Screening Tests You Should or Shouldn't Consider
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
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).
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.
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.
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.
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.
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.
8. Screening for breast cancer
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.
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
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.
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(c) 2010 Environmental Nutrition Newsletter