ROUTINE SCREENING TESTS
One of the best says to cut medical costs is by avoiding expensive medical bills that go along with chronic or catastrophic illness. The best way to do this is by making sure that you see your physician on a regular basis and get all recommended screening tests.
A screening test is a test that has been proven in a certain population to discover a disease in an early, more treatable or curable stage that will improve health and longevity in a cost-effective way.
The disease in question should constitute a significant public health problem, meaning that it is a common condition with significant morbidity and mortality and have a readily available treatment with a potential for cure that increases with early detection.
The test for the disease must be capable of detecting a high proportion of disease before symptoms occur, be safe to administer, be reasonable in cost, lead to demonstrated improved health outcomes and be widely available.
Some diseases do not benefit from early detection, such as thyroid disorders. Other diseases have no good test to discover the disease in a preclinical state, such as ovarian cancer or pancreatic cancer. Some tests do not show an improved outcome past a certain age, like most screening colonoscopies after age 80 or PSA testing after age 70. Some tests do not detect a high proportion of disease in a preclinical state at a reasonable cost, such as colonoscopies in people under the age of 45.
The following tests have all passed muster in achieving the goals stated above. They should be performed on the general population on a regular basis as all have shown to detect illness significant to public health in a preclinical state, are widely available, lead to improved health outcomes at a reasonable cost.
High blood pressure is a common condition that can lead to serious health complications such as heart disease, stroke and kidney problems if left untreated. The American Heart Association recommends having blood pressure checked at least once every two years if blood pressure is in the normal range, with normal being defined as below 120/80.
Elevated blood pressure are readings between 120-129/below 80. People with blood pressure in this range should have their blood pressure checked at least annually and lifestyle modifications, such as cutting down on sodium, weight loss, and exercise should be recommended to prevent high blood pressure.
Stage 1 hypertension includes blood pressure readings in the range of 130-139/80-89. Lifestyle changes are also recommended in this range, and in some patients, such as people with diabetes, smokers, people with vascular diseases or mild kidney dysfunction, medications recommended. Blood pressure should be checked annually, or more frequently if on medications.
Stage 2 hypertension are readings above 140/90. Lifestyle changes and medications are recommended for this, and blood pressure should be checked by a physician twice yearly. It is also recommended that people on medication check their blood pressure at home. When on medication, it is important to know that the blood pressure is under control. Many factors could elevate the blood pressure in a doctor’s office, so it is advantageous to have many readings at home to be certain control is good and risk of heart disease, stroke and kidney problems are lowered.
Checking cholesterol levels is an important screening test to assess one’s risk of heart disease and stroke. The AHA recommends checking cholesterol levels at age 20 and every 4-6 years after that. Depending on one’s health, levels may need to be checked at more frequent intervals.
The lipid profile consists of total cholesterol which includes both the good cholesterol, or high-density lipoprotein (HDL) and the bad cholesterol or low-density lipoprotein (LDL).
HDL helps remove LDL from the blood stream. Higher levels of HDL cholesterol are associated with a lower risk of heart disease.
LDL can contribute to the formation of plaque in the arteries, narrowing them and potentially leading to cardiovascular problems like heart attack, stroke or peripheral vascular disease.
Triglycerides are a type of fat that can increase the risk of heart disease when levels are high. They also increase the risk of gallstones and pancreatitis. They are influenced by factors such as diet, physical activity and genetics.
The American Heart Association recommends the following levels for cholesterol:
Total cholesterol: below 200 mg/dl is desirable.
HDL: the higher the better. Over 60 mg/dl is considered protective against heart disease.
LDL: optimal levels depend on individual risk factors. For people at low risk, less than 100 mg/dl is desirable. For those at higher risk, including those with existing heart disease, diabetes, history of smoking, peripheral vascular disease or multiple risk factors, less than 70 mg/dl is recommended.
Triglycerides: less than 150 mg/dl are considered normal.
