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From his column To Your Health

to-your-health-05-13-1About four years ago I shared some of the recommendations of the U.S. Preventive Services Task Force (USPSTF). This month, I thought it would be good to review and update some of those recommendations.

The USPSTF is a group of 16 volunteers whose task is to review the medical literature without bias on an ongoing basis. They then make recommendations as to what medical screening procedures are cost effective in the early detection of illness to make a difference in the quality of people’s lives. Having reviewed the latest information, I’ll share some of the new, as well as longstanding recommendations of the task force. Remember that decisions about what is right for you should be made in consultation with your physician. Your doctor can guide you through the process of having appropriate screening tests to fit your personal and family history.

Breast Cancer

This recommendation has not significantly changed. All women over age 40 should have a screening mammogram every one to two years, although a family history may alter this for an individual. Also, individuals should be tested for the gene mutation that leads to increased risk of breast cancer if there is a family history of that gene mutation. Because breast cancer has a greater chance of occurring as a woman ages, screening should continue into the later years unless other medical situations intervene.

Cervical Cancer

This recommendation has changed. All women ages 21 to 65 should have a Pap smear every three years. There are some variations to this for women over 30 who have both a Pap smear and human papilloma virus testing. If the two are combined, the length of time between screenings may be increased to five years. Note, if a woman has had a hysterectomy, screening for cervical cancer is no longer necessary.

Colorectal (Colon) Cancer

This recommendation remains the same. Screening should begin at age 50 and continue until age 75. How often the screening is done depends on what method is used. Stool cards for occult blood, sigmoidoscopy and colonoscopy are acceptable methods of screening. Stool cards are simpler, but have a higher rate of both false positive and false negative results. I feel most comfortable recommending a colonoscopy as the test of choice. Also, if the result is negative, it does not need to be done more often than once every ten years.

High Blood Pressure

All adults should have their blood pressure checked at least every two years if previous readings were less than 120/80. If higher, the screening should be performed annually. If a reading is 140/90 or greater, more readings are needed within two weeks and follow up with a physician is essential.

High Cholesterol

All men over age 35 and women over age 45 should be screened for high cholesterol at least every five years. If a younger person has diabetes, is obese, or has other risk factors (such as family history for heart disease), screening should begin as early as age 20.

Diabetes Mellitus (Type 2)

The recommendation is unchanged. Anyone with elevated blood pressure and/or abnormal cholesterol levels should be screened for diabetes. A fasting blood sugar level of over 100 is an indication of the need for close follow up. A single blood sugar level above 200 (fasting or not) is now considered diagnostic for diabetes.

Osteoporosis

Screening continues to be recommended for women over 65 years of age and in younger women who are at increased risk of fractures. Additionally, women under age 65 who are smokers, thin, or whose parents have a history of fractures should be considered for screening. Your physician can guide you in this decision. The data does not support screening for osteoporosis in men.

Prostate Cancer

There continues to be no recommendation for prostate cancer screening. The PSA test does not provide a precise cut off to adequately screen for cancer. Many men have undergone unnecessary expensive testing because of PSA results. However, some physicians in clinical practice have discovered that while the actual level of PSA may not be helpful, an upward trend over several years may indicate the possibility of prostate cancer. Still, the USPSTF says the need for screening is not necessary in the general population.

Use of Aspirin

Men between the ages of 45 and 79 should take an aspirin a day when the potential benefit of a reduction in heart attacks outweighs the risk for stomach bleed caused by aspirin. This same recommendation applies to women between the ages of 55 and 79.

Conclusion

I hope this overview is helpful. The USPSTF website has other recommendations that may be beneficial to you. In the meantime, be healthy, enjoy the spring, get some exercise, and eat right.

Dr. Paul Wardlaw is a board-certified family physician who has enjoyed the practice of medicine in various settings for 40 years.

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