At 12:23 PM 9/3/96 EDT, you wrote:
>I have a 54 yearold patient who has asked to be screened for cancer as he has a
>family history of colon and lung cancer. He is also concerned about prostate
>cancer. He has no symtoms other than an intermittent dry cough over the past 4
>years (PFR 640, lungs clear) Physical exam normal
>
>What do other GPs do in this situation?
>What screening tests would you offer if any?
>He is happy to pay for any tests if not available on NHS
>
>DR Amrit Takhar
>Cambs UK
I would be happy to screen this patient for colonic carcinoma as they have a
family history. The Australian Gastroenterological Society released
screening guidelines for colonic carcinoma about 3 years ago so GPs here
would know what to do. In the case of colonic carcinoma, screening by
colonic carcinoma should begin in all first degree relatives of the index
case at an age of 10 years younger than the diagnosis was made in the index
case. If our patient's father had a colonic malignancy diagnosed at age 55,
then screening of all first degree relatives should be done from age 45
every 5 years if asymptomatic. If symptoms develop, then colonoscopy is
warranted immediately. If familial polyposis is present, colonoscopies
should be at least biennial.
I am concerned that the patient has had a dry intermittent cough for 4
years. Have they had any trials of treatment with inhaled steroids or oral
steroids. Is their FEV1 able to be returned to 100% of predicted values with
treatment? Does the patient smoke? Is there any history of asbestos
exposure? Is there any history of seasonality to the symptoms? Are they
work-related? or geographically-related? or related to exposure to other
allergens (cats, dogs, house dust, foods etc)? I would arrange a Chest X-ray
in this patient, and if the patient is a smoker, or there is a family
history of lung cancer, I would also arrange bronchoscopy.
I screen any male over the age of 50 years once with Prostate-Specific
Antigen and Prostatic Alkaline Phosphatase and a rectal examination.
Thereafter, I screen if they have symptoms: Nocturia ( > once per night);
decreasing urinary stream; post-micturition dribbling; UTIs; dysuria.
In Australia, the colonoscopy is free if arranged through a public hospital,
but of course there is always a waiting list... In practice, I usually
refer them privately to be done in the specialist's rooms. The patient
usually has to pay on the day of the procedure, and uses the receipt to
claim back the Medicare rebate for the procedure. In most cases, the
patient is usually not more than $AUS50 "out of pocket" after the medicare
rebate is refunded. Chest X-rays are free at "bulk-billing" radiology
practices (or less than $AUS50 out of pocket if the AMA fee is charged).
Fees for bronchoscopy are in about the same league.
Regards, Christopher Collins :)
---------------------------------------------------------------------------
Dr Christopher T.G. Collins, M.B.B.S. F.R.A.C.G.P. Voice (wk) +61 74 957077
General Practitioner/Family Physician, Fax (wk) +61 74 957151
Caboolture 7 Day Medical Centre, Voice(hm) +61 73 3503009
King St, Caboolture QLD 4510 Email [log in to unmask]
AUSTRALIA _0_ _O_ "The World's
Information Technology Convenor, /_\ _o_ | true gold is
Brisbane North Division of General Practice _|_ _|_ _|_ its people" CC
Internet Home Page URL: http://www.uq.edu.au/~smccolli/index.html
Like Science Fiction? Try: http://www.uq.edu.au/~smccolli/Reed_Heart.html
---------------------------------------------------------------------------
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|
