Medical tests and yearly checkups: Are they necessary?

   General health check-ups have long been popular in the US, where they are often carried out yearly. By contrast, they have only recently been introduced in the UK, but to be done every five years, and this latter check-up is mainly focused on reducing the risk of heart and circulatory diseases. Doctors measure blood pressure, cholesterol levels and body mass index and give some general health advice. If any abnormalities are found, then follow-up evaluations and/or treatment should be done at the advice of the physician.

Having a regular yearly check-up for someone who is basically healthy sounds like common sense – the ultimate in preventative medicine – but this is surprisingly controversial. That’s because this is a form of screening – in other words, looking for illness in people who have no symptoms. And screening has a nasty habit of doing more harm than good, especially in the absence of evidence to prove its worth in reducing disease and mortality. The most recent trial, and one of the largest ever, looked at nearly 60,000 Danish people who were offered annual checks for five years. Five years after this period, there was no effect on heart attacks or overall death rates.

The potential downsides of screening are that it can worry people unnecessarily, offer false reassurance, or trigger unneeded tests and treatments. That has been shown for certain kinds of screening (see below).

Now routine pelvic exams for women are meeting the same skepticism. A recent study published in a leading internal medicine journal (Annals of Internal Medicine) has arrived at the conclusion that this type of examination should be dropped from routine care if it is performed on symptom-free women who are not pregnant. The study was based on a review that found no studies supporting the pelvic exam for finding ovarian cancer or any other serious disease. Exceptions to this recommendation are the periodic obtaining of so-called “PAP smears”, i.e. sampling of cells from the cervix to detect early cancer, but this test can be done every three years. Of course if any woman has any symptoms pointing toward this area, such as pelvic pain, abnormal bleeding, sexual dysfunction or other troubling complaints, more frequent examinations are usually needed.

Colonoscopy

This worthwhile procedure is capable of detecting, preventing, and curing colon cancer.  In most individuals not at high risk for such cancers, colonoscopy should begin at age 50 and repeated periodically at intervals advised by the physician performing the test. In general, repeated testing is done every five years until the age of 75. If no cancer or precancerous polyps are found initially, however, one can usually wait for 10 years for the next test. After age 75, testing usually is discontinued. For adults over 75 who have not previously been screened, decisions about first-time screening is usually made in the context of the individual’s health status and competing risks. For persons older than 85 years, competing causes of mortality preclude a mortality benefit that outweighs the harms, and, therefore this procedure is not indicated.

Mammography

For the average woman, the U.S. Preventive Services Task Force recommended (2009) mammography every two years in women between the ages of 50 and 74. The Canadian Task Force on Preventive Health Care (2012) and the European Cancer Observatory (2011) recommends mammography every 2–3 years between 50 and 69. After the age of 74, testing is optional and best done at the advice of your physician. These task force reports point out that in addition to unnecessary surgery and anxiety, the risks of more frequent mammograms include a small but significant increase in breast cancer induced by radiation. Most studies do not find an effect of mammography screening on total cancer mortality, including breast cancer, after 10 years. Thus when such information is offset by the fact that many women with “positive” mammography results will be suspected and treated unnecessarily for benign conditions and experience psychological distress including anxiety and uncertainty for years, we must conclude that universal screening is of questionable value at best.

In high risk groups, such as those with a strong family history of breast cancer, screening does make sense. In women who are otherwise healthy, screening with mammography is probably optional, but most data suggest that this is best accomplished when augmented by careful palpation of the breasts done by self examination or by a medical professional. When both examinations detect an area of increased density, then more intensive evaluation is justified and is more likely to yield a significant reduction of long-term mortality.

PSA Testing

   PSA is a blood test designed to detect early prostate cancer in men, and it too is falling under increasing scrutiny. A growing consensus suggests that it’s usually not necessary, but considerable disagreement persists. My take on this subject is that men should not routinely get this test, especially if they are younger than 50 or older than 74. If, however, you are between those ages, talk with your doctor about the risks and benefits of the test, and your risk factors, such as being African-American or having a strong family history of this disease.

Lung Cancer Tests: Only for long-term smokers

A recent study found that annual low-dose CT lung scans could cut the risk of death from cancer by 16%.in long-term heavy smokers. At present, Medicare refuses to cover the cost of this test, but they should! Thus the test should be employed in those between ages 55 and 80 who smoked a pack per day for 30 years or two packs for 15 years, provided that they currently smoke or stopped within the past 15 years.

