First, Amrit Takhar:
>> family history of colon and lung cancer. (snip) prostate cancer. He has
no >> symptoms other than an intermittent dry cough over the past years (PFR
640, >> lungs clear) Physical exam normal
>> What do other GPs do in this situation?
>> What screening tests would you offer if any?
Then, Patrick Atlas:
>In France, we could propose him an Hemocult test then a colonoscopy for the
>screening of colon cancer, a lung x-ray for the lung cancer. Anything else?
>Biological markers are not available here for the cancer screening.
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Here in Portugal we probably would do the Haemocult, the lung X-ray and a
PSA for prostate Ca. All to reassure the patient, since neither have decent
positive predictive values for asymptomatic patients, that is, for _screening_.
As for colonoscopy, only faced with a history of family polyposis; it would
be a violence to do it in an otherwise asymptomatic patient...
There is a great paper on Canadian Family Physician (Dec 95, I think, or
close) presented as a dialogue between a GP and a patient wanting to do a
PSA test. The physician discusses all the pros and cons of prostate cancer
screening while the patient makes the questions we regularly listen to.
Beautiful. I can dig the reference if someone is interested.
Armando
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Armando Brito de Sa'
Lisboa, Portugal
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