This document summarizes a presentation on men's health given by Dr. Rowland Chavez and Dr. David Gallinson. The key points are: 1) Men are more likely than women to develop certain illnesses and die from many leading causes of death. However, women on average live about 5 years longer than men. 2) Biological, social, and behavioral factors all contribute to differences in health outcomes between men and women. Behavioral risks for men include smoking, lack of exercise, poor diet, alcohol abuse, and not seeking regular medical care. 3) Doctors recommend that men adopt a healthy lifestyle through diet, exercise, moderating alcohol, managing stress, and regular medical checkups to help

1. Blueprint for Men’s Health
Presented by:
Rowland Chavez, MD, Internal Medicine
David Gallinson, DO, Medical Oncology
Livingston Public Library
December 5, 2018

2. Men’s Health
Dr. Rowland Chavez, M.D.
Internal Medicine
Summit Medical Group
Livingston, NJ

3. Men Have More Illnesses Than
Women
• ~ 10 X more likely to get inguinal hernias
• 5 X more likely to have aortic aneurysms
• 4 X more likely to contract AIDS
• 3 X more likely than women to develop
kidney stones, to become alcoholics, or to
have bladder cancer.
• 2 X as likely to suffer from emphysema or
a duodenal ulcer

4. Women Live Longer
• Women live longer than men on
average 5 years
Table 1: Life expectancy in America
Year Females Males Gender gap
1900 48.3 46.3 2 years
1950 71.1 65.6 5.5 years
2000 79.7 74.3 5.4 years
2007 80.4 75.3 5.1 years
Source: National Center for Health Statistics

5. Life Expectancy Gap Not Unique
to U.S.
Country
Overall life
expectancy
Females Males
Gap (in
years)
Japan 82.1 85.6 78.8 6.8
Canada 81.2 83.9 78.7 5.2
Italy 80.2 83.3 77.3 6.0
U.K. 79.0 81.6 76.5 5.1
Jordan 78.9 81.6 76.3 5.3
Bosnia 78.5 82.3 74.9 7.4
Source: CIA World Factbook (2009 estimates)

6. Men Die at a Faster Rate Than
Women
Table 3: America's 10 leading killers
Disease Male : female death rate ratio
1. Heart disease 1.5
2. Cancer 1.4
3. Stroke 1.0
4. Chronic obstructive lung disease 1.3
5. Accidents 2.2
6. Diabetes 1.4
7. Alzheimer's disease 0.7
8. Influenza and pneumonia 1.4
9. Kidney disease 1.4
10. Septicemia (blood infection) 1.2
All causes 1.4
Source: National Center for Health Statistics

7. Why Does a Gender Health Gap
Exist?
• No single answer
• Depends on a
complex mix of
biological, social,
and behavioral
factors

8. Biological Factors
• Sex Chromosome
 X linked diseases
• Hormone
 Estrogen raises HDL (“Good Cholesterol”)
 Women develop heart disease typically 10
years later than men
 Testosterone fuels prostate cancer

9. Biological Factors
• Metabolic
 Women have higher
HDL
 Differences in
overweight/obese
body types: apple vs
pear shape

10. Social Factors
• Stress levels
 Stress can increase the risk
of hypertension, heart attack,
and stroke
• Social Networks
 Interpersonal relationships
and support networks can
reduce risk of depression,
heart attacks
 Women tend to have larger,
more reliable social networks

11. Behavioral Factors
• Risky Behavior?
• Aggression, Violence?
 A man is nearly four times more likely to die from
homicide or suicide than a woman

12. Behavioral Factors
• Smoking
 17.5% of males, 13.5% of females were current
cigarette smokers in 2016 per CDC
• Alcohol and Substance Abuse
 Men are twice as likely as women to be binge
drinkers and to become dependent on alcohol

13. Behavioral Factors
• Diet ?
 Meat and potatoes vs vegetables
• Lack of exercise?
• Lack of routine medical care
 three times as many men as women had not seen
a doctor in the previous year
 more than half of all men had not had a physical
exam or cholesterol test in the previous year

14. Closing the Gap
• 1 – Avoid Tobacco
• 2 – Eat a healthy diet
 Eat more: whole grains, fruits, vegetables and
legumes, fish, low- or non-fat dairy products, and
nuts and seeds.
 Eat less: red meat, whole-milk dairy products,
poultry skin, high-sodium (salty) processed foods,
sweets, sugary drinks and refined carbohydrates,
trans fats
 DASH Diet, Mediterranean Diet

