Cancer Screening Checklist

Age-appropriate cancer tests for men with hemophilia
Author: Sarah M. Aldridge, MS

Nobody likes to contemplate the “c” word—cancer. But the truth is, routine screenings save lives. Men in the bleeding disorders community need to be just as proactive about undergoing screenings as the next guy. And even more so if certain cancers run in your family, or if you have HIV or hepatitis C virus (HCV).

A consultation may be in order with your primary care physician (PCP) to review your individual cancer risks. “The goal of the PCP in concert with the hematologist at the hemophilia treatment center (HTC) should be to ensure age-appropriate cancer screenings in all patients, including those with congenital bleeding disorders,” says Patrick F. Fogarty, MD, director of the Penn Comprehensive Hemophilia and Thrombosis Program at the University of Pennsylvania Medical Center in Philadelphia.

The following is a list of cancer screenings for men recommended by the American Cancer Society (ACS).

Prostate cancer

The prostate gland is part of the male reproductive system. Located under the bladder and near the rectum, it provides nutrients to semen. As men age, the prostate gland grows larger.

Prostate cancer is the second most common cause of cancer in the US. One in seven men will be diagnosed with it in the US, according to the ACS. The majority of cases occur at or after age 65. The ACS encourages initial prostate screening discussions with your PCP at age 50. However, men at greater risk—African Americans and those with a close male relative who has had prostate cancer—should begin the discussion at age 40 or 45.

Two main tools help detect prostate cancer: a blood test for prostate-specific antigen (PSA) and a digital rectal examination. PSA levels may be rechecked every year or two, depending on the results. Be advised that needle biopsy, which provides high-quality tissue samples, causes blood in the urine and semen, and rectal bleeding in 70%–80% of men in the general population. According to a 2012 review Fogarty co-authored in Haemophilia, adequate factor coverage for men with hemophilia, including daily infusions until post-biopsy bleeding subsides, is suggested.

Colorectal cancer

The colon, or large intestine, is also prone to cancerous growths. The risk is increased if you eat a diet laden with red meat, are inactive and obese, smoke and drink alcohol, or have a family history.

Colonoscopy, the use of a flexible tube to view the walls of the colon, is recommended by the ACS starting at age 50. It can reveal the presence of polyps, or precancerous growths, which can be removed.

People exchange well-knowing nods when they discuss the prep work before a colonoscopy. But for a man with hemophilia, a colonoscopy may require even more. “He should advocate for himself, and communicate that he has a bleeding disorder and request that the gastroenterologist works in tandem with the professionals at the HTC to develop a hemostatic plan,” Fogarty says. If polyps are removed or biopsies taken, you may need daily factor infusions for at least 3 days, according to a 2010 review Fogarty co-authored in Haemophilia.

Skin cancers

When the skin is exposed to ultraviolet (UV) rays from the sun, cells can become damaged, causing cancerous growths. Research shows that people with HIV are prone to basal cell carcinoma, the most prevalent skin cancer, and melanoma, which develops from melanocytes (pigment-forming cells) or from moles. Basal cell carcinomas typically appear on the head and neck. The most common areas for melanomas in men are the back and chest.

To examine the skin growth, a dermatologist takes a biopsy, or cell sample. Depending on the type of biopsy performed, bleeding can be profuse for someone with a bleeding disorder. “For individuals with severe hemophilia, some kind of prophylaxis would be required,” says ­Fogarty. “Ideally, patients should treat to a level of at least 30%–50%.”

The ACS encourages skin self-examinations. If a blemish, freckle or mole changes, schedule an appointment with your dermatologist.

Non-Hodgkin lymphoma

Lymphocytes are cells in your immune system that help fight disease. But they can also develop cancers, such as non-Hodgkin lymphoma. Studies have shown that people with HIV, especially when it’s poorly controlled, have an elevated risk of developing this type of cancer. “This has been looked at in-depth,” Fogarty says. The cause may be a deregulated immune system. A high viral load is also a risk factor, he adds. People taking immunosuppressant drugs after a liver transplant, for example, are also at increased risk, says the ACS.

Tests to diagnose non-Hodgkin lymphoma include biopsies of the lymph nodes and bone marrow, both of which can trigger bleeding. Before the biopsy is performed, patients need to infuse. “Correction of the deficient factor VIII or factor IX level with clotting factor concentrate is usually required,” says Fogarty.

Liver cancer

Men with hemophilia and hepatitis C and/or hepatitis B are at higher risk for liver cancer, called hepatocellular carcinoma (HCC), especially as they age. Further, co-infection with HIV can cause a more aggressive form of HCC, even in patients on antiretroviral therapy.

“Laboratory screening for markers of HCC has been done typically annually at the comprehensive visit in the HTC, whereas serial imaging studies, such as ultrasound, are usually coordinated through a hepatologist (liver specialist),” Fogarty says. A rise in the level of alpha-­fetoprotein, a tumor marker in the blood, may indicate HCC. “Then follow-up lab testing, additional imaging and/or referral to a hepatologist may be required,” he adds.

Other cancer screenings

Other cancer screenings you may need include tests for testes and thyroid cancer. If you’re a smoker, screenings for lung and mouth cancer may be called for, according to the ACS.

Catch it early

Make this the year that you decide to stay current with cancer screenings and tests. You’ve got your own team to work with you and for you—your HTC staff and PCP. When it comes to cancer, don’t wait. Cancer is con­querable when it’s caught early.