By Lisa Killinger, DC
“I have never considered it beneath my dignity to do anything to relieve human suffering.” — D.D. Palmer

While some patients come to chiropractors to get their back checked, some of our patients use our services for primary health and wellness care. Some patients may prefer chiropractic’s natural and less-invasive approach to health care, while others may prefer their chiropractor because they simply don’t like going to the medical doctor. Whatever the reason, there is a responsibility that comes with serving as a primary health care provider. One such responsibility is to ensure all of our patients are up-to-date on their recommended health screenings.

Preventive screenings are evidence-based examination procedures or tests to help detect disease or to identify patients at risk of developing disease later in life. These screenings save lives and should be a part of every primary care health professional’s practice. Of course, all chiropractors want their patients to be healthy and not die prematurely from diseases such as cancer or heart disease. But can we make a difference in such “bigger picture” health concerns?

Prevention and Our “Philosophy”

Chiropractic was all about prevention before prevention was cool. Let me pause here for a philosophical moment. Some chiropractors view their role as “finding and correcting vertebral subluxations.” Others see themselves as “spine care specialists” who provide nonsurgical conservative care for spinal conditions. Many chiropractors just see themselves as health care professionals and are out there caring for patients, noting that they do influence the overall health choices of their patients. Whatever the chiropractor perceives their role to be, we have two choices related to preventive screenings:

• We can choose to not recommend preventive screenings for our patients.
• We can take an active role in recommending preventive screenings.

The Ramifications of Our Choices

There are two very different outcomes attached to “choice A” and “choice B” above. In choice A, it is likely our chiropractic patients will not get their preventive screenings, since so many patients only get recommended screenings because a doctor recommends them. If our patient is not regularly seeing a medical doctor, this is a serious matter. Without early detection through preventive screenings, our patients will end up with later diagnoses of various serious health concerns (cancer or other illnesses), that might have been prevented. This results in poorer health outcomes, more medical / surgical intervention, and a significantly higher risk of death.

If we choose choice B above, the scenario is quite different. If the population of chiropractic patients is more likely to receive preventive screenings, it is likely our patients will have lower incidences of serious health crises and earlier detection of disease. With early detection, changes in lifestyle may be the only intervention needed to ward off a serious adverse event, and death due to late-stage detection is unlikely. The risk of death is also significantly lower in this scenario.

I am not sure about anyone else, but I personally like choice B, and I suspect our patients would also prefer this option.

One cannot help but ponder what the effect would be if future studies of the chiropractic patient population found our patients more likely to get preventive screenings, more likely to detect disease early, and less likely to experience late-stage disease and premature death. Such statistics could position the chiropractic profession front and center as leaders in health care delivery.

Why Chiropractors?

As chiropractors, we have a unique opportunity to steer patients toward preventive screenings and better overall health outcomes. It’s our choice. But are chiropractors well-suited to recommend preventive screenings? The required elements for success in recommending such screenings are:

• Good patient rapport
• Regular visits with the patient to build trust and ensure follow-up
• Willingness to recommend and remind about lifestyle changes if indicated

Chiropractors, perhaps more than any other health professional, possess the necessary ingredients to be advocates of recommended screenings. Further, according to the NBCE’s2010 Practice Analysis of Chiropractic, the vast majority of chiropractors are already very involved in recommending lifestyle changes, such as healthy diet and exercise, to their patients.¹

It is important to note that chiropractors do not have to take time out of their busy schedules to do most of the recommended screenings. They simply need to make sure toadvise patients to get their screenings done in the appropriate settings (e.g., female exams at a gynecologist’s office, heart-related blood chemistry tests or diabetes-related glucose tests at a lab, mammography or bone density tests at a radiological imaging center, etc.).

What is important is to make clear to patients that these screenings are essential to overall health, and that you need copies of the results for your file. As appropriate, you can then either follow up with lifestyle recommendations, or refer for further testing or treatment.