I might conclude by offering the following general advice: One should always designate a personal physician (usually a family physician or general internist). An initial visit should be scheduled to include a physical examination, a general blood profile that includes cholesterol and other markers for cardiovascular risk and diabetes, an electrocardiogram, and a chest X-ray. This should be followed by advice about life-style issues such as exercise, diet, and others as needed. After that, follow-up examinations can be performed on an as-needed basis, depending primarily on the initial assessment. If no abnormalities are found to warrant closer follow-up, for men, a regular five-yearly interval to measure blood pressure and focus mainly reducing risk of heart and circulatory diseases would be quite sufficient. As noted above, women should be followed in a similar fashion, but need a bit more attention, at least with regard to PAP smears at three-yearly intervals, and for those over the age of 50, mammograms every two years are probably OK, but stay tuned regarding this later recommendation. Colonoscopy, lung scans, and PSA testing have been covered above.

 

Facebooklinkedinmail
linkedin

A few tips for better sleep

                                  

Getting enough good-quality sleep is essential to staying healthy and aging well. Certain sleep problems — for example, sleep apnea — require medical treatment. Lack of sleep can have serious consequences—a higher risk of type 2 diabetes, obesity, heart disease, and other health conditions. It can also raise the risk of falling, particularly among older women, and increase the likelihood of having a car accident if you drive. Insomnia might also leave you feeling anxious, depressed, or irritable. Paying attention, learning, or remembering can become difficult. So here are a few simple steps that can help you overcome insomnia:

 

Stick to a consistent sleep schedule and routine

Go to bed at the same time each night and wake up at the same time each morning. A set sleep routine will “train” you to fall asleep and wake up more easily

 

Use the bed only for sleep and sex

                                        No explanation necessary

 

                        Cut down on caffeine

For some people, a single cup of coffee in the morning means a sleepless night. Caffeine can also increase the need to urinate during the night

 

Be physically active

   Regular aerobic exercise like walking, running, or swimming provides three important sleep benefits: you fall asleep faster, attain a higher percentage of restorative deep sleep, and awaken less often during the night.

 

Limit daytime naps

Prolonged napping can disrupt your natural sleep cycle and prevent you from feeling tired enough to fall asleep

 

If you use tobacco in any form, quit.

   Nicotine makes it harder to fall asleep, although this is the lesser of all its evils

 

Use alcohol cautiously

Alcohol depresses the nervous system, so a nightcap may help some people fall asleep. But this effect disappears after a few hours and may lead to waking up throughout the night. Alcohol can also worsen snoring and other sleep breathing problems

 

Improve your sleep surroundings

Remove the television, telephone, and office equipment from the bedroom. This reinforces the idea that this room is meant for sleeping. An ideal environment is quiet, dark, and relatively cool, with a comfortable bed and minimal clutter. If you are accompanied by someone who snores loudly, use of earplugs or background steady noisemakers may be helpful, but moving to separate sleeping quarters may be required.

 

If you’re still awake after about 20 minutes in bed

Get up and read awhile to relax. Otherwise, you’ll set yourself up for tossing and turning

 

Try to avoid sleeping pills

 

If you do take a prescription sleep medicine, work with your doctor to use it effectively and for as short a time as possible. If you must take medicine, I prefer short-term generic zolpidem (Ambien), which is fairly effective and inexpensive. Another type of inexpensive medication is melatonin, a non-prescription substance normally produced in humans by the pineal gland, which is located in the center of the brain. Although not the sole regulator, it is involved in the sleep-wake cycle. Its production is inhibited by light and stimulated by darkness, which seems related to a mild ability to promote sleep.

 

Sleeping Pills Especially Dangerous to the Elderly

 

Unfortunately, between 8 and 35 percent of the population over 65 consumes such pills, often on a regular basis. The so-called benzodiazepines are the most widely used for both insomnia and anxiety. The brand names include Ativan, Ambien, Halcion, Klonopin, Lunesta, Sonata, Valium and Xanax. (Some, like Ambien and Lunesta, actually belong to a class of sister drugs but have the same effects on the brain.)  But they all present a problem — especially given older users’ changing metabolisms and the likelihood that they’re taking many other drugs. Such people taking sleeping pills are five times more likely to report poor concentration and memory, and twice as likely to have hip fractures and car accidents. They also experience more incontinence.

Despite these risks, however, many older people keep taking these drugs because they’re psychologically addicted, believing they can’t function without them. They may have unrealistic ideas about how much sleep older adults actually need — most 80-year-olds will do fine with six hours a night. Unfortunately, it’s normal for older people to wake up a couple of times a night, but they don’t like it. The best countering strategy—after the risks above are explained—is to wean them off the pills over 12 to 20 weeks, allowing the blood levels to go down slowly. In the process, there may be a few nights of trouble sleeping, so they should just plan their activities accordingly. Eventually, the body will catch up.