JULY 2024
Khaas Baat : A Publication for Indian Americans in Florida
Health & Wellness


Dr. M. P. Ravindra Nathan

By Dr. Venkit Iyer, MD, FACS

Many people, including several doctors, are confused as to latest recommendations for screening for common cancers, such as breast, lung, prostate, colorectal, cervical, ovarian and skin. Screening entails performing tests on masses in large scale, who are otherwise healthy with no signs or symptoms of cancer. Such screening tests allow early detection of cancers that were hither-to unknown to exist, thus allowing early treatment and better chance for cure.

Breast cancer
USPSTF (Unites States Preventive Services Task Force) published its latest recommendations for screening for breast cancers in JAMA (Journal of American Medical Association) on April 30. This recommendation is also endorsed by American Cancer Society (ACS). All women are to get a routine mammogram every alternate year starting at age 40 till age 74. This is for those who are completely normal and healthy otherwise with no risk factors. Those who are known to have high risk for cancer should start screening much earlier or continue to further older age or get it done annually instead of biannually.

From September onward, FDA is expected to mandate that the mammogram reports should specify findings of dense breast tissue when noticed, so that those women can choose to get additional tests such as sonogram or MRI. About 50 percent of women are noted to have dense breast tissue. Incorporation of artificial intelligence in readings of mammograms is expected to increase further accuracy.

Prostate cancer
American Cancer Society (ACS) recommends that all men above age 50 should get a blood test known as PSA (Prostate Specific Antigen). Generally, 4.0 ng/L is the cutoff. Anything above this level would warrant additional evaluations, and close follow-up. Otherwise, the test is to be repeated every other year. Progressively rising PSA level is cause for alarm and should be evaluated by a urologist to rule out prostate cancer. Screening tests can be stopped at age 80 or if life expectancy is less than 10 years for the individual.

Lung cancer
USPSTF made specific recommendations for screening for lung cancer in March 2021.  The screening is required only for adults between 50 and 80 years of age, who have 20 pack-year history of smoking or are currently smoking or who quit smoking within the past 15-year period. They are recommended to have low dose computed tomography of chest (LDCT) once a year. If they have stopped smoking for more than 15 years duration or if they have serious other life limiting conditions, then the screening can be stopped. Basically, the test is a CAT scan of the lungs with low radiation to detect tumors or other abnormalities in the lung fields. A pack year of smoking means smoking one pack of cigarettes per day for one year. Smoking includes cigarettes, cigars, vaping and any other form of nicotine use.

Colorectal cancer
Recognizing earlier onset of colorectal cancers, USPSTF and American Cancer Society in 2022 recommended screening for colorectal cancers to start at age 45. Initial tests could be fecal occult blood test (FOBT) or DNA stool test (Cologuard) or fecal immunochemical test (FIT) once every three years. FDA just approved a new RNA-based test on the stool (ColoSense). Further evaluation is recommended with colonoscopy once every 10 years till age 75. Alternative is virtual colonoscopy or sigmoidoscopy every five years. If any of the tests are abnormal, or if the person is at high risk or symptomatic, additional investigations are needed.

Cervical cancer
Women are recommended to have Pap smear (Pap test) between ages of 21 to 65 once every three years. In addition, those aged 30-65 can optionally get a co-test for HPV (Human Papilloma Virus) infection once every five years. According to a recent published study, there is a 90 percent reduction in cancer of cervix by doing routine Pap smear and HPV vaccination. It has been declared as a preventable cancer in the USA. The only HPV vaccine available in America is Gardasil 9 by Merck. Routine HPV vaccination of all boys and girls by age 11-12 is a recommendation to prevent not only cervical cancer, but also oral and anal cancers. However, this is met with hesitance and resistance by many parents.

Ovarian cancer
This is a hidden cancer that can grow to a large size with minimal symptoms. Unfortunately, there are no screening tests recommended for the general population. Risk factors such as previous cancers, family history of cancers or lower abdominal symptoms are to be followed up with medical evaluations.

Skin cancers
Skin cancers are the most common type of all cancers, but there are no screening tests. All abnormal looking spots are best evaluated by a physician or dermatologist. Biopsy may be needed for confirmation. A newer development in this field is AI (Artificial Intelligence) powered algorithms of images of skin lesions and tele dermatology platforms, where a mobile phone image of a skin lesion can be interpreted for diagnosis.

