House Call: Men need checkups and screenings, too

Since June is Men’s Health Month, I thought it would be a good time to review current guidelines and recommendations for men’s health screenings and checkups for preventive medicine. As the COVID-19 pandemic eases, now is the time to get re-established with your primary care physician and get those delayed health screenings and checkups completed.

In the past year amid COVID-19 and the disruption it brought, 40% of U.S. adults skipped or delayed care and screenings. Even without a pandemic, men frequently put off health care. About two-thirds (65%) of men tend to wait as long as possible to seek care even if they have symptoms or an injury.

As men, we often follow the “If it’s not broke, don’t fix it” approach to health care, seeking care only when a serious health issue arises and rarely going for routine checkups. I was having a conversation with a female patient of mine who regularly comes in for her routine checkups, and I asked about her husband, as I had not seen him in quite a while. She said, “I know, he just thinks that if he feels OK, why bother, nothing must be wrong.”

In fact, it is often the patient’s spouse who winds up reminding the husband or scheduling the appointment because many men are reluctant to do so. I recently reviewed a study from Harvard Medical School that looked at 3,682 adults over a 10-year period. Even after taking major cardiovascular risk factors such as age, body fat, smoking, blood pressure, diabetes and cholesterol into account, married men had a 46% lower rate of death than unmarried men.

Men are usually pretty good at getting the oil changed in their car on a regular basis, and when I ask them why they do this, they say it is to prevent the car engine from breaking down. Unfortunately, when it comes to their own health, men are sometimes in denial about regular maintenance and checks.

So, let’s talk about what you should be doing, according to current U.S. Preventive Services Task Force guidelines and the American Academy of Family Physicians.

Just get in and get checked

Getting in for regular wellness exams where you can review risks and treat issues before they become more serious problems is key to health maintenance. Younger men should come in at least every four years, increasing to every other year in your 50s.

Heart health

Cardiovascular disease is the leading cause of death for men in the U.S. High cholesterol and hypertension often have no symptoms, and approximately 50% of men who die of sudden coronary heart disease had no previous symptoms. Getting regular blood pressure checks and cholesterol screening is vital, along with obtaining a detailed family history for early coronary events in first degree relatives.

A heart checkup would include reviewing personal risk factors like smoking, diabetes, lack of regular exercise, obesity and poor diet, as well as diagnosing new hypertension or hypercholesterolemia, then working with your provider to make a plan for a heart-healthy lifestyle, including healthier eating, regular exercise and strategies for stress reduction.

Stop diabetes before it starts

Like high blood pressure, diabetes starts with invisible changes long before diagnosis. The good news is it’s easily detectable before it becomes a bigger problem, and it’s often reversible through lifestyle modification.

Type 2 diabetes occurs when your body becomes resistant to the storage hormone insulin (often due to obesity and poor diet), and blood sugars become on average too high. Genetic risk factors, lack of exercise, being overweight and a diet high in simple carbohydrates, like soda, make the pancreas work harder, which is the organ that produces insulin.

Eventually, the pancreas starts to fail, blood sugars get too high, and you become diabetic. This pancreatic failure may take more than 10 years to develop, but we know that in the interim, serious changes and damage are happening to your heart, blood vessels, liver and kidneys. Through early detection, these changes can be mitigated or even reversed, and sometimes this can prevent the full-blown development of diabetes.

Discuss simple lifestyle changes regularly with your primary care physician.

Cancer screening

Early detection is key to fighting cancer. The three leading causes of death from cancer in men are prostate, lung and colorectal cancer. While there are risk factors for cancer that can’t be changed, such as having a close relative who has a particular type of cancer, many factors such as a healthy diet, getting regular exercise and quitting smoking can be. Know your risk, and get regular checks for these types of cancer:

• Colon cancer: Start getting checked at 50 (40 if you have a family history in a sibling or parent). This can be done with an annual at home (FIT) test or with a colonoscopy every 10 years.

• Prostate cancer: Consider screening, especially if you have a family history of prostate cancer. This can be a simple blood test, but there are false positives, so this decision should be made after discussion of the pros and cons with your physician. Standards have changed, and, sometimes in older men, we find asymptomatic cancer that needs to be watched rather than treated aggressively.

• Lung cancer: If you are between 50 and 80 years old, it’s recommended to get checked if you’ve smoked more than 20 “pack-years” or if you’re a previous smoker, but it’s been less than 15 years since you quit. Screening is an annual low-dose CT scan of the chest.

• Skin cancer: Caused by cumulative sun exposure, it’s the most common cancer in humans. It’s easy to check for and biopsy, and the most common – basal cell skin cancer – is a straightforward treatment. Melanoma incidence has been increasing significantly in the past several years, and this can be fatal if not caught and treated early.

Depression screening

It can be extremely difficult for patients to reach out and ask for help. Younger and older men are at increased risk of suicide compared to other people. Many older men, especially those who have lost a spouse and face social isolation and depression, are at even greater risk for suicide.

There has been added stress and anxiety experienced during the pandemic. Whether you are dealing with a challenge or you’re coping with the stress and anxiety of those around you, checking in privately with your health care provider is an opportunity to get help.

Getting regular vaccinations

Coming in for your regular well exams provides an opportunity to get updated on recommended vaccinations like annual flu shots, periodic tetanus and pertussis boosters, shingles vaccinations, as well as pneumonia shots (if older than age 65), in addition to the current recommendations regarding COVID-19 vaccine.

Conclusion

Life expectancy for men in Spokane County is almost four years shorter than for women. Early detection and prevention of health problems is the key to avoiding serious outcomes and even death. Additionally, it can mean the difference between poor quality of life in your later years and a life of vitality.

I encourage all men to look at your calendar and make that appointment for your well-exam checkup with your primary care physician, especially now that the COVID-19 pandemic is easing. Don’t wait for that engine to blow.

Dr. Jeff Markin is a family medicine physician practicing at Kaiser Permanente’s Veradale Medical Center.