total cholesterol, LDL "bad" cholesterol, HDL "good" cholesterol, and triglycerides (blood fat). If you’re 20 or older, you should get this test at least every five years.

Type 2 Diabetes

One-third of Americans with diabetes don’t know they have it. Diabetes can cause heart or kidney disease, stroke, blindness from damage to the blood vessels of the retina (shown here), and other serious problems. You can control diabetes with diet, exercise, weight loss, and medication, especially when you find it early. Type 2 diabetes is the most common form of the disease. Type 1 diabetes is usually diagnosed in children and young adults.

Screening for Diabetes

You’ll probably have to fast for eight hours or so before having your blood tested for diabetes. A blood sugar level of 100-125 may show prediabetes; 126 or higher may mean diabetes. Other tests include the A1C test and the oral glucose tolerance test. If you’re healthy and have a normal diabetes risk, you should be screened every three years starting at age 45. Talk to your doctor about getting tested earlier if you have a higher risk, like a family history of diabetes.

Human Immunodeficiency Virus (HIV)

HIV is the virus that causes AIDS. It’s spread through sharing blood or body fluids with an infected person, such as through unprotected sex or dirty needles. Pregnant women with HIV can pass the infection to their babies. There is still no cure or vaccine, but early treatment with anti-HIV medications can help the immune system fight the virus.

HIV Screening Tests

HIV can be symptom-free for many years. The only way to find out if you have the virus is with blood tests. The ELISA or EIA test looks for antibodies to HIV. If you get a positive result, you'll need a second test to confirm the results. Still, you can test negative even if you’re infected, so you may need to repeat the test. Everyone should get tested at least once between ages 13-64.

Preventing the Spread of HIV

Most newly infected people test positive around two months after being exposed to the virus. But in rare cases it may take up to six months to develop HIV antibodies. Use a condom during sex to avoid getting or passing on HIV or other STDs. If you have HIV and are pregnant, talk with your doctor about reducing the risk to your unborn child.

Colorectal Cancer

Colorectal cancer is the second most common cause of cancer death after lung cancer. Most colon cancers come from polyps (abnormal masses) that grow on the inner lining of the large intestine. The polyps may or may not be cancerous. If they are, the cancer can spread to other parts of the body. Removing polyps early, before they become cancerous, can prevent it completely.

Screening for Colorectal Cancer

A colonoscopy is a common screening test for colorectal cancer. While you’re mildly sedated, a doctor inserts a small flexible tube equipped with a camera into your colon. If she finds a polyp, she can often remove it right then. Another type of test is a flexible sigmoidoscopy, which looks into the lower part of the colon. If you’re at average risk, screening usually starts at age 50.

Glaucoma

Glaucoma happens when pressure builds up inside your eye. Without treatment, it can damage the optic nerve and cause blindness. Often, it produces no symptoms until your vision has already been damaged.

Glaucoma Screening

How often you should get your eyes checked depends on your age and risk factors. They include being African-American or Hispanic, being over 60, eye injury, steroid use, and a family history of glaucoma. People without risk factors or symptoms of eye disease should get a baseline eye exam, including a test for glaucoma, at age 40.

Ask Your Doctor About Screenings

It's good health sense to talk with your doctor about screening tests. Some tests, such as a Pap test or breast exam, should be a routine part of every woman’s health care. Other tests might be necessary based on your risk factors. Proper screening won’t always prevent a disease, but it can often find a disease early enough to give you the best chance of overcoming it.

Lung cancer accounts for over a fifth of cancer deaths

Lung cancer campaigners have called on health officials to warn people about the symptoms of the biggest cancer killer in Wales.

It accounts for more than a fifth of cancer deaths, more than bowel and breast cancer combined, according to a recent report from Public Health Wales.

The UK Lung Cancer Coalition said Wales also had one of the lowest survival rates in Europe for the disease.

The Welsh government accepted it had to go further in tackling lung cancer.

The call by a collection of charities, experts, professionals and healthcare companies follows a report on cancer in Wales from Public Health Wales in April which revealed lung cancer killed nearly 1,900 people in Wales in 2012 - 22% of the total number of deaths from cancer.

Lung cancer sufferers were also 12 times less likely to survive up to five years after diagnosis compared to people with breast cancer, according to the report.