Screenings: A Life-or-Death Example

There is simply no reason that a woman should ever die of cervical cancer in America, a country with vast health resources. After all, cervical cancer, if detected early, has a nearly 100 percent survival rate. Yet approximately 3,900 American women die each year from cervical cancer alone.^2-3

A quick glimpse into history shows that the use of a simple preventive screening, the Pap test, has reduced U.S. cervical cancer death rates by 60-75 percent over the past 50 years.⁴ Pap tests are considered one of the greatest public health successes of the last century. By contrast, in developing nations, where Pap tests are not widely used, cervical cancer remains the most common cause of cancer-related death among women and a leading cause of death overall.⁵

So, why are there still 3,900 deaths in the U.S. per year? When women choose to skip their female exams, don’t have access to Pap tests or cannot afford the tests, pre-cancerous tissue can turn to cancer and progress to late-stage, fatal cervical cancer. As the Affordable Health Care Act comes into effect, Pap tests and other preventive screenings will be free for anyone who should appropriately receive them. It will be interesting to see if our nation’s health statistics improve once financial impediments to receiving such screenings are removed.

What Should I Recommend?

It is easy to become overwhelmed and say, “I just don’t know what to recommend!” It is true that some organizations have slightly different lists of appropriate preventive screenings than others. It is wise to choose an information source that is reputable and non-profit. For example, I’d be wary of a company selling ultrasound machines for bone density screening that claims all patients should get an ultrasound each year.

There are reputable and easily accessible preventive screening charts for both men and women available online. The list below includes several links to such charts. The recommendations by the U.S. Preventive Services Task Force and those from the Centers for Disease Control and Prevention are based on the best scientific evidence related to such screenings. Several physicians groups and nonprofit organizations, such as the American Cancer Society, also put forth screening recommendations. While these recommendations may vary slightly, all provide good, basic information on the key screenings for leading health concerns in America.

• Screening Schedule for Women: www.womenshealth.gov/publications/our-publications/screening-tests-for-women.pdf
• Screening Schedule for Men: http://womenshealth.gov/publications/our-publications/screening-tests-for-men.pdf
• Screening for Heart Disease: www.ghc.org/all-sites/guidelines/ascvd.pdf
• U.S. Preventive Services Task Force Recommendations:www.uspreventiveservicestaskforce.org/recommendations.htm

The APHA: Leading Advocates of Prevention

Since its inception, 140 years ago, the American Public Health Association (APHA) has been a leading advocate of health promotion and prevention in America. APHA has always championed the use of evidence-based preventive screenings, and when necessary has driven policy change and legislative processes to ensure such screenings continue as a part of everyday health practice in America. And for the past 20 years, an elite group of chiropractors has participated in APHA as part of the Chiropractic Health Care section.

At APHA, health is the focus. No special-interest group has ever swayed APHA from its mission to improve the health of the public and achieve equity in health status for all. If you are interested in the public’s health and engaging in positive health care efforts at the national level, inquire about joining the Chiropractic Health Care section of APHA today. Visit APHA.org to learn more.

References

1. Christiansen MG, Kollasch MW, Hyland JK. Practice Analysis of Chiropractic, 2010: A Project Report, Survey Analysis and Summary of Chiropractic Practice Within the United States. Greeley, CO: National Board of Chiropractic Examiners; 2010.
2. National Institutes of Health. Cervical Cancer. NIH Consensus Statement, 1996;14(1):1-38.
3. U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2009; Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2013. Available at www.cdc.gov/uscs.
4. Shepard EM. “George Papanicolaou: Development of the Pap Smear.” Medical Center archives of New York Presbyterian / Weill Cornell, June 29, 2011.
5. NIH Research Timelines; Research Portfolio Online Reporting Tools. Cervical Cancer.

Dr. Lisa Z. Killinger is the director of diagnosis and radiology at Palmer College of Chiropractic and section councilor for the Chiropractic Health Care section of the American Public Health Association.