January 28, 2014

Do You Need That Annual Physical? What Medical Tests DO You Need?

The January issue of Consumer Reports included an article, “Do you need an annual checkup?”

The answer -- echoing my mantra “less is more’ -- was probably NOT. For most people, those regular annual physicals – with blood tests, EKGs, chest X-rays, etc. -- waste time, money, and often lead to unnecessary and dangerous additional procedures.

The advice isn’t coming from patient advocacy groups, as one might expect. It’s the doctors – from the American College of Physicians, the American Medical Association, and the Society of General Internal Medicine – who are challenging the long-held practice.

Said Dr. Ateev Mehrotra, who teaches healthcare policy at Harvard Medical School, “No one is saying preventive care is unnecessary. You just don’t need the annual, one-size-fits-all physical.”

Instead, the newer trend favors a targeted approach according to one’s age, gender, and health, with a focus on what really works. Here are just two examples:
  • Pap smears: if results are normal, women can wait three years between tests. After age 65, they can usually skip the tests altogether.
  • Prostate screening: The new guidelines suggest that the benefits of standard PSA blood tests do not outweigh the risks.
The Numbers Don’t Lie
In 2013, the independent Cochrane Collaboration published its review of 14 well-designed studies that included over 182,000 people. In all those studies, some participants were given regular annual physicals; others weren’t. The research showed NO difference between the two groups in a variety of categories:
  • Number of deaths
  • Number of deaths from cancer or heart disease
  • Hospitalizations
  • Disability
  • Doctor visits
  • Time off from work
Most tellingly, the Cochrane review indicated that annual exams may in fact CREATE health problems. The group that received those regular exams had more new diagnoses -- including many that might never have caused symptoms or shortened lives – and were treated with drugs and other interventions that carried serious risks.

When symptomless patients receive additional testing as a result of annual physicals, false alarms are more likely, including improper readings of EKGs, blood and urine tests. Unfounded suspicions lead to damaging stress and inappropriate treatments like X-rays, drug therapies, and invasive procedures like angioplasty.

So, What Tests Do You Need?
The independent U.S. Preventive Task Force offers the following guidelines for healthy people. People with symptoms, chronic diseases, or risk factors should ask their doctors what other tests might be useful for them. In any case, it’s a good idea to talk with the doctor about the need for and real usefulness of any test that s/he recommends.

BLOOD PRESSURE TEST
  • How often: at least every two years. More often with readings above 120 (upper, systolic) and 80 (lower, diastolic)  [Note: New guideline for those over 60 is 150 AND 90]
CERVICAL-CANCER TEST: Pap smear and human papillomavirus (HPV) test
  • How often: Pap smear every three years. Every five years for women 30-65 if they get HPV tests with Pap smears 
CHOLESTEROL TEST: blood test for LDL (bad) and HDL (good) cholesterol, and artery-clogging triglycerides
  • Who needs it: men 35+ and women 45+ with other coronary risk factors, like high blood pressure or smoking history
  • How often: at least every five years
DIABETES TEST: test for blood glucose level
  • Who needs it: anyone with systolic (upper) pressure 135+, diastolic (lower) pressure +80, or LDL (bad) cholesterol 130+, or body mass index +30 (obese)
  • How often: every three to five years years
MAMMO0GRAM: breast X-ray
  • Who needs it: women 50-74. Women in their 40s and women 75+ should discuss usefulness of test with doctor based on their risk factors
  • How often: every two years
COLON-CANCER TEST: colonoscopy (exam of entire colon with flexible scope), sigmoidoscopy (exam of lower third of colon), or stool test
  • Who needs it: people 50-75
  • How often: colonoscopy every ten years; sigmoidoscopy every five years plus stool test every three years; or stool test every year
OSTEOPOROSIS TEST: bone density test
  • Who needs it: women 65+. Men 70+ should discuss usefulness with doctor.
  • How often: once. Results determine need for follow-up
ABDOMINAL AORTIC ANEURYSM TEST: ultrasound to detect potentially deadly ballooning of main artery carrying blood from heart to body)
  • Who needs it: men 65-75+ who smoked at some point
  • How often: just once, unless results are abnormal
What about the dentist?
Twice-a-year dental exams are probably not necessary, except for people at high risk of gum disease (they smoke, have diabetes, or are genetically prone to inflammatory disease).

Experts agree people get too many X-rays in the dentist’s chair. Guidelines suggest that full-mouth X-rays should not recur within ten years. Talk to the dentist.

OTHER RESOURCES
If you search online about the need for an annual physical, there are many sites ready to provide advice. Here are just a few:

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