Rx to Wellness

10 Medical Tests to Avoid




According to the March 2014 AARP

Bulletin, doctors are warning that some of the medical tests routinely

taken by Americans do more harm than good, waste billions of health care

dollars annually and could endanger your health or even your life.  Some

of the tests that are overused by prestigious panels of doctors include annual

Pap smears, regular PSA tests, regular EKG’s, and even routine yearly

physicals.  Doctors are saying that the overuse of such tests can lead to

dangerous side effects, pain, radiation exposure, unnecessary surgery, even


The American Board of Internal

Medicine Foundation asked more than 50 medical societies—of family

doctors, oncologists, cardiologists, and other specialists—to identify tests

and treatments that are often unnecessary.  AARP is a consumer partner

with this campaign, called Choosing Wisely.



Wisely partner is John Santa, M.D., medical director at


Reports, and he says that these screening tests often yield false-positive

results that lead to a spiral of unneeded invasive procedures, medications and

even surgeries.  If you have symptoms or certain risk factors, these tests

can be valuable—even life-saving—but they’re performed on far too many people.


stress tests, and other imaging tests, after heart procedures:

Many people who have had a heart bypass, stent or other

heart procedures want to be reassured that their hearts are functioning

properly, which is understandable because they feel as if they’ve had a brush

with death.  A common way to reassure their patients is for doctors to

perform tests like a nuclear stress test or other tests, to make sure their

hearts are beating strongly.  But according to William Zoghni, M.D.,

performing these tests every year or even every two years in patients without

symptoms rarely results in any change in treatment.  “More testing is not

necessarily better,” he says.

In fact, it can lead to unnecessary invasive procedures

and excessive radiation exposures without helping the patient improve.

Instead, patients and doctors should focus on what does make a difference in

keeping the heart healthy: managing weight, quitting smoking, controlling blood

pressure and increasing exercise.

Yearly electrocardiogram

or exercise stress test

A survey of nearly 1,200 people ages 40 to 60 who have

never had heart diseases or any symptoms found that 39% had an EKG over the

previous five years, and 12% said they had an exercise stress test.  The

problem with this is that someone at low risk for heart disease could be 10 times

more likely to get a false-positive result than to find a real problem, says

John Santa of Consumer Reports, which conducted the 2010 survey.  This

could lead to unnecessary heart catheterization and stents.  Instead, have

your blood pressure and cholesterol checked.  If you’re at risk for

diabetes, have your blood glucose level checked, as well.

PSA to

screen for prostate cancer

Cancer is always scary, but the PSA test often finds

slow-growing cancers that won’t kill men.  “The evidence is extremely

convincing that in a man with usual risk and no symptoms, the PSA test causes

more harm than benefit,” says Reid Blackwelder, M.D., president of the American Academy of Family Physicians (AAFP).

He also says that as a result of the test, men often have ultrasounds, repeat

lab tests and even biopsies for a problem that isn’t there—an estimated 75% of

tests that show high PSA levels turn out to be false alarms.  When men do

have treatments like surgery or radiation, 20-40% end up with impotence,

incontinence or


Not all doctors agree with AAFP’s recommendation against

routine PSA screening, but many agree that the test is overused.  Even the


Urological Association, which supports the use of PSA testing, says

that it should be considered mainly for men age 55 to 69.  TheAmerican Society of Clinical Oncology recommends against PSA testing

for prostate cancer screening in men with no symptoms when they are expected to

live less than 10 years.  A recent study published in the journal Cancer

found that Medicare spent almost $450 million a year on PSA screenings,

one-third of which was for men over the age of 75.

PET scan to

diagnose Alzheimer’s disease

Until recently, the only way to accurately diagnose

Alzheimer’s was during an autopsy.  In the last few years, doctors have

begun using PET scans with a radioactive dye to look for beta-amyloid protein that

is found in the brains of people with the disease.  Although this test has

promising use for research, there are serious questions about whether it should

be used on those who complain of fuzzy memory.  PET scans in older people

consistently find the protein in 30 to 40% of people whose memories are just


Although beta-amyloid plaques are present in all of

those who have Alzheimer’s, it’s not known if or when everyone with the plaques

will develop the disease, says Peter Herscovitch, M.D., president-elect of the Society of Nuclear Medicine and Molecular Imaging.

What’s more, even if a PET scan could accurately diagnose the disease,

it’s untreatable.  If you’re concerned about your memory, the better

course would be a complete medical evaluation by a doctor who specializes in

diagnosing and treating dementia.  Many other medical conditions, like

stokes, thyroid deficiencies and vitamin deficiencies can cause the same

symptoms, and these are treatable.

