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Do You Really Need That Test?

By Deepi Brar | October 5, 2016 | Rally Health

In recent years, there’s been a trend towards evidence-based medicine — looking at the body of medical evidence and deciding what works and what doesn’t. The good news is that in some cases the evidence actually points to needing fewer tests.

The United States Preventive Services Task Force is an independent panel of experts in preventive care. It looks at the evidence and makes recommendations that influence government agencies and private health plans.

Here are some of the more significant changes from the past couple of years. And for those of us who hate the whole idea of tests, be sure to check out our guide to making them easier on you.

And of course, not all experts agree with all these guidelines, and everyone’s situation is different. Always talk to your doctor and decide what’s right for you.

What you might need less often

Mammograms

Not everyone needs annual mammograms. According to the United States Preventive Services Task Force (USPSTF), women at average risk of breast cancer need a screening only every two years from ages 50 to 74.

In a 2015 update, the American Cancer Society (ACS) also recommends less-frequent mammograms. The ACS now advises once-a-year screenings between 45 and 55, and every two years after that (before it was annual tests starting at 40). Talk to your doctor about what’s best for you.

Pap tests

Likewise, routine annual Pap tests are a thing of the past for most women. According to 2012 guidelines from the USPSTF, women at average risk need this cervical cancer screening only once every three years from ages 21 to 65.

Women ages 30 to 65 can have a DNA screening test in addition to the Pap, which can let you go five years in between screenings if your doctor agrees.

Pelvic exams (maybe)

Fewer Pap tests don’t mean you can skip your wellness visit altogether — or the dreaded pelvic exam. Experts are definitely divided here. On one hand, the advisers with the USPSTF feel that most women don’t need routine pelvic exams.

On the other hand, the American College of Obstetrics and Gynecology feels that annual well-woman exams should still include a pelvic to check for problems in the uterus, ovaries, or vagina. Talk to your doctor and see how she feels about pelvic exams; perhaps you might be able to have them less often.

What you may not need

Prostate cancer screening

If your doctor is still ordering a prostate-specific antigen (PSA) test at your annual exams, you might want to talk about it. In 2012, the USPSTF recommended against routine PSA tests as a way to screen for prostate cancer.

That’s because a high PSA level doesn’t necessarily mean cancer, but does often result in treatment, sometimes with serious side effects. While PSA test rates have been going down since 2012, a recent study found that around 40 percent of men over age 60 were still getting them.

What else is new or different

Depression screening for everyone

Depression is an important health issue, and your doctor can help. In 2016 the USPSTF recommended screening all adults for depression, including pregnant and postpartum women, saying it is “among the leading causes of disability among persons 15 years and over.”

If you're feeling down, primary care physicians and other health care providers can use standard questionnaires to screen for depression. There are a wide range of therapies and medicines that can help you feel better.

Changes in diabetes screening rules

Revised USPSTF guidelines say that everyone ages 40 to 70 who’s overweight should be screened for diabetes, a condition marked by high blood sugar. (The previous guidelines were a little more complex and considered your sex, blood pressure, and other factors.)

You're considered overweight if your body mass index or BMI is over 25. You can find yours in the "profile" section of this site. There are a couple of simple blood tests to screen for high levels of glucose (a sugar) — a fasting glucose level (done on an empty stomach) or an A1C test, which can be done anytime.

New colon cancer screening methods

If you’re between 50 and 75 you probably know that you need regular colon cancer screenings. You have a growing number of options now, and they all generally involve a tradeoff between thoroughness and the length of time between screenings.

In recent years, more insurance companies have started to cover virtual colonoscopies (Medicare is a notable exception). Unlike traditional colonoscopies that use a camera to look inside your colon, a virtual colonoscopy is basically a CT scan (these scans use a series of X-rays to create sharp images).

Bottom line: check in with your doctor

These are just some of the highlights, and depending on your health and risk factors, you may need more tests or have some of them more often than most people. Ask your doctor if you have any questions or concerns.

 

Deepi Brar
Rally Health