Tuesday, December 8, 2009;
Many Americans -- and their doctors -- seem to think that better health means more health care, including as many screening tests as possible. But many researchers are questioning that notion, saying that some common screening tests are unproven and can not only waste your time and money but also cause more harm than good.
To help identify preventive practices that work, the government-sponsored U.S. Preventive Services Task Force reviews the evidence for and against screening tests. (The task force generated controversy last month when it suggested that most women did not did not need mammograms as early or as often as some breast cancer experts suggest.) Below, Consumer Reports discusses exams to which the task force has given a D rating, meaning that they failed to meet the group's standards.Skip these
More than 40 percent of routine preventive exams included D-rated tests, according to a 2006 study by researchers at Johns Hopkins University. Many of those tests should be limited to people who have symptoms or risk factors for specific conditions. Listed below are several tests that healthy and average-risk people generally don't need.
-- Urine cultures for bacteria in men and in women who aren't pregnant. Exceptions: People who have symptoms of a urinary-tract infection.
-- Blood tests, manual exams or ultrasound to screen for ovarian cancer in women. Exceptions: Your mother or a sister had the malignancy or you have symptoms of the disease, such as frequent lower abdominal pain and an unexplained sensation of bloating.
-- The genetic test for the breast cancer susceptibility gene (BRCA). Exceptions: You have a history of breast or ovarian cancer or a relative who has tested positive for the mutation. Even then, talk with a genetic counselor before undergoing the test.
-- Pap smears for women who have had a total hysterectomy for a noncancerous condition such as fibroids, or for those older than 65 who have had three or more normal smears in the past 10 years and who have not had cervical cancer.
-- The PSA blood test for prostate cancer in men who are older than 75 or have a life expectancy of less than a 10 years. Other men should weigh the unproven benefit of that test against its possible risks, notably false alarms that can lead to unnecessary testing and treatment.
-- Ultrasounds for plaque buildup in the neck's carotid arteries. Exceptions: Your doctor hears a swishing sound, called a bruit, with a stethoscope, or you have had a stroke or mini-stroke.
-- Ultrasounds for peripheral artery disease or clogged leg arteries. Exceptions: You're at high risk of heart disease and your doctor detects weak or absent pulses in your feet, or you have symptoms such as pain in a calf while walking or foot wounds that won't heal.
-- Screenings for heart disease using electrocardiograms, exercise treadmill tests or electron-beam computerized tomography (EBCT). Exceptions: You have coronary artery disease or are at high risk for it and plan to start a vigorous exercise program.Get the most from these
You can get the most from the tests you do opt for by preparing for them properly.
-- Blood pressure: Don't smoke, exercise or consume caffeine for at least a half-hour before your appointment. Sit with your feet flat on the floor or a stool for five minutes before the reading. Rest your arm on a table so it's at heart level. Remain quiet during the test. Ideally, the doctor or nurse should take three readings: once in each arm and then again in the arm with the higher reading.
-- Blood-sugar (fasting-glucose) test and lipid (cholesterol) profile: Avoid nonessential drugs and all food and drink, except water, for nine to 12 hours before testing. Don't exercise within 12 to 24 hours of the test, since that might falsely elevate HDL (good) cholesterol.
-- Colonoscopy: Schedule this first thing in the morning. Stop taking supplements with iron a week before and avoid red-colored liquids or gelatin the day before. Avoid drugs such as ibuprofen (Advil and its generic versions) for one week, since they can cause gastrointestinal bleeding. Relax during the procedure by breathing deeply or listening to calming music. If the sedation seems light, ask for more. If you would rather be knocked out entirely, ask if that's wise in your case.
-- Pap smear. Avoid sexual intercourse, vaginal creams and vaginal douches for 24 hours before the exam. Reschedule the exam if you have your period or a vaginal-yeast or urinary-tract infection.
-- Mammograms. If you're still menstruating, avoid scheduling a mammogram during the week before your period, when your breasts are likely to be swollen or tender. Don't use an antiperspirant, a deodorant or powder until after the procedure, because they can show up as white specks on the film.
-- PSA test for prostate cancer. Wait a month or so after treating a urinary infection or inflamed prostate, or any procedure involving the prostate. Avoid sex for a day or two before the test. If your physician is also performing a digital rectal exam, have the blood drawn first. And tell your doctor if you regularly use over-the-counter pain relievers or drugs to treat an enlarged prostate, since both might falsely lower PSA.
Copyright 2009. Consumers Union of United States Inc.
For further guidance, go to ConsumerReportsHealth.org. More-detailed information -- including CR's ratings of prescription drugs, conditions, treatments, doctors, hospitals and healthy-living products -- is available to subscribers to that site.