15. 3 – Exercise Regularly
• The Physical Activity Guidelines for
Americans (11/20/2018)
 150 - 300 minutes a week of moderate-
intensity (e.g. brisk walking)
 Or 75 - 150 minutes a week of vigorous-
intensity aerobic physical activity (e.g. jogging)
 Or combination of the two
 Muscle-strengthening activities on 2 or more
days a week

16. Benefits of Exercise
• A single episode of moderate-to-
vigorous physical activity can improve:
• Sleep
• Reduce anxiety symptoms
• Improve cognition
• Reduce blood pressure
• Improve insulin sensitivity on the day the
activity is performed

17. 4 – Stay Lean
• Maintain a healthy Body Mass Index (BMI)
 BMI = weight (kg)/height (m) squared
• BMI < 18.5 -> underweight it falls within
the Underweight range.
• BMI 18.5 - 24.9 -> Healthy Weight range.
• BMI 25.0 - 29.9 -> Overweight range.
• BMI >30 -> Obese range

18. Waist Circumference
• Abdominal fat is risk factor for diabetes, high
blood pressure, and coronary artery disease
• Unhealthy waist circumference
 >40 inches for men
 >35 inches for women

19. 5 - Drink Alcohol in Moderation
• If you choose to drink, limit yourself
to one to two drinks a day

20. 6 – Reduce Stress
• Get enough sleep
• Build social ties and community support
• How much sleep?
Age Group Recommended Hours of Sleep Per Day
Adult 18–60 years 7 or more hours per nigh
61–64 years 7–9 hours
65 years and
older
7–8 hours

21. 7 – Avoid Risky Behavior
• Avoid drug abuse, unsafe sex,
dangerous driving, unsafe firearm use,
and living in hazardous household
conditions

22. 8 - Reduce Exposure to Toxins
and Radiation
• Reduce exposure to sunlight and
medical x-rays
• Sunscreen
 Broad-spectrum protection (protects
against UVA and UVB rays)
 SPF 30 or higher
 Water resistance

23. Radiation
• Radiation
 CT scans were developed in the 1970s
 Use hundreds of X-rays
 Their use in the United States grew from 3 million in
1980 to more than 85 million in 2011
 Studies published in 2007 and 2009 by teams from
Columbia University and the NCI predicted that up to 2
percent of future cancers — about 29,000 cases and
15,000 deaths annually — might be caused by CT
scans.
 https://www.washingtonpost.com/national/health-science/how-much-to-worry-about-the-radiation-from-ct-
scans/2016/01/04/8dfb80cc-8a30-11e5-be39-0034bb576eee_story.html?noredirect=on&utm_term=.18dd2684cf09

24. 9 – Get Regular Medical Check
Ups
• Cancer Screening tests - (Dr. Gallinson)
• Immunizations
 Flu shot – yearly
 Tetanus booster – every 10 years (one of them should be Tdap)
 Pneumonia vaccines (Prevnar 13 and Pneumovax 23)– starting at
65 yrs old
 Shingles Vaccine (Shingrix)– starting at 50 yrs old
• In adults 50 to 69 years old who got two doses, Shingrix was
97% effective in preventing shingles
• In adults 70 years and older, Shingrix was 91% effective.
• Zostavax reduced the risk of shingles by 51%

25. Preventative Care
 Blood Pressure
• ~30% of the adult population.
• It is the most commonly diagnosed condition at
outpatient office visits.
• High blood pressure is a major contributing risk
factor to heart failure, heart attack, stroke, and
chronic kidney disease.
• The USPSTF recommends annual screening for
adults aged 40 years or older and for those who are
at increased risk for high blood pressure.

26. Blood Pressure Guidelines

27. Preventative Care
• Weight
• Statin Use Without a history of CV Disease
 USPSTF recommends that adults without CVD use a low- to
moderate-dose statin for the prevention of CVD events and
• 1) they are aged 40 to 75 years;
• 2) they have 1 or more CVD risk factors (i.e., dyslipidemia,
diabetes, hypertension, or smoking);
• 3) they have a calculated 10-year risk of a cardiovascular event of
10% or greater.
• Hepatitis C
 1-time screening for HCV infection to adults born between
1945 and 1965.