Diabetes screening should be done in adults aged 40-70, and if normal repeated every three years. Individuals who are overweight or have other risk factors such as a family history of diabetes, or high blood pressure, may need earlier or more frequent screenings.
Diabetes is a chronic condition that affects how your body processes blood sugar. If left unmanaged, diabetes can lead to various complications, including heart disease, kidney damage, vascular disease, nerve damage, and vision problems. Early detection through diabetes screening is crucial as it allows for timely intervention, lifestyle modifications, and appropriate medical management.
Colorectal cancer screening is recommended to start at age 45 for most adults, either through a stool test every year, a flexible sigmoidoscopy every five years, or a colonoscopy every ten years.
There are several stool tests that can be done in lieu of direct scoping. The Fecal Occult Blood Test. (FOBT) is not done as much now as in the past due to the many restrictions on diet and medications needed prior to testing. The Fecal Immunochemical Test. (FIT) is more specific for human blood and does not have as many restrictions as the FOBT. Both need to be done annually. If either of these tests are positive, a colonoscopy is recommended as follow-up.
Cologuard, a test that detects certain types of DNA in the stool, is another option. It would be done every three years. The Cologuard is more sensitive, meaning it has more positive tests than the FIT or FOBT, but is less specific, meaning more of the tests are false positives, or no disease present. Since the Cologuard is much more expensive than the FIT or FOBT, and usually leads to more colonoscopies but no higher rate of detecting colon cancer, the ACP does not highly recommend it currently. It is done every three years if normal.
CT colonography is a non-invasive test that uses X-rays and computer technology to create detailed images of the colon and rectum. It is typically performed every five years. This test, however, does require the same prep as a colonoscopy and if positive does require a colonoscopy for follow-up.
Flexible sigmoidoscopy involves the insertion of a flexible tube with a small camera into the rectum and lower colon to examine the lining for polyps or signs of cancer. Most polyps and cancers are found in the lower colon. Flexible sigmoidoscopy does not examine the upper part of the colon so it may miss some cancers. It is done every five years.
Colonoscopy is the gold standard for colon cancer prevention. It is like a flexible sigmoidoscopy except the tube is longer and examines the entire colon. If any polyps or abnormal tissues are found, they can be removed during the procedure. Colonoscopy is typically recommended every ten years if normal, more frequently depending on family history or findings on colonoscopy.
Colorectal cancer screening plays a vital role in preventing and detecting colorectal cancer at an early stage, when treatment outcomes are generally better.
Breast cancer screening aims to detect breast cancer at an early stage when it is more treatable and potentially curable. Regular screening can help identify breast abnormalities, such as lumps or tumors before they are noticeable through physical examination or cause symptoms. Women aged 40-49 should discuss the benefits and risks of mammograms with their physician. From age 50 on it is generally recommended to have a mammogram every two years.
Mammography is the primary screening tool for breast cancer. Mammograms use low-dose X-rays to create images of the breast tissue. It can detect small tumors or calcifications that may be signs of cancer. The American Cancer Society recommends that women aged 40 and older should have a mammogram every one to two years. Other organizations have differing recommendations due to the risk of false positive tests leading to possible invasive testing at earlier ages. That is why it is recommended for women aged 40-49 to discuss with their physicians their specific risks.
It is also recommended that women perform breast self-exams monthly to become familiar with the normal look and feel of their breasts. This can help women become more aware of any changes in their breasts and prompt them to seek medical attention if needed.
In cases where there is a strong family history of breast cancer or specific risk factors, genetic testing may be suggested to identify genetic mutations associated with an increased risk of breast cancer.
Cervical cancer screening is crucial for the early detection of abnormal cell changes in the cervix, which can potentially develop into cervical cancer. Regular screening can help identify these changes before they progress and allow for timely intervention and treatment.
The pap smear involves collecting cells from the cervix and examining them under a microscope to detect any precancerous or early cancer cells. The American Cancer Society recommends that individuals with a cervix should start pap smears when sexually active or at least by age 21 and continue every three years until age 29. From ages 30-65 pap smears can be done every three years, or every five years if combined with a human papilloma virus test (HPV).
