Physician, Get Yourself Screened

Maureen Miller, MD, MPH
Epidemic Intelligence Service Officer
Division of Cancer Prevention and Control
Centers for Disease Control and Prevention

In recognition of Cancer Prevention Month, a “disease detective” in CDC’s Division of Cancer Prevention and Control talks about what happened when she seemed too busy screening patients for cancer to get screened herself.

As a medical resident in pathology, I worked in several hospital laboratories that screened dozens of patients for cancer every workday. We issued results of routine screening tests for colorectal, prostate, breast, lung, and cervical cancers and reviewed tests from patients thought to have other cancers for which there were no official screening recommendations. That added up to thousands of potential cancer patients every year.

We caught some cancers early. Occasionally, we prevented a patient from dying of cancer who did not know that they were even sick. It was a lot of work, but every patient we screened was worthy of the best cancer care possible—even if they didn’t have cancer then or wouldn’t ever. That did mean, though, that providers like me had to work hard to find time to take care of ourselves while taking care of others.

During my time in hospital residency, I was the right age for cervical cancer screening. I put it off for a few years, thinking I was low-risk. In those days—not long ago, granted—I only saw my gynecologist for urgent problems. Work was my excuse. Women rarely have physical symptoms of HPV infection until advanced cancer develops, but I thought my clinical knowledge base made me smarter than screening. I knew, for example, that cells infected with the human papillomavirus (HPV) looked like sea green and salmon pink leaves with dark blue, raisin-shaped blobs in the middle. From microbiology work, I knew the virus spread by skin contact during sexual activity, that it was common, and that the HPV vaccine could prevent infection from high-risk HPV types that cause over 90% of cervical cancers. Many women live with HPV for decades unknowingly—knowledge we cannot have from a book, only from the screening tests. I just didn’t know I was one of them until I finally got screened myself.

At age 33, I visited my nurse practitioner for GYN care and was educated in proper screening. Women between ages 30 and 65 can now be offered an HPV test along with the Pap test or HPV test alone. The nurse practitioner suggested I get a DNA test for HPV infection, a quick sample taken with a swab during the normal exam. It took about as much time as a Pap test and did not require annual follow-up, just periodic Pap and HPV tests after that for low-risk patients.

It turns out that I, like some of my patients, was underscreened. That came as a surprise to me. Previously, I had talked to healthcare providers using old screening guidelines or ordering the wrong tests. By learning what tests I needed, I could better appreciate what my patients went through as they scheduled appointments or asked questions.

There is an old expression, “Physician, heal thyself.” I now always tell my coworkers, screen yourselves! Even well-informed, smart people benefit from regular reminders. Screening makes sense. It prevents cancer deaths and reduces the number of new cancer diagnoses. Regular screening offers us a chance to catch cancer, if present, at an early stage. It could cure you, or at least block the disease’s path to worse disease. Talk to your healthcare providers about the latest screening guidelines. Help them break old habits (including their own) and protect you!

Learn more about recommended screening tests.