Fewer medical tests may be enough, national panel says

Tuesday, February 19, 2002

WASHINGTON -- It seems almost every week brings a new headline: Get diabetes tests at younger ages. Seek annual thyroid exams. Get screened for prostate cancer. Oh, and don't forget to check for kidney disease.

Specialty medical groups and patient advocates are urging more and more seemingly healthy Americans to get screened for early signs of numerous diseases. After all, spot an illness early and often you can fight it better.

But how much testing does the average symptom-free person really need?

Not all that much, is the answer from the expert panel that sets the nation's primary care standards.

Even that traditional checkup where "all of us go in and just get checked from soup to nuts" isn't needed every year for many people, says Janet Allan, co-chair of the U.S. Preventive Services Task Force.

And several often-recommended tests, such as prostate cancer screening or bone-density tests, actually are controversial because of mixed studies about their benefit. In fact, studies by the Centers for Disease Control and Prevention cite only a handful of screenings -- for breast, cervical and colorectal cancers, high blood pressure and high cholesterol -- considered most essential.

Some risks overlooked

Testing isn't always the best preventive care, adds Allan, dean of nursing at the University of Texas, San Antonio. The counseling that busy health workers often forget or bypass is crucial.

For example, most of Americans' leading diseases are related to smoking, poor diet, little exercise and risky sexual practices. Yet a recent analysis by Georgetown University's Center on an Aging Society found only about half of adults even were asked about such risk factors during their last doctor's exam.

Customizing preventive care to adjust for risks that patients can change -- and those they can't, like family history -- is overtaking the more mass appeals to screen millions for everything. That means consumers must have a regular doctor who knows their health history intimately -- a "medical home" -- to ensure they get the right tests at the right time, says Dr. Edward Hill, a Tupelo, Miss., family physician and chair-elect of the American Medical Association's board.

For the average person

But is there a checklist to ensure consumers get the most essential tests? Allan's task force is an independent panel charged by the government to come up with such a master list. It now is reevaluating the latest research for a six-month rollout of updated advice.

Here's the checklist so far for people at average risk of disease:

Cholesterol testing: every five years starting at age 35 for men and age 45 for women, to check total cholesterol and the "good" HDL type and "bad" LDL type, but not triglycerides.

Regular checks of blood pressure, whether by a doctor or more accessible spots like drugstores, and oral health.

To detect colorectal cancer, an annual fecal occult blood test for men and women starting at age 50.

For women, a Pap smear to check for cervical cancer every one to three years. Also, a mammogram every year or two starting at age 50.

Young women who have had more than one sexual partner need testing for chlamydia, a common sexually transmitted disease. There is no easy male test.

A regular hearing exam starting at age 65.

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