28. Preventative Care
• Aspirin Use to Prevent CV and Colorectal Cancer
 The USPSTF recommends initiating low-dose aspirin
use for the primary prevention of cardiovascular
disease (CVD) and colorectal cancer (CRC)
• Adults aged 50 to 59 years
• Have a 10% or greater 10-year CVD risk
• Not at increased risk for bleeding
• Have a life expectancy of at least 10 year
• Willing to take low-dose aspirin daily for at least 10 years.

29. Preventative Care
• Abdominal Aortic Aneurysm Screening
 Population-based studies in adults older than 50
years have found that the prevalence of AAA is
3.9% to 7.2% in men and 1.0% to 1.3% in
women
 Most are asymptomatic
 USPSTF recommends one-time screening for
abdominal aortic aneurysm (AAA) with
ultrasonography in men ages 65 to 75 years who
have ever smoked.

30. 10 – Be Happy
• Seek joy and share
it with others
• Laughter is good
medicine

31. David Gallinson, DO
Medical Oncologist
Summit Medical Group MD Anderson
Cancer Center
CANCER SCREENINGS

32. Impact of Tobacco
• Single largest preventable cause
of death.*
• Responsible for death in about half of all
long-term users.
• Over 480,000 Americans die
from tobacco-related illnesses
each year.*
• Since 1964, 20 million have died from
smoking and secondhand smoke
exposure.*
• Recent research shows that smoking is
responsible for up to 60,000 more U.S.
deaths annually than previously
thought.**
* US Surgeon General Report 2014. ** Article: Smoking and Mortality –
Beyond Established Causes, N Engl J Med 2015;372:631-40; DOI:
10.1056/NEJMsa1407211
Source: American Cancer Society, Cancer Prevention and Early
Detection

33. Lung Cancer Prevention
• DO not smoke
• Quit Smoking
• Keep Quitting...Just keep quitting
• Smoke Less
• See your physician...you will be glad
you did
Source: Breathing Easy: Lung Cancer Prevention and Screening, Dr. Jessie S. Wilt, Summit Medical Group

34. Lung Cancer Prevention
• DO not smoke
• Quit Smoking
• Keep Quitting...Just keep quitting
• Smoke Less
• See your physician...you will be glad
you did
Source: Breathing Easy: Lung Cancer Prevention and Screening, Dr. Jessie S. Wilt, Summit Medical Group

35. Lung Cancer
• Leading cause of Cancer deaths
• Third most common Cancer in the US
• Does not cause symptoms until it is
either large or out of the lung and on the
move...at a point where treatment
cannot cure
Source: Breathing Easy: Lung Cancer Prevention and Screening, Dr. Jessie S. Wilt, Summit Medical Group

36. Lung Cancer Screening
• What is SCREENING
 Screening looks for a disease BEFORE
and patient has symptoms
 Goal to detect cancer at the earliest and
potentially MOST CURABLE stage
 Low risk, least invasive, inexpensive, able
to repeat with little impact to the patient,
rely on those results, accessible
 BENEFIT far greater than any risk
Source: Breathing Easy: Lung Cancer Prevention and Screening, Dr. Jessie S. Wilt, Summit Medical Group

37. Lung Cancer Screening
Source: Breathing Easy: Lung Cancer Prevention and Screening, Dr. Jessie S. Wilt, Summit Medical Group

38. Low Dose CT Scan (LDCT)
• Low Dose CT is a "CAT" scan that uses
a low dose of radiation
• Uses a computer and basically a series
of small 2 mm x-ray images
• Screening is NOT for everyone
 Only patients at HIGH risk for lung cancer
Source: Breathing Easy: Lung Cancer Prevention and Screening, Dr. Jessie S. Wilt, Summit Medical Group

39. WHO should be screened
• AGES 55-80
• CURRENT or FORMER smoker who
quit within the past 15 years
• Smoked at least 30 pack-years
 1 pack per day for at least 30 years
 2 packs per day for 15 years
 3 packs per day for 10 years
Source: Breathing Easy: Lung Cancer Prevention and Screening, Dr. Jessie S. Wilt, Summit Medical Group