Cancers are dreaded diagnosis. The best chance for cure is with early detection and treatment. Screening tests are useful in this context for healthy living.

Dr. Venkit S. Iyer, MD, FACS, is a retired general and vascular surgeon. He has authored six books: “Decision making in clinical surgery” first and second editions; “Aging well and reaching beyond,” “The Clinic,” “Geriatrics Handbook” and “Iyer’s story book for children.” They are available through Amazon or from the author. His website venkitiyer.com has necessary links and contact information.

Editor’s Note: Khaas Baat sincerely thanks Dr. Ravindra Nathan for his valuablecontributions through his monthly health column starting with our first year of publication.


Cataract Awareness Month: Understanding, PreventiON, TREATMENT

Dr. M. P. Ravindra Nathan


June was recognized as Cataract Awareness Month, a vital period dedicated to educating the public about cataracts — a leading cause of vision impairment among the elderly, yet often treatable with timely intervention. This month, health organizations and eye care professionals unite to highlight the importance of early detection and the effective treatments available for those affected.

I have in my previous columns (KhaasBaat) described my “cloudy” concept of cataract, the importance of awareness and the fact that modern technology today can allow cataract to be an excuse to custom designer surgery and provide you the best vision for the rest of your life.

What is a cataract?
A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. The lens works like a camera lens, focusing light onto the retina for clear vision. It also adjusts the eye's focus, allowing us to see things clearly both up close and at a distance. As we age, the proteins in the lens can clump together, starting to cloud a small area of the lens. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see.

Risk factors
While the most common cause of cataracts is aging, various other risk factors can accelerate their development: diabetes, excessive exposure to sunlight, smoking, obesity, high blood pressure, previous eye injuries or surgeries, prolonged use of corticosteroid medications and excessive alcohol consumption.

Most common symptoms
Cataracts start small and initially have little effect on your vision. Symptoms might include blurry sight, colors that seem faded, trouble with vision at night, glare and halos around lights and frequent changes in prescription glasses.
If you experience any of these symptoms, it's crucial to see an eye care professional.

Prevention tips
While not all cataracts are preventable, certain actions might reduce your risk:
* Wear sunglasses and a hat with a brim to block ultraviolet sunlight.
* Quit smoking and reduce alcohol consumption.
* Maintain a healthy weight and diet that includes plenty of fruits and vegetables.
* Manage health problems like diabetes and high blood pressure.
* Get regular eye examinations, especially as you age.

Advancements in treatment and lens implant technology
Cataract surgery has undergone significant advancements, making it one of the safest and most effective surgeries performed worldwide. The procedure generally involves removing the cloudy lens and replacing it with an artificial lens called an intraocular lens (IOL). Today's IOL options include:
* Monofocal lenses, which provide clear vision at one distance only (usually set for distance vision).
* Multifocal lenses, which can reduce the need for reading glasses by providing clear vision at multiple distances.
* Toric lenses, designed to correct astigmatism as well as cataracts.
* Accommodating lenses, which can move or change shape inside the eye, allowing focusing at different distances.
* Adjustable and combined lens implant technologies.
Additionally, new generation and innovative cataract surgical concepts like LenzOplastique® and further allow custom-designing of vision with advanced diagnostics, technology and artistic surgical skills.
AI-based advances in lasers and phacoemulsification make the surgery easier and predictable to include a smaller incision. This smaller incision often requires no stitches, reduces risks, and speeds up recovery time.

The Role of education
Education is key. Knowing about the risk factors, symptoms and treatment options can lead to earlier detection and care, significantly improving the quality of life. Various organizations provide resources and support for those affected, making it easier than ever to get help.

Conclusion: Cataract Awareness Month is not just about spreading awareness; it's about encouraging action. It serves as a reminder for individuals to care for vision as they age. Early detection through regular eye exams can lead to effective management and treatment of cataracts, allowing individuals to enjoy clear vision longer. Let this month be a reminder to prioritize your eye health, for clear sight is a crucial part of a high-quality life.

So, don’t wait for your cataract to “mature;” please go see your eye doctor and insist on it being taken care of as an avenue toward your best vision potential.

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