How to determine what medical screening is necessary
There has been a lot of news about medical tests lately. Physicians are coming out against unnecessary testing and screenings to save patients time, money and health risks.
As a senior, how do you know which tests or screenings you should have done, and which you can skip?
Choosing Wisely is a coalition of medical associations that was created by the American Board of Internal Medicine Foundation to answer those questions. Participating medical societies were asked to identify five tests or treatments that are commonly overused in their specialty. This year, 90 new tests and procedures were added to the lists. Anyone can view the lists at ChoosingWisely.org.
Paul Mulhausen, clinical professor of medicine at the University of Iowa and a geriatrician, is a spokesman for Choosing Wisely. He specializes in care of the frail elderly, and also is an internist.
He says the following tests are the most common ones seniors ask about — and also are commonly over prescribed.
One of the most commonly over prescribed tests today is the colonoscopy. In fact, close to one-quarter of colonoscopies performed on older adults in the U.S. may be uncalled for, a new study from the University of Texas suggests.
The American Gastroenterological Association says a screening colonoscopy every 10 years is the recommended interval for adults without increased risk for colorectal cancer, beginning at age 50. Even if a previous colonoscopy has found polyps, it may not need to be repeated for five years.
A colonoscopy is an invasive test, requires sedation, and may be harmful to an elderly person, Mulhausen explains.
PAP test (for cervical cancer)
Most women older than 65 no longer need a PAP test, Mulhausen says. Women who have had adequate prior screening and are not otherwise at high risk for cervical cancer can stop. Women who have had a total hysterectomy (cervix and uterus removed) for a noncancerous condition do not need the test.
The same "less is better" thinking goes for mammograms. New government guidelines from the U.S. Preventive Services Task Force state that routine screening of average-risk women should begin at age 50, instead of age 40, and routine screening should end at age 74. Women should get screening mammograms every two years instead of every year, as was recommended in the past.
If a woman has had breast cancer, or if it runs in her family, then her doctor might request she get mammograms more often."However, if a woman never had health insurance, and has never had these tests (PAP test and mammogram), and becomes eligible for Medicare at age 65, she might want to have them," Mulhausen says.
Prostate cancer screening (PSA test)
This is a controversial test because an elevated PSA (prostate-specific antigen, a protein made in the prostate gland) does not always signify cancer, and false positives are common, medical research shows.
"There is evidence to support that it does and doesn't work well," Mulhausen says. "There is evidence that treatments cause a lot of side effects."
According to the American Society of Clinical Oncology, PSA testing may save lives but is associated with harms, including complications, from unnecessary biopsy, surgery, or radiation treatment.
The society's website states that in men with a life expectancy of less than 10 years, it is recommended that general screening for prostate cancer with total PSA be discouraged, because harms seem to outweigh potential benefits.In men with a life expectancy greater than 10 years, it is recommended that physicians discuss with their patients whether PSA testing for prostate cancer screening is appropriate for them.
Bone density tests (for osteoporosis)
Bone density testing does not need to be done before 65 in women or 70 in men, if they are not at high risk, Mulhausen says.
"Many people in the medical community viewed osteoporosis as a woman's disease, but with the large population of aging men, it has become a substantial illness in the late life of men, though most men do not view themselves at risk for this. They are surprised when at the age of 70 I ask them to get one," he says.
The primary test is called DEXA (dual X-ray absorptiometry) which is a type of X-ray.
Alzheimer's disease (a type of dementia) is not a simple diagnosis because there is not an X-ray or blood test you can do, Mulhausen says. MRIs and CT scans don't show it, though they may be part of the work-up to make sure the person does not have something else causing symptoms. The traditional way to test is through neuropsychology testing done with questionnaires, Mulhausen says.
"It's called the mini-cog. It is a nice way to address the concerns of a person who says they are losing their memory," he adds. "Tests for Alzheimer's disease are in the research stages."
The Alzheimer's Association unequivocally states that there is no single test that proves a person has the disease.Mulhausen recommends patients who complain of memory loss should have their thyroid and vitamin B12 levels tested first.
Vision is one of those areas that should be tested annually regardless of age, Mulhausen says. "There are a lot of vision changes as people get older, and poor vision predisposes them to falls," he says. Their eye pressure should be checked for glaucoma, and, he adds that many eye problems such as cataracts are treatable.
If people are having hearing loss that is impacting their ability to communicate, they should have it tested, Mulhausen says. Left untreated, hearing loss can lead to isolation in seniors.
"In the last 10 to 15 years technology has improved substantially. Their loss could be worse in the future, so they could benefit now. "
Originally published in the Chicago Tribune Prime Time Senior Living section on April 8, 2013.