40. Who should NOT be screened
• Younger or older than range 55-80
• Unwilling to have treatment for cancer if
detected
• Smoked less than 30 pack-years
• Other Medical problems that would
prevent surgery or treatment
• Unwilling to have repeated CT scans
• You have signs of Lung cancer
Source: Breathing Easy: Lung Cancer Prevention and Screening, Dr. Jessie S. Wilt, Summit Medical Group

41. Signs of Lung Cancer
• New cough that will not go away
• Change in chronic cough
• Coughing up blood
• Accelerated weight loss without trying
• Pain in the chest wall, ribs, spine
• These ARE NOT specific to lung cancer
Source: Breathing Easy: Lung Cancer Prevention and Screening, Dr. Jessie S. Wilt, Summit Medical Group

42. Screening Without Listed
Risk Factors
• Likely will not benefit from LDCT, test
was not designed to detect ALL forms of
lung cancer in all patients
• FALSE positive
 50% of patients have nodules, less than
2% of nodules are cancer even in high risk
 Need for more testing and EVEN invasive
testing Source: Breathing Easy: Lung Cancer Prevention and Screening, Dr. Jessie S. Wilt, Summit Medical Group

43. Non-smoking Risk Factors
• Family history of lung cancer
• Exposure to asbestos or radiation
• Second Hand smoke
• Other lung conditions such as
emphysema or pulmonary fibrosis
• Prior therapeutic radiation (for
lymphoma)
Source: Breathing Easy: Lung Cancer Prevention and Screening, Dr. Jessie S. Wilt, Summit Medical Group

44. National Lung Cancer
Screening Trial
• Screening reduced lung cancer death rate by
20%
 For every 1,000 people who DID NOT get
screened, 21 people died from lung cancer
 For every 1,000 people who DID get
screened, 18 people still died from lung
cancer
• 300 people need to be screened to save ONE
life.
Source: Breathing Easy: Lung Cancer Prevention and Screening, Dr. Jessie S. Wilt, Summit Medical Group

45. Risks of Screening: False Positive
Results
• 50% of patients WILL have a nodule
• Less than 2% of these nodules will
represent cancer
 NEED to pursue further testing (365/1000)
 Invasive procedure to make sure it is not
cancer (25/365)
 Complications of invasive procedures
(3/25)
Source: Breathing Easy: Lung Cancer Prevention and Screening, Dr. Jessie S. Wilt, Summit Medical Group

46. Prostate Cancer
Source: American Cancer Society

47. Source: American Cancer Society

48. Source: American Cancer Society

49. Source: American Cancer Society

50. Source: American Cancer Society

51. Source: American Cancer Society

52. Source: American Cancer Society

53. Source: American Cancer Society

54. Source: American Cancer Society

55. Source: American Cancer Society

56. Source: American Cancer Society

57. Source: American Cancer Society

58. Source: American Cancer Society

59. Source: American Cancer Society

60. Source: American Cancer Society

61. Source: American Cancer Society

62. Source: American Cancer Society

63. Source: American Cancer Society

64. Source: American Cancer Society

65. Source: American Cancer Society

66. Source: American Cancer Society

67. About Colorectal Cancer
• Colorectal cancer (CRC)
is a common, sometimes deadly disease
 It is the second leading cause of cancer
death in the U.S.
• 1 in 3 people who develop colorectal
cancer die from the disease
• It accounts for almost 10 percent of all
cancer deaths

68. Who gets CRC?
 Colorectal cancer is uncommon in people
at average risk who are age ≤50 years
 But by age ≥50 years, risk of the disease
increases for all people
• 90 percent of cases occur in people
age ≥50 years

69. What are risks for CRC?
• CRC arises due to a combination of genetic and
acquired (environmental) factors
• Other risk includes:
 Age
 Family history
 Ethnicity and racial background
 Geographic area
 Smoking
 Dietary and exercise habits

70. More About CRC Risk
• Risk for CRC is greater if you have:
 History of colorectal cancer or polyps
 Inflammatory bowel disease, including
• Crohn’s disease
• Ulcerative colitis
 Familial adenomatous polyposis (FAP)
 Hereditary nonpolyposis colon cancer
(HNPCC) or Lynch syndrome

71. Do you solemnly swear
to follow my advice?

72. Screening Matters!
• Having risk for CRC does not
ensure you will get the disease
• Having little risk for CRC does not
ensure you will not get the disease