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Outcomes for lung cancer patients also remain poor in Wales when compared to other UK and European countries.

Dr Ian Lewis, director of research and policy at Cardiff-based cancer charity Tenovus, said: "More can be done to alert people to the signs and symptoms of this devastating disease in order to ensure earlier diagnosis and increase chances of survival."

"People don't like to bother their doctor and that's an issue for people not getting diagnosed early enough and not getting treatment.

"Prognosis overall for lung cancer is poor but if discovered early enough the success for treatment is improved greatly."

Mags Roberts, 58, from Cardiff, was diagnosed with lung cancer at the age of 52 after feeling breathless while walking up a hill in Pembrokeshire.

She said: "I was quite shocked as I'd never smoked so I never thought I'd get it.

"I wasn't ill in bed - I was going to work every day."

Mrs Roberts had to take early retirement from her job as a secondary school teacher for treatment with chemotherapy followed by courses of tablets which she continues to take to this day.

"I've got to live with it but I'm really fortunate to have a fantastic medical team looking after me and the support of my family and friends," said Mrs Roberts.

"It was only because I'd had asthma as a child that I thought of going to the doctor to check - it was lucky I went really.

"I'm really positive about life - I wake up every day and feel keen to make the most of it."

A Welsh government spokesperson said: "The Welsh NHS is spending more than ever on cancer care and while Wales has shown the biggest improvement in overall cancer survival rates of all UK nations, we need to go further when it comes to lung cancer.

"From this year all GPs will have to review every diagnosis of lung cancer to improve awareness and skills to support earlier diagnosis."

Dr Peter Bradley, executive director of public health development at Public Health Wales, said the organisation was already taking steps including anti-smoking campaigns.

He added: "We have also carried out a review of the way we support people to stay healthy, and invested in a wide ranging strategy to help us work towards a healthier, happier and fairer Wales."

General symptoms of lung cancer

• Having a cough most of the time
• A change in a cough you have had for a long time
• Being short of breath
• Coughing up phlegm (sputum) with signs of blood in it
• An ache or pain when breathing or coughing
• Loss of appetite
• Tiredness
• Losing weight

Leukaemia research may lead to new drugs for difficult-to-treat breast cancers, say scientists.

These types of tumours cannot be treated with the targeted drugs which have hugely improved survival.

A team in Glasgow says a faulty piece of DNA which causes leukaemia also has a role in some tumours and could help in research for new drugs.

Meanwhile, other researchers say they have taken tentative steps towards a blood test for breast cancer.

Oestrogen or progesterone positive breast cancers can be treated with hormone therapies such as Tamoxifen.

Another drug, Herceptin, works only on those tumours which are HER2-positive.

But around one in five breast cancers is "triple negative" meaning chemotherapy, radiotherapy or surgery are the only options.

Leukaemia

A team at the University of Glasgow investigated the role of the RUNX1 gene, which is one of the most commonly altered genes in leukaemia.

However, they have now shown it is also active in the most deadly of triple negative breast cancers.

Tests on 483 triple negative breast cancers showed patients testing positive for RUNX1 were four times more likely to die as a result of the cancer than those without it.

The results were published in the journal PLoS One.

One of the researchers, Dr Karen Blyth, said: "This opens up the exciting possibility of using it [RUNX1] as a new target for treatments."

She told the BBC: "First we need to prove this gene is causative to the cancer, if it is then what would happen if we did inhibit it?

"There's a couple of drugs in development in the US to target this gene from a leukaemia point of view, if they work we can test it in breast cancer cells."

Could leukaemia lead to insight into breast cancer?

However, the gene has a complex role. Normally it is vital for cell survival and plays a critical role in producing blood. However, depending on circumstances, it can either encourage or suppress tumours.

It means any use of a drug to target the gene might cause side-effects.

Dr Kat Arney, the science communications manager at Cancer Research UK, said: "There's still so much we need to understand about triple negative breast cancers, as they can be harder to treat in some people.

"Almost two out of three women with breast cancer now survive their disease beyond 20 years.

"But more must be done and we urgently need more studies like these, particularly in lesser-understood forms of the disease, to build on the progress we've already made and save more lives."

Blood test

In a separate development, scientists at University College London think they have taken the first steps towards a blood test for breast cancer.

