What role does a family doctor serve in cancer prevention?
As family physicians, our responsibility is to serve as health companions for our clients and their loved ones, regardless of age, sex, health status, or complexity of their conditions. We are dedicated to providing patient-centered, holistic, and comprehensive care, including episodic, chronic, and preventative care. In Hong Kong, consultations regarding cancer prevention and concerns usually occur in the context of health screenings, the presence of alarming symptoms, or when a family member or friend is unfortunately diagnosed with cancer. Family doctors provide personalized advice on evidence-based check-ups at different ages and in different contexts. The following are some common important cancer prevention or screening measures:
- Colorectal cancer (CRC) screening through the HK Department of Health's CRC screening program, which is recommended for individuals aged 50-75 who meet the criteria. Colonoscopy is also commonly used for CRC screening in private practice.
- Breast cancer screening: Family doctors provide advice and education on self-breast awareness, self-breast examination, mammogram, and ultrasound screenings at appropriate intervals.
- Pap smear screening for cervical cancer.
- Other cancer screenings for high-risk individuals, such as liver cancer screening for hepatitis B carriers or individuals with a family history of cancer.
Is cancer preventable?
Prevention is always better than cure, but it is easier said than done. Some individuals are health-conscious and take proactive measures to manage their diet, exercise, stress levels, sleep, and lifestyle. Taking supplements has also become a trend. However, we still encounter people who are diagnosed with various types of cancer. Some of these cancers can be particularly devastating, such as pancreatic cancer, metastatic lung cancer, ovarian cancer in young individuals, or the incidental finding of asymptomatic blood cancer. The question is whether being health-conscious and paying attention to lifestyle choices and health screenings can reduce the chances of developing cancer. Do smokers have a higher risk of lung cancer than non-smokers? We are currently in the era of genomic medicine, where scientists have successfully identified more genetic markers for various types of cancer, such as EGFR for lung cancer and BRCA1 and BRCA2 for breast cancer. However, not all cancers can be attributed to genetics alone. Therefore, as family doctors, we advise every person to meet with their family doctor at least once or twice a year to discuss their health and recommended essential health screenings. Nowadays, cancer can be more easily diagnosed through sophisticated tests, and many cancers have "manageable" treatments. Some even argue that cancer is now more like a chronic disease rather than an incurable condition.
Why does colorectal cancer screening matter?
Symptoms of colorectal cancer include blood in the stool, changes in bowel habits, mucus in the stool, abdominal discomfort, or systemic symptoms such as weight loss and fatigue in severe cases. While colorectal cancer screening aims to prevent the disease, it involves healthy individuals undergoing screening examinations to detect the disease at an asymptomatic stage for early treatment. The Hong Kong government has supported a colorectal cancer screening initiative for many years. Individuals aged 50-75 are eligible to register for the program after assessment by their primary care physician. Private doctors or medical groups have been highly supportive of this initiative over the years. Typically, individuals with negative stool test results repeat the test every two years, while those with positive results are scheduled for a colonoscopy examination. Nowadays, colonoscopy can be performed as a day procedure with a few simple and standardized steps. Patients do not experience any discomfort during the procedure, as they are either sedated or under Monitored Anesthesia Care (MAC). The most beneficial aspect of colonoscopy is that the endoscopist can visually examine the bowel and remove polyps immediately if detected. Subsequent microscopic examination of the polyp informs the doctor and patient about any potential cancer risk or pre-cancerous stage (yet the polyp was already removed!). The next step is to schedule another follow-up colonoscopy in the recommended interval, such as 1-2, 5, or 10 years later, to monitor for any recurrent polyps. It is generally recommended to start colorectal cancer screening at the age of 50, or earlier for those with a positive family history or suspicious conditions. The key message is that while some cancers are more challenging to prevent and screen, colorectal cancer is one of the few cancers that can be prevented.
Vibrant Quinoa Power Bowl with Sesame-Ginger Dressing
Ingredients:
1 cup quinoa, dry
12 oz shelled edamame, about 2 cups
3 cups thinly sliced green cabbage
2-3 cups thinly sliced curly kale
1 1/2 cups grated carrot
1 large apple, cored and thinly sliced
1/2 medium red onion, thinly sliced
1/2 cup fresh herbs, such as cilantro, green onion or mint
1-2 tablespoons toasted sesame seeds
Ginger Tahini Dressing:
1/2 cup tahini
1/4 cup fresh lime juice
2 1/2 tablespoons tamari
2 tablespoon apple sauce
1 tablespoon apple cider vinegar
1 teaspoon grated ginger
1 teaspoon grated garlic (1-2 cloves)
Salt and red pepper flakes to taste
Water for thinning out, if needed
Instructions:
- 1. Cook the quinoa by rinsing 1 cup of dry quinoa and simmering it in 2 cups of water for 15-20 minutes until the water is absorbed. Let it cool or use it immediately.
- 2. Slice the cabbage, kale, red onion, apple, and grate the carrot. Thaw the edamame if using frozen.
- 3. Make the tahini ginger dressing by combining all the dressing ingredients in a small bowl. Adjust the flavors as needed.
- 4. In a large bowl, mix the cooked quinoa, edamame, cabbage, kale, red onion, carrot, apple, and fresh herbs. Pour the dressing over the salad and mix well. Add toasted sesame seeds and season with salt to taste.
Potential anti-cancer properties:
Certain foods offer potential health benefits and may help reduce the risk of cancer. Quinoa is rich in fiber, flavonoids, and saponins. Edamame contains isoflavones, which have been studied for their anti-cancer effects. Cabbage and kale are cruciferous vegetables that contain glucosinolates, which may inhibit tumor growth. Carrots are high in beta-carotene, an antioxidant associated with a reduced risk of cancer. Apples provide antioxidants and flavonoids that can potentially inhibit cancer cell growth. Additionally, herbs like cilantro, green onion, and mint offer antioxidants and phytochemicals with potential anti-cancer properties.
