Necessity vs. Sufficiency: Deciphering the Medical Screenings That Can Save Your Life

In the words of Ralph Waldo Emerson, “the first wealth is health.”

While maintaining ones good condition is of crucial importance, these days experts are asking whether we’ve become “hyperaware” of our health and well being, subjecting ourselves to needless testing, invasive procedures and costly X-rays.

In the Internet age when access to round-the-clock healthcare coverage is broadcast seemingly nonstop, medical advertisers are on every channel and the masses are sure to know someone who’s had something, it is becoming more and more challenging for doctors to ease the public’s often unfounded fears about illnesses considered imminent. While many of these tests can prevent disease and save lives, the increased patient demand for all-inclusive testing has doctors treading a thin line: are they addressing legitimate concerns or creating new problems needlessly?

A recent study in the New England Journal of Medicine found that medical practitioners now order about 68 million CT scans each year, triple the number ordered in 1995. The downside? A single CT scan exposes patients to 100 times the radiation dose of a regular X-ray and could possibly be the cause of two percent of cancer cases that will be reported over the next 20 to 30 years. False positives, in similar tests can lead to the unnecessary ordering of more invasive tests, which can be painful and even result in infection and other problems down the line.

The U.S. Preventative Services Task Force (USPSTF) released recommendations for deciphering which tests you need and which you can live without in this month’s AARP Magazine.

Those you need:

- Abdominal ultrasound
o What it is: Ultrasonic waves that can reveal a potentially fatal aortic aneurysm in the main blood vessel of the abdomen.
o When to get it: It’s a one-time screening if you are a man between 65 and 75 and have ever been a smoker.

- Blood cholesterol
o What it is: A blood test to measure LDL (low-density lipoprotein), the “good” cholesterol; HDL (high-density lipoprotein), the “bad” cholesterol and total cholesterol.
o When to get it: On a regular basis; high cholesterol it considered a red flag for heart disease and other medical issues, so results should be discussed with your doctor.

- Blood glucose
o What it is: A test for levels of blood sugar which can reveal the risk for or presence of diabetes.
o When to get it: If you have high blood pressure or a family history of diabetes.

- Blood pressure
o What it is: A test that measures the force of blood flow inside arteries; high levels could signal heart disease, diabetes or other issues.
o When to get it: At least every two years if pressure is less than 120/80 and once a year if it is 120 to 139/80 to 90; more often if it is higher.

- Bone density
o What it is: An X-ray that measures calcium and other minerals in the bone to check for the risk of osteoporosis.
o When to get it: Starting at age 65 or at 60 if you have risks factors, such as low body weight or a family history of osteoporosis.

- Colonoscopy
o What it is: An exam that uses a camera to check for cancer, polyps, ulcers and other abnormalities in the colon and rectum.
o When to get it: Starting at age 50 and every 10 years afterward – more often if you have risk factors – until age 75.

- Mammography
o What it is: A low-radiation scan of breast tissue in women to check for abnormalities.
o When to get it: Every one to two years starting at age 40.

- Pap smear
o What it is: A test to detect changes in the cells of the cervix that indicate cervical cancer.
o When to get it: At least every three years, but if you’ve had three consecutive normal tests within the past 10 years, you can stop at age 65.

Tests you might not really need:

- Full-body CT scan
o What it is: Computerized X-rays that produce multiple 3D images of a person’s torso.
o The debate: According to the USPSTF and AARP, medical clinics have promoted the scan as a way to pin-point early warnings of diseases. However; most medical experts advise against it when no symptoms are present. It’s expensive, uses high amounts of radiation and often renders false positives or reveals harmless abnormalities.

- Prostate-specific antigen (PSA)
o What it is: A blood test to check for PSA, a protein made by the prostate. Elevated levels could detect cancer.
o The debate: 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 other patients.

- Virtual colonoscopy
o What it is: A CT scan, called CT colonoscopy, to check for colorectal cancer. Polyps and other abnormalities in the colon and rectum.
o The debate: A noted study found this scan to be as accurate as a regular colonoscopy and less invasive. Other research found that it produces more false-positives, leading to unnecessary biopsies and testing. The USPSTF is neutral on the issue.

So keep your feelers out and your eyes open for anything abnormal such as pain, fatigue, or a persistent cough, and just take an extra moment with your doctor to consider whether you are getting the right test for the right reasons. Additionally, ask the right questions, avoiding double doses of tests and try to keep a detailed X-ray history.

For more information visit aarp.org/womenchecklist and/or aarp.org/menchecklist.