Panel debates call for some medical tests

By Lauran Neergaard

Associated Press

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 surprising 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, said 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.

Testing isn’t always the best preventive care, said 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 a family history of disease — is slowly overtaking the more typical 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 chairman-elect of the American Medical Association’s board.

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 re-evaluating 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.

Anyone at high risk of heart disease — a smoker, a diabetic, someone whose parent died of heart disease before age 50 or who has high blood pressure — needs cholesterol testing starting at age 20, Allan cautions.

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

To detect colorectal cancer, an annual fecal occult blood test for men and women starting at age 50. Also, they need a more invasive exam — a sigmoidscopy or colonoscopy — once or twice a decade.

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. But mammography has suddenly become embroiled in debate — some scientists challenge its effectiveness while others urge earlier testing — so the panel is re-examining it.

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

A regular hearing exam starting at age 65.

What about other widely pushed tests?

Some are controversial. For instance, studies are mixed on just who benefits from prostate cancer screening since there’s no good way to tell if men have a type of tumor that needs immediate therapy or not, Allan said. For now, the task force advises men to discuss this one with their doctors.

For bone-crippling osteoporosis, doctors argue over just which bone test to use, much less who needs it when. But if the doctor is counseling women about proper weight, nutrition and exercise, "you’re already treating the problem," Hill contends.

Specialty groups urged screening for diabetes as early as age 30 plus a list of other tests to catch such ailments as thyroid or kidney disease.

Stay tuned: The task force now is debating many such tests. Meanwhile, Allan advises people to "demand of your provider more information" so you can tailor testing to your biggest disease risks.

Lauran Neergaard covers health and medicine for The Associated Press in Washington.

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.

Blood pressure, whether by a doctor or more accessible spots such as drugstores.

Colorectal cancer: An annual fecal occult blood test for men and women starting at age 50. Also, a sigmoidscopy or colonoscopy once or twice a decade.

Hearing exam: Starting at age 65.

For women: A Pap smear to check for cervical cancer every one to three years. A mammogram every year or two starting at age 50, although the panel is reconsidering its recommendation.

Young women who have had more than one sexual partner need testing for chlamydia, a common sexually transmitted disease.