73. The Good News
Colorectal cancer deaths
are declining in the United States!
•Screening is key
 Data show an estimated 53 percent of the
reduction in colorectal cancer deaths
likely result from screening and early detection
 Between 1987 and 2010, screening is likely to
have prevented the disease in nearly ≤500,000
people

74. Reducing CRC Risk
• Know your risk
• Get screened
• Eat a diet
 Low in saturated fat, cholesterol, and red meat
 High in fiber and calcium
• Don’t smoke

75. CRC Screening
• Helps your doctor find precancerous
tissues and remove them before they
become cancerous
• Helps your doctor find and remove CRC
in its early stages before it has spread

76. Prepping for Screening
• Is not as difficult as you might
think!
• It’s relatively quick
• It’s worth the trouble because
screening can save your life

77. Importance of Proper Prepping
Your doctor cannot conduct your
colonoscopy unless your colon
is completely clean!

78. Types of Screening
• Tests that are good at detecting colon
cancer at an early stage
• Tests that are good at detecting colon
polyps

79. Tests for Early Cancer
Detection
Stool- based tests
 Tests that detect blood
 Tests that detect blood and DNA
Radiologic tests
 CT colography (‘virtual colonoscopy’)

80. Tests for Polyp (and Early
Cancer) Detection
 Sigmoidoscopy
 Colonoscopy

81. Which test is best?
Colonoscopy is the gold standard
for early detection of polyps and cancer.
Allows for visualization of the entire colon,
and removal of polyps before they
become cancer

82. When to Be Screened
• At age ≥50 years and every 10 years
thereafter if you are at average risk
 If you have a adenomatous polyp,
your doctor will likely advise you
to be evaluated in less than 10 years

83. More Frequent Screening
 If you have a personal or family history
of CRC or adenomatous polyp
 If you have a genetic syndrome increasing CRC risk
• Hereditary nonpolyposis CRC (HNPCC)
• Familial adenomatous polyposis (FAP)
• One or more first-degree relatives with CRC
• Two or more second-degree relative with CRC
• IBD causing pancolitis or long-term (≥8 years)
disease

84. The Bottom Line
Know your risk,
live a healthy lifestyle,
and get screened!

85. Websites for
Additional Information
Summit Medical Group:
www.smgcolonoscopy.com
American Society for Gastrointestinal Endoscopy:
www.asge.org

86. What is Melanoma

87. What is Melanoma

88. Melanoma
• 120,000 detected each year
• 8,700 death per year

89. Melanoma Risk Factors
• Sun Exposure (Ultra Violet Radiation)
• Family history of Melanoma
• Dysplastic nevi
• More than 50 moles
• Age/Gender
• Skin type
• Occupation
• Socioeconomic Status

90. Ultraviolet Light

91. Natural Sunlight

92. Natural Sunlight
• 5 sunburns doubles your risk of melanoma
• Cumulative and intermittent sun exposure
• High altitudes increase exposure
• Reflection off sand and snow increase
exposure

93. Seek Shade

94. Sun Protective Clothing

95. • 1-2 ounce
• 30 minutes prior exposure
• Reapplied every 2 hours
• SPF 30- 50
Sunscreen

96. Does modifying sun exposure work?
 Increases use of sun protection
 Decrease sunburns
 Decrease thickness of melanoma

97. Detection
• Increase the detectors
 General Public
• Spot the Spot
• ABCDE’s
• High Risk Patient
• Improve the detectors
 Technology
• Dermoscopy
• Full Body Photography

98. Melanoma ABCDE’s

99. Asymmetry

100. Benign Mole — Symmetrical

101. Melanoma Asymmetrical

102. Border

103. Benign Mole — Even Edges

104. Melanoma — Uneven Edges

105. Benign Mole — One Shade

106. Melanoma — Two or More Shades

107. Diameter

108. Benign Mole — 6mm or Smaller

109. Melanoma — Larger than 6mm

110. Evolving

111. Melanoma — a Mole that Changes

112. Screening High Risk Patients
• New or Changing Mole ABCDE’s
• History of Melanoma
• Family history Melanoma
• Tanning salon users
• Older men
• All new patients

113. Screening
• American Cancer Society
 Every 3 years between 20-40 years
 Every year over 40 year

114. Improving the Detectors
• Dermatologist are the best at
finding melanoma

115. Summit Medical Group MD Anderson
Cancer Center in Florham Park
Photo Credit: Björg Magnea
Thank you!