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Medical Screenings You Can't Live Without
By Dawn Fallik, May & June 2009
Which health tests you can skip—and which can save your life
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In her 30-year career, Rosanne M. Leipzig, M.D., Ph.D., says, she's never seen patients so anxious about their health. They want to be X-rayed, scanned, and tested, even if they're feeling fine. They want to be checked for diseases they've heard about only on television or the Web. "We've become hyperaware of our health," notes Leipzig, a professor and geriatrician at Mount Sinai School of Medicine in New York City. What with 24/7 health news, relentless medical advertising, and the reality that "everybody has heard about somebody who's had something," it's becoming more difficult for doctors to calm often unfounded fears of impending illness.
RADIATION 101
How harmful are all these tests?
We're exposed all the time to natural radioactive materials just by living on earth. Here's how to put scanning tests into perspective.
X-rays
An X-ray penetrates the body but not the bones. One chest X-ray gives off the same amount of radiation as a person would receive naturally in ten days.
CT scans
These are 3-D X-rays, taken multiple times to show several layers of bone and muscle. The amount of radiation varies depending on the area scanned. A CT of the abdomen or spine, for example, equals three years of daily radiation. But a head scan equals eight months' worth.
Ultrasound
This test uses acoustic radiation, or sound waves, to show an internal body part and does not pose a radiation risk.
MRI
Magnetic resonance imaging does not use radiation. Instead, it employs magnets and a radio-frequency pulse that tracks the hydrogen atoms in the body to create an image. The downside: An MRI is very expensive and is not used for routine screenings.
Bone-density scan This test uses X-ray technology but at a very low dose—one scan is equivalent to a day of natural radiation.
Source: Radiological Society of North America
Giving patients a reassuring test or two once seemed harmless enough, says Leipzig. As a member of the U.S. Preventive Services Task Force (USPSTF), an independent panel of medical experts who review the effectiveness of screening tests, she knows many of these tests can prevent disease and save lives. Bone-density scans detect the presence of osteoporosis and can signal the need for protection against potentially life-threatening fractures. Mammograms can catch abnormalities that may point to breast cancer. Blood tests give doctors a quick heads-up about everything from bacterial infections to diabetes.
But, says Leipzig, with booming patient demand for all manner of tests—and a $100 billion diagnostic-imaging industry helping to drive that demand with CT scans, MRIs, and X-rays—physicians are walking a fine line between addressing real patient concerns and creating new problems.
Take CT scans, those three-dimensional X-rays that can "see" through bones, muscles, and organs. Doctors now order an estimated 68 million each year—triple the number in 1995. Yet a recent study in The New England Journal of Medicine found that a single stomach or spine CT scan exposes patients to a radiation dose equal to 100 regular X-rays. Such imaging, researchers say, may be responsible for up to 2 percent of cancer cases over the next 20 to 30 years. CT scans can also produce false positives: one 2004 study found that 43 percent of patients received at least one false-positive result after undergoing scans for prostate or ovarian, colorectal, and lung cancer, when no symptoms were present. And those results can lead to other, more invasive tests, such as biopsies—which can be painful and bring on infection and other problems—and risky surgeries.
The problems are leading many doctors to question which tests are beneficial and under what circumstances. And they're setting off some highly charged debates in the medical community and beyond.
"We get a lot of what we call 'incidentalomas,' abnormalities we see on the CT scan and don't know what they are," says Leipzig. "Then we're left wondering if it's something to be concerned about and whether the patient wants to go through what it takes to chase this down." In her own experience, she says, the chase is often not worth the stress, cost, and pain. It's one reason many medical experts have gone out of their way to strongly recommend against the full-body CT scan that has been so heavily marketed to consumers in recent years.
So which tests are essential? Routine screenings recommended by the USPSTF (which is supported by the Department of Health and Human Services), such as mammograms and colonoscopies, are critical to spotting emerging health problems and heading off disasters—and the potential benefits far outweigh whatever risks are involved (see "Medical Tests You Need…," below). If you're noticing something different, though—pain, fatigue, a persistent cough—additional specialized diagnostic tests may be appropriate. But if those tests involve radiation, Arl Van Moore, M.D., president of the American College of Radiology, recommends these three steps:
Want a Free Screening?
The buses are rolling! AARP and Walgreens have launched a nationwide effort to deliver free health screenings to people in more than 2,000 communities across the Lower 48 states and Puerto Rico. Nine buses will travel 240,000 miles, and participants can be screened for total cholesterol levels, blood pressure, blood glucose levels, bone density, waist circumference, and body composition/body mass index. For more information, including locations and dates, call 866-484-8687 or visit aarpwalgreens.com/tour. Also, AARP has teamed with the U.S. Preventive Services Task Force to make info about screenings—what they are for, who needs them, and when—easy to get. Visit aarp.org/womenchecklist or aarp.org/menchecklist for a screenings guide and more.
