Getting all the health screening tests possible sounds like a great idea. After all, frequent screening tests help detect diseases early and help you live longer, right? Not always…
Do You Need That Test?
People who are sick obviously need medical attention and appropriate tests. So do those at high risk for certain diseases. If you have a family history of melanoma, for example, I believe an annual skin check is wise. But many tests administered to millions of healthy people every year have no clear benefits. So why, then, do doctors order unnecessary tests? According to a 2014 physician survey, more than half admitted that they do it to protect themselves from malpractice lawsuits…36% said they recommend these tests “just to be safe”…and 28% said they do it because patients insist.
My advice: Before getting any medical test, ask your doctor why he/she is recommending it and what he will do with the information. Will the test reveal a problem that needs to be fixed? Is it likely that you will live longer if your doctor confirms a tiny thyroid nodule? If the answer is no, the test might be unnecessary—and needlessly risky.
Common tests you may not need…
Most people are advised to have a colonoscopy every 10 years, starting at age 50. The benefits seem obvious. Colonoscopy allows doctors to detect early-stage cancers and remove precancerous growths. Overall, the test has reduced the risk for death from colorectal cancer by about 40%.
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Exception: For those who are age 75 or older, the risks of colonoscopies usually outweigh their benefits. A Harvard study looked at data from more than 1.3 million Medicare patients between the ages of 70 and 79. The researchers found that while colonoscopy slightly reduced cancer death rates in those who were under age 75, the test made little to no difference in those who were older.
Why: Between 30% and 50% of Americans will eventually develop polyps in the colon, but the vast majority of polyps will never turn into cancer. This is particularly true in the elderly because cancers take a long time to develop. Someone who’s age 75 or older probably won’t live long enough for the polyps to become cancerous.
Routine colonoscopies are generally safe but not totally risk-free. Bleeding and perforations can occur, and in rare cases, there have been deaths as a result of complications of colonoscopy. Plus, the test is expensive, and the “bowel prep” can be very unpleasant.
My advice: Get a colonoscopy every 10 years starting at age 50 (or as directed by your doctor), but if nothing serious is ever found, you can skip the test after age 75.
Millions of Americans ask their dermatologists to perform an annual head-to-toe skin exam. The early detection and removal of melanoma skin cancers is critical. More than 80,000 cases are diagnosed annually, and almost 10,000 people will die from melanoma. But only about 1% of all skin cancers are melanomas. The vast majority of skin cancers are basal and squamous cell carcinomas, which are slow-growing and present little health risk.
The US Preventive Services Task Force (USPSTF), an independent group of national experts that makes evidence-based recommendations about tests and other medical services, concludes that the evidence is insufficient to recommend for or against annual dermatological screening for melanomas. According to the group, the downsides of screening include overdiagnosis (the detection of diseases that are unlikely to ever be a threat) and the possibility of disfigurement caused by needless biopsies. There is also the expense of procedures and visits to the dermatologist. The USPSTF consciously did not address screening for basal and squamous cell carcinomas because of their relative medical insignificance.
My advice: An annual skin screening by a dermatologist doesn’t make sense for everyone—particularly individuals who don’t have a personal or family history of melanoma or those who are not severely immune impaired, such as people who have HIV. However, do be sure to see a dermatologist if you notice a mole, growth or “spot” that meets the ABCDE criteria—Asymmetrical…Border irregularity…Color that is not uniform (often with shades of black, brown or tan)…Diameter greater than 6 mm (which is about the size of a pencil eraser)…and Evolving size, shape or color, or new symptoms such as bleeding or itching. These are the changes that are most likely to signal melanoma.
Prostate-Specific Antigen (PSA) Test
Before this blood test was developed, about 70,000 men in the US were diagnosed with prostate cancer every year. With the advent of PSA testing in the 1990s, that number has increased to about 161,000 per year, and at the same time, the number of men dying from prostate cancer has decreased slightly. Is this due to early diagnosis using PSA testing? Many experts believe that the decline in prostate cancer death is from improved treatment of advanced prostate cancer, not early detection.
The vast majority of cancers that are discovered by routine PSA tests are indolent, meaning that they grow so slowly that they’re unlikely to ever threaten a man’s health. In fact, prostate cancer is typical in aging men. By age 80, about 60% of men have cancer in the prostate gland, but most never know it and go on to die from something else. Finding these cancers early is of no value and even may cause harm.
PSA test findings can lead to treatments that are not risk-free. For example, men who have elevated PSA levels will often be advised to undergo biopsies, which carry risks, such as bleeding and infection. Others will have radiation therapy, which can cause fatigue and frequent urination…or surgery, which can cause incontinence, impotence and, in rare cases, death. Plus many men will have to live with the scary knowledge that they have cancer, even though most of the cancers pose no risk at all.
The USPSTF recommends that men ages 55 to 69 discuss the benefits and harms of screening with their doctors to make the best decision for themselves based on their values and preferences. But for men age 70 and older, the group has concluded that the risks of routine testing outweigh the likely benefit and that PSA testing should not be done.
The USPSTF does not address PSA screening in men under age 55, but the American Cancer Society recommends that men at average risk for prostate cancer discuss screening with their doctors beginning at age 50 and that men at high risk consider screening at age 45. The American Urological Association recommends that men discuss PSA screening with their doctors before age 55 if they are at high risk for prostate cancer…between the ages of 55 and 69 if they are at average risk…and at age 70 or older if they have a greater than 10-year life expectancy.
Bottom line: Men should be sure to discuss the pros and cons of PSA testing with their doctors.
Ultrasound technology has made it easier to find and evaluate growths in the thyroid gland. As a result, there has been a threefold increase in the diagnosis of thyroid cancers, but there hasn’t been any change in the thyroid cancer death rate.
A study from the Department of Veterans Affairs Medical Center and Dartmouth Geisel School of Medicine concluded that the apparent increase in thyroid cancer was mainly due to improved detection. About 87% of the cancers measured were just 2 cm or smaller and were unlikely to ever pose a threat. Yet patients were treated surgically with the risk for bleeding, vocal cord paralysis and disfigurement. They also had to deal with the psychological trauma of being told they had cancer. Radiation is also standard treatment for thyroid cancer and can cause side effects. Additionally, radiation exposure presents a cumulative lifetime risk of developing cancer.
My advice: Don’t get routinely screened for thyroid cancer. However, if you have a neck mass or lump…you notice changes in your voice…or have a family history of medullary thyroid cancer, an ultrasound of your thyroid may be advised.
Remember: At the proper age and appropriate intervals, screening tests, such as colonoscopy, mammograms and Pap smears, are necessary. Also be sure to get a cholesterol test every five years and blood pressure checks annually…and regular dental and eye exams.