Top Docs 2008 Part II: What to Know

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Colorectal Cancer Screening
Who: Adults 50–75
How often: Every 5–10 years, depending on method

• There’s more than one of these tests, but only one everybody knows: the colonoscopy. Those patients eager to sign up for next-generation virtual colonoscopies should know the least pleasant part—a vigorous scrubbing-out
of the works—is still required.

Cholesterol Screening
Who: Men 35+; women 45+
How often: Every 5 years

• Also called a lipid panel, this checks your levels of HDL (“good”), LDL (“bad”), and total cholesterol, plus triglycerides. A new type of test also measures the size and number of the individual cholesterol particles, which could be a more precise indicator of heart-disease risk.

Mammogram
Who: Women 40+
How often: Every 1–2 years

• More patients have been clamoring for digital mammograms lately, but its benefits are negligible unless you’re high-risk or have dense breast tissue. The real Next Big Thing will be digital tomosynthesis, offering 3-D imaging and no compression (a.k.a. squishing).

Pap Test

Who: Women 21–65

How often: Annually until 30; then every 3 years

• The buzz is that the HPV test (which looks for the virus that’s the number-one cause of cervical cancer) could eventually displace the 65-year-old Pap, which some call the world champion of screening tests. Until then, it’s smart to double up on protection and ask for HPV testing with your Pap.

CONSIDER IT

PSA Test
Who: Men 50–75
How often: Annually

• This shows when prostate-specific antigen (PSA) levels are elevated, a marker for prostate cancer. But prostate inflammation or enlargement also hikes PSA. To rule that out, a biopsy may be needed, and then a decision on whether the cancer is likely life-threatening. And as your doctor may have mentioned, nearly all men will die with their prostate cancer, not from it.

Blood Glucose Test
Who: Adults 45+
How often: Every 3 years

• The CDC, among others, has voiced doubts about whether early detection and treatment of diabetes in people with no symptoms actually reduce the long-term complications of this disease. Check with your caregiver, though, especially if you’re in a high-risk group (obesity, high blood pressure, family history).

Skin Cancer Screening
Who: Adults 20+
How often: Every 3 years for ages 20–39; annually after that

• The U.S. Preventive Services Task Force makes no recommendation on the merits of the total-body skin exam for early detection of melanomas and carcinomas. And if you’re giving your doctor the full monty, you kind of want to know for certain it’s worth it.

Glaucoma Test

Who: Adults 20+

How often: Depends on age

Note: Testing can detect early-stage glaucoma, a condition that damages the optic nerve and is the leading cause of blindness. There’s scant evidence that regular screening benefits most people; on the other hand, there’s scant evidence it harms them. Best for seniors, African Americans, and relatives of glaucoma sufferers.

SKIP IT

Full-Body CT Scan
Tempted by the opportunity to “check under the hood,” many people request this as a kind of be-all, end-all health screening. The problem: Not only does it pack a serious radiation punch, but there’s also no proof it detects real disease early enough for your doctor to actually do anything about it.

CA-125 Test
A blood test for certain ovarian cancer patients, the CA-125 is not meant to be a general screening test for the cancer. Yet that isn’t stopping a lot of women from demanding it, say local docs. The closest thing to what they’re looking for is a blood test called OvaSure, which debuted this summer; however, it’s not even close to winning FDA approval.

Carotid Ultrasound
A favorite offering of “scan-in-a-van” services, this checks for plaque buildup in the neck arteries to gauge stroke risk. Arterial plaque is common in older adults, however, so knowing it’s there may stress you out needlessly. And a clean scan isn’t an all-clear signal, either, since there are lots of other risk factors.

Cardiac Stress Test
According to the head of Tufts’s Pratt Diagnostic Center, Dr. Brian Cohen, this is one of the most overrequested tests out there: Though useful for people who have symptoms of heart disease or who are in a high-risk group, it’s much less so for the average patient.