Ask the right questions
Find out why your doctor is ordering a particular test, what the risks are, and if alternative diagnostic tools are available.
Keep an X-ray history
A simple notebook listing the date, type of scan, and location of the tests will do. Also ask for a copy of the scan from the hospital or lab. That way if you see another physician who wants to scan the same region, you may be able to avoid the test by showing the prior images.
Don't double dose on tests
Even if earlier scans screened for ailments that are not now a problem, let your doctor know about them, too. Sometimes a scan will encompass several organs, although only one is the focus. If a new test is needed, the earlier scan can provide a basis of comparison.
The bottom line, says Moore, is to be prudent. "Patients shouldn't back away from having tests that can save lives," he says. "They should get the right test for the right reasons."
Dawn Fallik is a freelance writer and journalism teacher based in Philadelphia.
For black-and-white reprints of this article call 866-888-3723.
| TYPE |
WHAT IT IS
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WHEN TO GET IT
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CAUTION
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| BLOOD CHOLESTEROL |
A blood test to measure LDL (low-density lipoprotein), the "bad" cholesterol; HDL (high-density lipoprotein), the "good" cholesterol; and total cholesterol
| On a regular basis; high cholesterol is considered a red flag for heart disease and other medical issues, so talk about the test with your doctor
| None
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| BLOOD GLUCOSE |
A test for levels of blood sugar, which can reveal the risk for or presence of diabetes
| If you have high blood pressure or a family history of diabetes
| None |
| BLOOD PRESSURE |
A test that measures the force of blood flow inside arteries; high levels could signal heart disease, diabetes, or other issues | At least every 2 years if pressure is less than 120/80, and once a year if it's 120 to 139/80 to 90; more often if it's higher |
Many doctors prefer to check much more regularly, so be sure to discuss this |
| BODY MASS INDEX |
A formula that calculates your body fat—and obesity risk—using your weight and height |
No specific USPSTF recommendation, but doctors like to monitor this regularly, particularly for overweight patients | Doesn't take into account frame size or muscularity, so athletic types may show up as overweight |
| BONE DENSITY |
An X-ray that measures calcium and other minerals in the bone to check for the risk of osteoporosis
| Starting at age 65, or at 60 if you have risk factors, such as low body weight or a family history of osteoporosis
| Some doctors recommend a baseline test at menopause, or before for those with risk factors
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| COLONOSCOPY |
An exam that uses a camera to check for cancer, polyps, ulcers, and other abnormalities in the colon and rectum | Starting at age 50, and every 10 years afterward—more often if you have risk factors—until age 75 | A small risk of perforation of the colon lining increases with age |
| MAMMOGRAPHY |
A low-radiation scan of breast tissue in women to check for abnormalities
| Every 1 to 2 years, starting at age 40
| Some doctors recommend CT scans or MRIs, but only for women with very dense breast tissue or implants
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| PAP SMEAR |
A test to detect changes in the cells of the cervix that indicate cervical cancer | At least every 3 years, but if you've had 3 consecutive normal tests within the past 10 years, you can stop at age 65 | Make sure you get your doctor's approval before stopping this test |
Recommendations from the U.S. Preventive Services Task Force (USPSTF).
| TYPE |
WHAT IT IS
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THE DEBATE
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THE BOTTOM LINE
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| FULL-BODY CT SCAN |
Computerized X-rays that produce multiple 3-D images of a person's torso
| Medical clinics have long promoted this scan as a way to give patients an early warning about all kinds of diseases. But most medical experts strongly advise against its use when no symptoms are present. It's expensive, uses extremely high amounts of radiation, and often renders false positives or reveals harmless abnormalities
| Like other specialized CT scans (such as for lung or pancreatic cancer), this is a diagnostic tool, say doctors, that should be used to help explain symptoms—not fish for medical problems that may not exist
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| PSA |
A blood test to check for prostate-specific antigen (PSA), a protein made by the prostate. Elevated levels could indicate cancer
| Evidence for or against the need for routine testing for men 50 through 74 is inconclusive. Some groups, such as African American men, have higher rates of the disease; physicians often recommend yearly screenings for them and many other patients
| Consult your doctor, especially if you have symptoms, such as painful urination or blood in the urine |
| VIRTUAL COLONOSCOPY |
A CT scan, called a CT colonography, to check for colorectal cancer, polyps, and other abnormalities in the colon and rectum | A noted study recently found this scan to be as accurate as a regular colonoscopy, and less invasive. But other research found it produces more false-positive results, which may lead to unnecessary biopsies and testing. The USPSTF is neutral on the issue |
If the CT colonography shows an abnormality, you still will need a regular colonoscopy to remove it, so speak with your physician about which test is best for you |
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