They found changes in the DNA of immune cells in the blood of women who were at high risk of breast cancer as they had inherited the BRCA1 risk gene.

Prof Martin Widschwendter, from UCL said: "Surprisingly, we found the same signature in large cohorts of women without the BRCA1 mutation and it was able to predict breast cancer risk several years before diagnosis."

They think it could become the basis of a blood test.

Dr Matthew Lam, senior research officer at Breakthrough Breast Cancer, said: "These results are definitely promising and we're excited to learn how further research could build on these findings."

Sumber : Media online kesehatan

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BELAJAR TENTANG MENGETAHUI RISIKO TINDAKAN MEDIS (SCREENING TREATMENT) TERHADAP PENYAKIT KANKER

Berikut merupakan kutipan ilmiah kedokteran yang sangat bermanfaat bagi Penyusun sehingga disusun dan digunakan sebagai referensi pribadi.

Perpustakaan keluarga Helmut Todo Tua Simamora dan dr. Olga Y.V Hutapea

Routine cancer screening can save lives. It can also cause serious harm.

This is the "double-edged sword" of cancer screening, says Otis Webb Brawley, MD, chief medical officer at the American Cancer Society.

Did You Know?

Under the Affordable Care Act, many health insurance plans will cover preventive care services, including checkups, vaccinations and screening tests, at no cost to you. Learn more.

Health Insurance Center

"Many of these cancers we treat and cure never needed to be treated and cured," Brawley says. "They are never going to kill that patient."

At the heart of the problem is our justifiable fear of cancer. The message has been drummed into us: Find cancers early while they're still curable and get rid of them. We want out from under the shadow of the dreaded C word.

Not so very long ago, most cancers were in their deadliest, late stages by the time doctors could detect them. That's still true of some kinds of cancer, but with others -- such as breast cancer, colon cancer, cervical cancer, and prostate cancer -- advances in cancer screening now make it possible to find many tumors in their earliest stages.

Some of these early cancers will become killers. Others never will. But there's no reliable way to tell which is which. Doctors feel their hands are forced.

"We are treating lesions that never would come to medical attention were it not for increasingly sensitive medical tests," says Barnett S. Kramer, MD, MPH, associate director for disease prevention at the National Institutes of Health.

Biopsy Harm

Maybe it's already happened to you.

You feel perfectly fine as you walk into the doctor's office for a check-up. You get a routine screening test. Later, you get a call. The test says you may have cancer. You'll need more tests to be sure.

Yesterday you were a healthy person. Today you might be a cancer patient. And you won't find out for sure until you have a bit of your body removed with a needle or scalpel or scope -- a biopsy -- to find out if it's cancer.

Maybe that biopsy didn't hurt much. Maybe it did. Or maybe you're one of the unlucky few who suffered a serious injury, such as a perforated colon or a blood infection.

But now you have a new problem. You anxiously wait for the next call, the one that will tell you whether there really are cancer-like cells in your body.

If it's not cancer, you may breathe a sigh of relief. If it is cancer, you might think the test saved your life. But maybe not.

The vast majority of screening-triggered, cancer-positive biopsies detect cells in the very earliest stages of becoming cancers.

That's good, isn't it? Early-stage cancers usually are curable. But there's a catch, Kramer says.

"Unfortunately, right now we are diagnosing a large number of people without precise enough knowledge to spare those who don't need to be treated from treatment," Kramer says. "We treat them, but we have to accept the possibility that there is overtreatment."

Not All Cancers Kill

In 1924, a Johns Hopkins doctor named Joseph Bloodgood noted that the earlier a cancer was detected, the longer patients survived. In a famous New York Timeseditorial, he predicted that future cancer screening tests would virtually eliminate cancer by detecting lesions at their earliest stage.

Bloodgood was right that better screening tests would come along. And he was right that earlier diagnosis increases survival, although not always in the way he predicted. Earlier diagnosis may increase the time a person lives with cancer without necessarily letting him or her live longer.

But Bloodgood was wrong about eliminating cancer. Cancer rates have fallen since routine screening began, but they haven't dropped off a cliff. Over 1975 to 2007, the U.S. cancer death rate dropped from 200 to 178 deaths per 100,000 people.

