Screening Tests You Should or Shouldn't Consider

Katherine Hobson

Getting your blood drawn to measure the good and bad cholesterol, having a blood pressure cuff wrapped around your arm to check for hypertension--these are examples of medical screening tests that have become a familiar part of a routine checkup or physical. But which screening tests make sense for different individuals, and at what age they should be performed, are issues for debate.

Here's a quick guide to some of the common tests, to help you decide which are appropriate for you and your family:

1. Screening for high cholesterol

The U.S. Preventive Services Task Force recommends a blood test to measure "bad," "good," and total cholesterol (it says every five years is a reasonable interval) for all men 35 and older and for men 20 to 35 who are at increased risk of heart disease. Women 20 and older at higher risk of heart disease should also be screened. But the USPSTF makes no recommendation for or against screening men 20 to 35 or women 20 and over who aren't at higher risk of heart disease, saying there's not enough information on the net benefit.

The American Heart Association recommends screening all adults over age 20 every five years.

2. Screening for high blood pressure

The USPSTF recommends hypertension screening for adults 18 and older using the standard blood pressure test. The agency doesn't suggest a specific interval (though other reports recommend two years for people with low blood pressure and annually for those with high blood pressure). The American College of Physicians and other bodies also endorse routine blood pressure checks.

3. Screening for heart disease

In adults at low risk of heart disease, the USPSTF advises against using ECG, an exercise stress test, or a coronary calcium CT scan as routine screening to predict heart disease or identify severely narrowed arteries. For people at higher risk, it says there isn't enough information to assess the usefulness of such technologies in screening. Finally, it says there's not enough information to use newer risk factors, including levels of C-reactive protein and carotid artery thickness, to better predict heart problems in men and women without symptoms and with no history of the disease.

The American Heart Association doesn't recommend ECG as a general screening tool and says CT calcium scores should be used only for people at an intermediate risk of the disease.

4. Screening for diabetes

The USPSTF recommends type 2 diabetes screening for asymptomatic adults (with blood tests that measure levels of blood glucose) only if they have blood pressure greater than 135/80. There's not enough evidence to weigh the benefits and harm (perhaps labeling a broad swath of the American public as "abnormal," for instance) of screening people with blood pressure lower than that, the group says.

The American Diabetes Association recommends screening adults over 45. Depending of BMI and other risk factors, some younger adults should be screened, the ADA says.

5. Screening for skin cancer

The USPSTF says that there isn't enough evidence to know if the benefits of whole-body skin exams for skin cancer--either by a physician or the patient herself--outweigh the harms, including diagnosing and treating lesions that never would have threatened health.

The American Cancer Society doesn't give detailed recommendations; it says that a periodic health exam for adults over 20 might include an exam to look for skin cancer, depending on age and gender.

The American Academy of Dermatology and the Skin Cancer Foundation offer free skin cancer screening.

6. Screening for colorectal cancer

The USPSTF recommends screening for colorectal cancer, using fecal occult blood testing and sigmoidoscopy or colonoscopy, for adults ages 50 to 75. How often depends on the test used; a person at average risk is advised to get a colonoscopy every 10 years, for instance. It says most adults older than that don't need to be screened and that adults older than 85 shouldn't be screened. There's not enough evidence, says the USPSTF, to assess the benefits and harms of CT colonography ("virtual" colonoscopy) or fecal DNA testing.

The American Cancer Society recommends that adults 50 and up who are at average risk of the disease be screened, preferably using tests such as flexible sigmoidoscopy, colonoscopy, barium enema, or virtual colonoscopy. Again, frequency depends on the test.

7. Screening for prostate cancer

The USPSTF says there isn't enough information to know if the benefits of screening men younger than 75 for prostate cancer outweigh the potential harms, which can include invasive tests and treatment of cancers that would never have become deadly. And it recommends against screening men 75 and older, saying there's little evidence of benefit.

The American Cancer Society doesn't endorse routine use of the PSA test or digital rectal exam either; it says doctors should offer screening to average-risk men 50 and older and discuss the pros and cons of the tests. (Men at higher-than-average risk, including African-Americans, should have this conversation earlier, the ACS says.)

8. Screening for breast cancer

As of Nov. 17, 2009, the USPSTF recommends that mammography not be routine for women in their 40s; instead, it says, women should discuss the risks and benefits of the test with their physician. It says women between 50 and 74 should have a mammogram every two years. More information is needed before any recommendation can be made for women over 74, the USPSTF says.

The task force also says breast self-exam shouldn't be taught, since it hasn't been shown to work, and says there isn't enough information to know if clinical breast exams add any benefit to mammography or if newer imaging methods, such as digital mammography or MRI, are any better than traditional mammography.

Meantime, the American Cancer Society stands by its recommendations of annual mammograms for healthy women 40 and older. Depending on their risk level, women at higher risk should consider also getting an MRI, the society says. The ACS also says that a clinical breast exam should be part of a woman's periodic health exams and that women should be familiar with their own breasts.

9. Screening for cervical cancer

The USPSTF strongly recommends cervical cancer screening using the Pap smear at least every three years in women who've been sexually active and have a cervix. It recommends against routinely screening women older than 65 who aren't at high risk of cervical cancer and have had recent normal Pap smears and also for women who've had a total hysterectomy for noncancer reasons.

The task force says there isn't enough information to weigh the pros and cons of using new screening technologies or the HPV test to screen for cervical cancer.

The ACS also recommends screening starting at age 21 or within three years of becoming sexually active. At age 30, women who've had three normal Pap smears in a row can begin being screened every couple of years, the organization says. It also says it's OK for women to get screened less frequently but to add the HPV test into the mix.

10. Screening for Alzheimer's disease

The USPSTF says there's not enough evidence to recommend for or against routine screening for dementia in older adults using "memory tests." The Alzheimer's Foundation of America sponsors memory screenings, but the Alzheimer's Association emphasizes going to the doctor at the first sign of symptoms.

11. Screening for abdominal aortic aneurysm

The USPSTF recommends a one-time ultrasound screening for men 65 to 75 who are current and former smokers. It makes no recommendation for or against testing men in that age bracket who have never smoked, and it recommends against screening in women. The Society for Vascular Surgery says adults older than 55 who have cardiovascular risk factors may benefit from screening.

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Health - Screening Tests You Should or Shouldn't Consider