X-ray, CT scan or

MRI for

lower back pain

Unfortunately, back pain is incredibly common—80% of

people will suffer from back pain at some point in their lives.  It can be

both excruciating and debilitating.  Of course, people want to know what’s

wrong with them.  Here’s the catch:  The best imaging machines in the

world often can’t tell them what’s wrong.  Many older people with no back

pain can have terrible-looking scans.

Most back pain goes away in about a month and imaging

tests tend to lead to expensive procedures that often don’t help

recovery.  One study found that people who got an MRI during the first

month of their back pain were 8 times more likely to have surgery than those

who didn’t have an MRI—but they didn’t get relief any faster.  If you

don’t feel better in a month, talk to your doctor about other options like

physical therapy, yoga or massage.  But if you’re experiencing numbness or

weakness in your legs, you have a history of cancer or you have had a recent

infection, see your doctor as soon as you can.

Yearly Pap tests

The yearly Pap smear is

a common part of women’s health checklists, but it doesn’t need to be.

Women at average risk only need them every three years, since cervical cancer

generally takes 10 to 20 years to develop.  If women have also had

negative tests for the human papillomavirus (HPV),

which is now known to cause the cancer, they only need a Pap test along with

the HPV test every five years.  And women older than 65 who have had

several normal Pap tests in a row can stop having them altogether.  Do

note, however, that a yearly visit to an ob-gyn stays on the to-do list.

Bone density scan for women before age 65 and men before

age 70

For the estimated 10 million people—mainly women—in the U.S.

who have osteoporosis,

bone-strengthening medications can lower the chances of breaking a bone.

But many experts argue that for those age 50 to 65 who have osteopenia—mild

bone loss—testing and aubsequent drug prescriptions may be a waste of time and

money.  Not only is the risk of fracture often low, medications like Fosamax (alendronate) and Boniva (ibandronate) have been linked to

throat or chest pain, difficulty swallowing, heartburn, muscle pain, bone loss

in the jaw and thigh-bone fractures.  And there’s scant evidence that

people with osteopenia get much benefit from the drugs.

To help keep your bones strong, try walking and

weight-bearing exercises, says Blackwelder.  Get enough calcium and

vitamin D in your diet.  If you smoke, quit.

Follow-up ultrasounds for small



Many women receive repeated ultrasounds to verify that

ovarian cysts have not become cancerous, but current research says that these

tests are not necessary.  For one thing, premenopausal women have harmless

ovarian cysts regularly.  For another, about 20% of postmenopausal women

also develop harmless cysts.

“The likelihood of these small simple cysts ever

becoming cancer is exceedingly low,” says Deborah Levine, M.D., chair of the

American College of

Radiology Commission on Ultrasound and a professor of radiology at Harvard Medical School.

In postmenopausal women, only cysts larger than 1

centimeter in diameter need a follow-up ultrasound.  For premenopausal

women, who typically have benign cysts every monthly when they ovulate, cysts

smaller than 3 centimeters aren’t even worth mentioning in the radiologist’s

report, Levine says.

Colonoscopy after age 75

Most people should have screening for colon cancer at

age 50 and then every 5 to 10 years after that, if the first test is

normal.  By age 75—if you’ve always had normal colonoscopies—you can stop

taking this test altogether.  That should be good news, because a colonoscopy can

cause serious complications in older people.

“Just the preparation for colonoscopy can be

exceptionally harsh,” says James Goodwin, M.D., director of the Sealy Center on Aging at University of Texas Medical Branch,

who studies overuse of colonoscopies.  Some patients become incontinent or

experience weeks of pain, diarrhea and constipation.  In worst cases, the

procedure can perforate the colon.  Despite such risks, recent studies

have found that substantial numbers of people over 75, even over 85, are still

getting screening colonoscopies.

To protect your colon, eat plenty of fruits, vegetables

and whole grains for fiber.  Cut down on fatty foods, red meat and

processed meats.  Lose weight if you’re overweight and exercise.

Sound familiar?  It should, because that’s the best advice for protecting

the rest of your body—and mind—as well.

Yearly physical

There’s little evidence that having an annual checkup

can keep you healthy.  Many tests that doctors regularly perform—to

diagnose anemia, liver disease or urinary tract infections, for example—don’t

make sense unless there’s a reason to suspect a problem.  “A healthy

52-year-old does not need to see the doctor once a year,” says Jeremy Sussman,

M.D., an internist for the VA system and assistant professor at the University of Michigan

who was on the


of General Internal Medicine task force for making the ChoosingWisely recommendation.

“We certainly don’t think people should never see

doctors—quite the opposite.  We question the value of seeing someone for

the sake of seeing someone.”  Your specific needs should determine how

often you go to the doctor’s office, he adds.  If you have an illness that

needs treatment, you should see your physician.  And do talk to your

doctor about how often you need to have your blood pressure and cholesterol

tested.  “Our real point is, don’t do these things for the sake of a calendar,” he says. “Do them for the sake of

your health.”

Health and Wellness Associates


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