House Calls / Dr. Michael Schwartz
A frequent question and concern from patients is when to undergo preventative tests. It is often confusing for both the doctor and patient as these recommendations are continuously changing and evolving. There is usually a cost involved in performing these screening exams and patients want to make certain they are truly necessary.
Ultimately, the decision to perform a screening exam is based on the specific needs and medical history of each individual patient. Nevertheless, below are the current guidelines and recommendations for patients to consider.
Screening with a colonoscopy generally begins at age 50.
If you have one family member with colon cancer, then screening should begin at age 40 or 10 years earlier than the age when your family member was first diagnosed with colon cancer.
If three or more family members were diagnosed with colon cancer, then your first screening should begin at age 25.
The colonoscopy should be repeated every 10 years if the results are normal, but may be more frequent depending on the results of the test and the patient's medical history.
In patients with inflammatory bowel disease, the colonoscopy should be performed eight to 10 years after the diagnosis of this disease and then repeated every one to two years.
Mammography has shown to be most beneficial for woman over the age of 50. However, most doctors still recommend that screening begin at age 35 with a baseline exam. A repeat mammogram is then recommended at age 40 and should be repeated every one to two years.
Women over 75 should no longer be screened for breast cancer unless the benefits outweigh the risks.
High-risk patients may benefit from MRI breast screening and genetic testing.
All women over 20 should perform monthly self-breast examinations.
Women between the ages of 20 and 39 should have a breast exam by a physician every one to three years, while patients over 40 should have them yearly.
If a lesion is discovered on a self-exam, further testing should always be performed.
Smokers or former smokers (who quit within 15 years), who are between 55 and 79 and have smoked the equivalent of a pack a day for at least 30 years should undergo a yearly low dose radiation CT scan. Some medical centers are now offering this exam free of charge.
Prostate cancer testing is no longer recommended for routine screening; although this is controversial with many physicians.
It is recommended to only screen men under 40 who are at high risk. The benefits of screening have not shown that they outweigh the risks and benefits of diagnosing and treating this age group.
Although not recommended in men between the ages of 40 and 54, patients can discuss the risks/benefits of testing with their doctors and determine if screening is necessary. Men at high risk (e.g., family history of prostate cancer) may benefit from testing.
Men between 55 and 69 may benefit the most from screening. The decision to screen should still be discussed with your physician and may be repeated every one to two years.
Men over 70 should not be screened, but the decision can be made based on the health and life expectancy of the patient.
Pap smears should begin at age 21 even if a woman is not sexually active.
They are not necessary for women older than 65.
They should be repeated every three years or five years with human papilloma virus (HPV) testing.
There is no need for testing in women who have had a hysterectomy. However, your physician may still recommend testing depending on the reason for the surgery.
Abdominal aortic aneurysm
Recommended for all men who are or were former smokers and are between the ages of 65 to 75. Generally, an ultrasound is performed to evaluate the size of the aorta.
Men of all ages should perform a monthly testicular exam. If a nodule is detected, an ultrasound should be obtained.
Carotid artery disease screening is not recommended unless an abnormality is detected on physical examination.
Stress testing is not recommended for routine screening, but is still recommended for patients who may exhibit symptoms of heart disease or have multiple risk factors.
Bone density screening is recommended for woman older than 65. However, if a patient has additional risk factors, then the study may begin at age 60. The test is usually repeated every two years.
Blood pressure should be checked by your doctor at every office visit.
Cholesterol testing is recommended for men older than 35 and for women older than 45. However, testing may begin at 20 if patients have risk factors or a strong family history for heart disease or stroke.
Diabetes (blood sugar) is tested during a physical exam. However, those with elevated blood pressures, high cholesterol or a family history of diabetes should be tested on a yearly basis. Additionally, diabetics should have yearly eye exams and foot exams.
Human immunodeficiency virus (HIV)
Testing is now recommended for all adults and adolescents as a one-time blood test at their next physical examination. Additional testing may be performed based on risk factors.
Preventative screening can save lives. Guidelines are only recommendations and you should always discuss testing with your doctor. Finding things and fixing them before they break is always the best way to lead a long, healthy life.
Dr. Michael Schwartz is board certified in internal medicine with a private practice in Darien. For comments or questions, visit his website at www.drmichaelbschwartz.com.