I just had my annual physical examination. I am without any symptoms; take a baby aspirin and a vitamin; have no co morbid conditions. I asked myself did I really need a chest x-ray when I am exposed to so much radiation during my work at the hospital or did I need an EKG with no symptoms and a negative family history? I found my answer in a recent AARP article about “10 Tests To Avoid”.
1. Nuclear stress tests, and other imaging tests, after heart procedures
If you have had heart bypass, stent or other heart procedure, you don’t need nuclear stress test or other tests that their hearts are beating strong and the results rarely change the plan of management. Instead, patients and doctors should focus on what does make a difference in keeping the heart healthy: managing weight, quitting smoking, controlling blood pressure and increasing exercise.
2. Yearly electrocardiogram or exercise stress test
Someone at low risk for heart disease could be 10 times more likely to get a false-positive result than to find a true problem with their heart. The stress test could lead to unnecessary heart catheterization and stents. Instead, it is important to have your blood pressure and cholesterol checked at least once a year. And if you’re at risk for diabetes, have your blood glucose level checked as well.
3. PSA to screen for prostate cancer
Cancer is always scary, but the PSA test often finds slow-growing cancers that won’t kill men. An estimated 75 percent of tests that show high PSA levels turn out to be false alarms.
The American Urological Association, of which I am a member, supports the use of PSA testing, but should be considered mainly for men ages 55 to 69. I also believe that no testing is required in the man without any symptoms if the man is more than 75 years of age. However, men with a positive family history of prostate cancer and African American men should have an annual PSA test and a digital rectal examination.
4. PET scan to diagnose Alzheimer’s disease
In the last few years, doctors have begun using PET scans with a radioactive dye to look for beta-amyloid protein that is found in the brains of people with the Alzheimer’s disease. Even if a PET scan could accurately diagnose the disease, it’s untreatable. If you’re concerned about your memory, the better course is to have a complete medical evaluation by a doctor who specializes in diagnosing and treating dementia.
5. X-ray, CT scan or MRI for lower back pain
Back pain is incredibly common — 80 percent of people will suffer from back pain some time in their lives. It can be both excruciating and debilitating. Naturally, people want to know what’s wrong. Here’s the catch: The best imaging machines in the world often can’t tell them. Many older people with no back pain can have terrible-looking scans.
Most back pain goes away in about a month and imaging tests tend to lead to expensive procedures that often don’t help or shorten recovery. If you don’t feel better in a month, talk to your doctor about other options such as physical therapy, yoga or massage. But if your legs feel weak or numb, you have a history of cancer or you have had a recent infection, see your doctor.
6. Yearly Pap tests
The yearly Pap smear is a common part of women’s health checklists, but it doesn’t need to be. Women at average risk only need them every three years, since cervical cancer generally takes 10 to 20 years to develop. If women have also had negative tests for the human papillomavirus (HPV), which is now known to cause the cancer, they only need a Pap test along with the HPV test every five years. And women older than 65 who have had several normal Pap tests in a row can stop having them altogether. Also, if you have had a total hysterectomy for a benign condition such as uterine fibroids and the entire uterus and cervix have been removed, you do not need any further Pap test. Do note, however, that a yearly visit to an ob-gyn stays on the to-do list.
7. Bone density scan for women before age 65 and men before age 70
For the estimated 10 million people — mainly women —in the United States who have osteoporosis, bone-strengthening medications can lower the chances of breaking a bone. But many experts argue that for those ages 50 to 65 who have osteopenia — mild bone loss — testing and subsequent drug prescriptions may be a waste of time and money. Not only is the risk of fracture often quite low, medications such as Fosamax (alendronate) and Boniva (ibandronate) have been linked to throat or chest pain, difficulty swallowing, heartburn, muscle pain, bone loss in the jaw and thigh-bone fractures. And there’s scant evidence that people with osteopenia get much benefit from the drugs.
To help keep your bones strong, try walking and weight-bearing exercises,. Get enough calcium, 1000mg\day, and vitamin D, 1000IU\day, in your diet. If you smoke, quit.
8. Follow-up ultrasounds for small ovarian cysts
Many women receive repeated ultrasounds to verify that ovarian cysts have not become cancerous, but current research says that these tests aren’t necessary. For one thing, premenopausal women have harmless ovarian cysts regularly. For another, about 20 percent of postmenopausal women also develop harmless cysts.
The likelihood of these small simple cysts ever becoming cancer is exceedingly low.
9. Colonoscopy after age 75
Most people should have screening for colon cancer at 50 and then every five to 10 years after that, if the first test is normal. By age 75 — if you’ve always had normal colonoscopies — you can stop taking this test altogether. That should be good news, because a colonoscopy can cause serious complications in older people.
To protect your colon, eat plenty of fruits, vegetables and whole grains for fiber. Cut down on fatty foods, red meat and processed meats. Lose weight if you’re overweight and exercise. Sound familiar? It should, because that’s the best advice for protecting the rest of your body — and mind — as well.
10. Yearly physical
There’s little evidence that having an annual checkup can keep you healthy. Now I they tell me! Many tests that doctors regularly perform — to diagnose anemia, liver disease or urinary tract infections, for example — don’t make sense unless there’s a reason to suspect a problem.
Certainly, if you have an illness that needs treatment, you should see your physician. And do talk to your doctor about how often you need to have your blood pressure and cholesterol tested.
Bottom Line: Use good judgment about your health and your visit to the doctor. Ask the doctor if the test is really necessary and if the results will change how he\she is taking care of you. My message is that patients, including myself, need to become involved in their healthcare.
This article was inspired and modified from AARP, 10 Test to Avoid, by Elizabeth Agnvall, http://www.aarp.org/health/conditions-treatments/info-2014/choosing-wisely-medical-tests-to-avoid.3.html
Dr. Neil Baum's Urology Blog 