Health and Wellness Associates
10 TESTS TO AVOID AT THE DOCTOR’S OFFICE
10 TESTS TO AVOID AT THE DOCTOR’S OFFICE
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 death.
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.
Another Choosing Wisely partner is John Santa, M.D., medical director at Consumer 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.
Nuclear 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 2015 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 both.
Not all doctors agree with AAFP’s recommendation against routine PSA screening, but many agree that the test is overused. Even the American Urological Association, which supports the use of PSA testing, says that it should be considered mainly for men age 55 to 69. The American 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. A bone density test for anyone over the age of 70 is unnecessary. You can no longer prevent osteoporosis at this age.
But many experts argue that for those age 50 to 65 who have osteopenia—mild bone loss—testing and subsequent drug prescriptions may be a waste of time and money also.
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 ovarian cysts
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 70
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 70—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.
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 Societof 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