HPV is a common sexually transmitted infection that can cause cervical cancer. The HPV test checks for the presence of high-risk HPV strains that are most likely to cause cervical cancer. It can be performed alone or in combination with a pap smear.
HPV vaccination is recommended for both males and females before becoming sexually active, typically around the age of 11 or 12. The HPV vaccine can protect against several high-risk HPV strains that can cause cervical and other cancers.
Prostate cancer screening aims to detect prostate cancer early, when it is most treatable. The main screening test is the PSA, a blood test that detects a protein produced by the prostate gland in the blood. The PSA mainly detects prostate tissue and is most definitely not solely associated with prostate cancer. The PSA will rise as men age and the prostate gland hypertrophies. It will also be high in inflammatory conditions or infection of the prostate. It is basically used as a proxy for prostate cancer in screening.
It is important to note that prostate cancer screening has both potential benefits and risks. While early detection can lead to timely treatment, it can also result in unnecessary treatments and procedures for slow-growing cancers or non-aggressive cancers. Elevated PSA tests can result in many normal biopsy results since the PSA rises as the prostate grows and most men develop prostate enlargement as they age.
It is important to discuss prostate cancer screening with your doctor starting at age 50, 45 for African Americans or those with a strong family history of early prostate cancer. One current method of screening is to check the PSA every two years and rather than looking at the raw number of the PSA, looking at the growth rate of the PSA over that time period. In other words, rather than looking at a PSA of 3, look at what it was last time. If it was 2.8 last check that is not a very fast rate of growth. That may mean that this is just routine enlargement of the prostate. If it was 1.5 last time, that is a doubling of the number and may be more concerning for cancer, even though it is below the previous limit of prostate cancer screening of 4. It is generally recommended, because of the usual slow growth of most prostate cancers, that if the PSA has been normal previously, screening should stop at age 70. Screening after that has been shown to result in more harm than benefit for most men.
Osteoporosis is a condition characterized by low bone mass and deterioration of bone tissue, leading to an increased risk of fractures. Screening is performed to assess the density and strength of bones, helping to identify individuals at risk of developing osteoporosis or those who may already have the condition.
The most common type of bone mineral density test is the Dexa scan which is a painless and non-invasive procedure that uses low-dose X-ray to measure bone density.
Postmenopausal women have an increased risk of osteoporosis due to the decline in estrogen levels, which play a protective role in bone health. Women aged 65 and over should be screened for osteoporosis. While osteoporosis is more prevalent in women, older men are also at risk of developing the condition, particularly if they have risk factors such as low testosterone levels or a history of fractures. Men aged 70 and over should also be screened.
Individuals with risk factors such as family history of osteoporosis, a personal history of fractures, low body weight, smoking history, excessive alcohol consumption, or chronic use of steroids may need earlier screening.
Usually, osteoporosis screening is recommended ever 2-5 years depending on the results and history of the patient.
Maintaining a healthy lifestyle that includes regular weight bearing exercise, a balanced diet rich in calcium and vitamin D and avoiding smoking and excessive alcohol consumption can help promote bone health and prevent osteoporosis.
Vision and hearing tests are important screening tools to assess the health and function of these senses. Regular screening can help detect any potential issues early on and allow for appropriate interventions or treatment. Generally, it is recommended to have a comprehensive eye exam at least every two years, or more frequently if you have specific eye conditions or concerns. The frequency of hearing tests may vary depending on factors such as age, occupational noise exposure and any existing hearing concerns. Adults should generally have a baseline hearing test in their 20s or 30s and then regular screening every 3-5 years. Hearing loss has been shown to increase the risk of mental decline in older age, so screening and treatment is especially important in this population.
The last routine maintenance recommended to stay healthy and reduce medical costs is to stay up to date on all vaccinations. Vaccinations are used to prevent illness and can help cut costs by keeping one healthy and avoid missed work. This topic was just discussed in the last section.