Doctors are screening for some of the biggest cancer killers on earth. Screening is routine for cancers of the breast, prostate, colon, and cervix. Smokers get screened for lung cancer. Cure rates are up. Death rates are down -- but not as much as cure rates would predict.

Why? As Brawley notes, many of the cancers we're detecting and curing would never have killed. Some cancers are, or become, benign. Some "spontaneously remit," meaning they go away. Some -- doctors call them "indolent" -- grow so slowly that a person would die of something else.

"Overtreatment is treatment that was not necessary at all because the tumor did not need to be treated," Kramer says. "There is more and more evidence that there is an increasing pool of these tumors."

The Downside of Cancer Treatment

No question: Cancer treatment saves many lives. But it's serious, often involving surgery, toxic drugs, and/or radiation. Treatment can scar and damage bodies, increase the risk of other cancers, and reduce the quality and length of a person's life.

It's worth it if it saves your life. But what if it doesn't? Many people have to accept the risks of routine cancer screening in order for one person to benefit. And when a cancer is found, treatment is no walk in the park.

"We do major surgery. We give radiation, a known carcinogen. We givechemotherapy, also a known carcinogen," Kramer says. "It is difficult to make a healthy person better than they are, and that is the very high bar screening tests must clear."

Yet most doctors would agree that it would be wrong not to treat people with early cancers, says Stefan Gluck, MD, an oncologist at the University of Miami Sylvester Comprehensive Cancer Center.

"With any cancer, even the smallest one can be very aggressive," Gluck says. "I do not believe it is wrong to find cancer early and get rid of it."

Living With Uncertainty: The Limits of Science

Short of a cure, perhaps the greatest unmet need in cancer research is to find tests that tell us which tumors need to be treated.

"What we need to do as scientists is to find better tests. Tests that are more specific, cheaper, not expensive, and five to 15 years later show we are detecting more cancers and less people are dying," Gluck says. "But if the tests detect the same number of cancers and same numbers of people are dying, a test is not effective."

Nearly all patients treated for screening-detected cancers believe their treatment cured their cancer and saved their lives. But many if not most of them never needed to be cured at all. They were overdiagnosed and overtreated.

"Unfortunately right now we are left with diagnosing a large number of people without precise enough knowledge to spare those who don't need to be treated," Kramer says. "And because cancer is such a fearsome disease, we often feel that patients can't tolerate going untreated."

Prostate cancer offers a good example. According to the U.S. Preventive Services Task Force (USPSTF), "A large majority of the men who are being treated would do well without treatment." Yet in the U.S., 90% of these men opt for treatment.

"We have a culture of treating cancers aggressively, but we know all those men don't need to be treated," Kramer says.

Another example is the most feared form of skin cancer: melanoma. Melanoma rates have gone up since the late 1980s. Most of the increase is in early cancers detected as skin-exam screening became more common. But late-stage melanoma cases didn't decline, Kramer says. Neither did the death rate.

Brawley agrees. "I cannot quote a study showing that melanoma screening definitely saves lives," he says. "We cure some melanomas that don't need to be cured."

Nobody wants to live with cancer. Nobody wants to be overdiagnosed or overtreated. It's just that we want -- need -- answers that medical science does not yet have.

"What we really need is a 21st century definition of cancer so we can move away from 20th century screening and diagnosis using an 1840s definition of cancer," Brawley says.

There are limits to science, says Susan G. Fisher, PhD, professor and chair of public health sciences at the University of Rochester, N.Y.

"People are uncomfortable and concerned because they think we are recommending less screening in some groups," she says. "The message for the public is that science is hard. As we get more and more information we get smarter about our advice. The most recent evidence says that in groups at low risk, we are creating more problems than benefits with early screening."

To Screen or Not to Screen?

Some people are at higher risk of cancer than other people. For example, a woman may have inherited genes that raise her risk of breast cancer. Or she might be a smoker, raising her risk of lung cancer.

For people at risk of cancer, the benefits of screening often outweigh the harms. For those not at risk, deciding on whether to undergo cancer screening can be a close call.

The USPSTF recommends routine screening -- that is, for people at normal risk -- for only three cancers:

• Breast cancer screening mammography is recommended for all women aged 50 to 74. Women under age 50 must weigh the benefits and harms before deciding to undergo screening mammography.
• Colon cancer screening is recommended for all adults from age 50 until 75.
• Cervical cancer screening every three years via Pap smear is recommended for all women aged 21 to 65. At age 30, women may opt for screening every five years with a combination of Pap tests and testing for human papillomavirus (HPV).
• Groups such as the American Cancer Society and the National Cancer Institute say CT screening should be offered to those at high risk of lung cancer. That includes smokers and former smokers ages 55 to 74 who have smoked for 30 pack-years or more and either continue to smoke or have quit within the past 15 years. A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Their guidelines are based on research that showed CT screening decreases the chance of death overall but increases the chance of having a false alarm that requires more testing.

The USPSTF says there's not enough evidence to recommend for or against routine screening for bladder, oral, and skin cancers. The panel advises against routine screening for ovarian, pancreatic, prostate, and testicular cancers.

If you're not sure what cancer screenings are recommended for you -- or you're not sure you want to go through with those tests -- talk it over with your doctor. Ask for the pros and cons of testing, in light of your preferences, overall health, and family history.

When it comes to cancer screening, doctors often do not adequately discuss the balance of pros and cons with their patients, a new study suggests.

Guidelines call for doctors and patients to engage in shared decision making regarding cancer screening, such as whether to have prostate specific antigen (PSA) testing for prostate cancer.

That’s because although screening can help spot some cancers early on, it can also come with a risk of false positives and unnecessary and invasive follow-up procedures.

Often there is no right decision on whether to screen, and different people may weigh the options and their potential consequences differently, researchers said.

“Cancer screening and a number of other medical services are not all just plain benefit,” said Dr. Michael Pignone at the University of North Carolina at Chapel Hill, who worked on the new study.

“People should really know what they’re getting into,” he told Reuters Health.

Pignone said that in the past few years, a growing number of organizations like the American Cancer Society have pointed to the importance of shared decision making.

To see if that movement is being reflected in practice, the researchers analyzed data from a web-based survey that asked participants about their experiences with cancer screening.

The current study includes responses from roughly 1,100 adults ages 50 and over who had discussed a screening-related decision with a healthcare provider in the past two years. It focused on colon, breast and prostate cancer screening decisions.

Participants reported that between half and two thirds of the discussions covered the potential benefits of cancer screening. But less than one in ten conversations about breast or prostate cancer screening and only slightly more on colon cancer screening covered possible reasons not to get tested.

Between 27 and 38 percent of patients reported engaging in shared decision making with their provider, and another 45 to 69 percent said they were mainly responsible for making the final screening decision.

Depending on the screening test in question, between 69 and 93 percent of study participants chose to get screened, and most said they would make the same decision again, the authors write in the American Journal of Preventive Medicine.

But given that people were often not informed about potential risks, having confidence in the decision to undergo screening doesn’t guarantee it was the best choice, they point out.

Dr. Michael Wilkes has studied shared decision making at the University of California, Davis but was not involved in the new research.

“The bottom line is, doctors just aren’t doing this,” he told Reuters Health.

Brian Zikmund-Fisher, from the University of Michigan in Ann Arbor, said he and his colleagues saw similar results when they studied doctor-patient screening discussions five or six years prior to the current report.

“What this study does is it shows that despite all of the initiatives and the discussion of shared decision making that has been going on, we don’t seem to be moving the needle very much,” he told Reuters Health.

“The thing that I wish would be more part of the conversation is a recognition that there’s always a trade-off in cancer screening. It’s not perfect,” Zikmund-Fisher, who was not part of the research team, said.

Many times, the answer to whether a person should get screened will be yes, he added. “But that doesn’t mean we shouldn’t have the conversation.”

It’s not that doctors don’t want patients to make informed decisions, Pignone said. But some may think having a discussion isn’t worth it if they have their own beliefs about screening and not much time to spend with each patient.

“Some of us really like having these conversations. But for the vast majority, it’s a pain in the neck,” Wilkes said. “Most (doctors) think this is just some legal requirement, and it really isn’t, it’s a moral imperative.”

To encourage a shared decision making process, people should come into an appointment ready to ask questions about the benefits and downsides of screening and to talk about their own screening-related values, Pignone said.

“A prepared and informed patient is likely to get the most out of their encounter with their doctor,” he said.

Sumber : MD dan R.net