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Preventive Health Tests: When You Should Ask Your Doctor for a Screening Test Posted: February 19th, 2010

By Jim Sloan

Jim Sloan is a freelance writer in Reno, Nev.

Physicians use diagnostic tests for patients with a particular disease, but may also order screening tests for patients who don't exhibit symptoms but may be at risk for certain illnesses.
Your doctor might order screening tests because of your age, lifestyle, or family history of a particular ailment. Screening tests can uncover a medical condition early -- when it's easier to treat. So it's important to know which tests are recommended, and whether those tests are covered by your health insurance.

Screening Tests Are Controversial at Times

There are a number of misconceptions about screening tests. Private companies, which profit from screening exams, sometimes suggest tests that medical experts say are unreliable or unnecessary.

The most respected screening recommendations come from the U.S. Preventive Services Task Force, which is made up of 16 specialists in family medicine, pediatrics, and nursing who are part of the Agency for Healthcare Research and Quality (AHRQ). The task force has raised eyebrows in the medical field recently by downplaying some screenings -- such as the breast self-exam and the prostate-specific antigen (PSA) test for prostate cancer -- which doctors had previously endorsed.

Nevertheless, the American Academy of Family Physicians (AAFP), one of the nation's largest medical organizations with more than 94,700 family physicians, family medicine residents, and medical students as members, endorses most of the task force's 20 or so screening recommendations. The AAFP also suggests some screening tests not recommended by AHRQ.

Here are the screening tests that your doctor might recommend. If you think you're a good candidate for a screening, ask your doctor about it.

Tests for Men and Women at Any Age

The following are screening recommendations for men and women at any age.

  • Obesity: Both AHRQ and AAFP say family physicians should screen all adult patients for obesity, and offer intensive counseling and behavioral intervention to promote sustained weight loss for obese adults.
  • Fluoride: AAFP recommends that doctors screen patients from infancy to 16 years old for fluoride supplementation if the local water supply has less than 0.6 ppm of fluoride.
  • Blood pressure: AHRQ says doctors should check a patient's blood pressure at least every two years. High blood pressure is 140/90 or higher. AAFP recommends screening for high blood pressure in adults age 18 and older.
  • Depression: The AHRQ says that you should talk to your doctor about depression screening if you've felt sad or hopeless over the last two weeks, or if you find little interest or pleasure in routine activities. AAFP recommends doctors screen adolescents (12-18 years of age) for major depressive disorder (MDD) when systems are in place, to ensure accurate diagnosis, psychotherapy (cognitive-behavioral or interpersonal), and follow-up. Depression counseling and medication are covered under many health insurance policies.
  • Diabetes: Ask for a diabetes screen if you have high blood pressure or high cholesterol. The AAFP recommends screening for Type 2 diabetes if your blood pressure (either treated or untreated) exceeds 135/80 mm Hg
  • Tuberculosis (TB): The AAFP says to ask your doctor about the Mantoux test if you've been in close contact with people with known or suspected TB, such as health care workers, immigrants from countries with high TB prevalence, HIV positive individuals, alcoholics, injection-drug users, residents of long-term care facilities, and medically under-served low income individuals.
  • Human Immunodeficiency Virus (HIV): The AHRQ recommends that you get HIV screening if you had intercourse with men between 1975 and the present, have had unprotected sex with multiple partners, are pregnant, have used or now use injection drugs, exchange sex for money or drugs or have sex partners who do, have past or present sex partners who are HIV-infected, are bisexual, or use injection drugs, are being treated for sexually transmitted diseases, or had a blood transfusion between 1978 and 1985. The AAFP strongly recommends that physicians screen all adolescents and adults who have an increased risk for HIV infection

Tests for Men and Women Age 50-65

  • Colorectal Cancer: You should get a fecal occult blood test, sigmoidoscopy or colonoscopy at age 50 -- or earlier if there is a family history of colorectal cancer. The AAFP suggests the tests continue until you're 75, but also recommends against routine screening for colorectal cancer in adults age 76 or older.
  • Hearing: The AAFP recommends your doctor screen you for hearing difficulties if you report any kind of impairment.

Recommended Tests for Men

The AAFP and AHRQ also have screening recommendations for men who are in specific age ranges.

Men Age 20-39

  • Lipid disorders: The AAFP says doctors should screen patients age 20-35 if they have an increased risk for coronary heart disease.
  • Cholesterol: Get your cholesterol checked regularly starting at age 35. If you smoke or have diabetes, high blood pressure, or a family history of heart disease -- the AHRQ recommends getting screened for high cholesterol sooner.

Men Age 60 and Over

  • Abdominal Aortic Aneurysm: If you are 65-75 and have ever smoked (100 or more cigarettes during your lifetime), you need to be screened once for abdominal aortic aneurysm, which is an abnormally large or swollen blood vessel in your abdomen.

Suggested Screening Tests for Women

There are several tests that are recommended for women at any age, as well as for pregnant women, and women in specific age ranges.

Recommended Tests for Women at Any Age

  • Cervical Cancer: The AHRQ recommends a Pap smear every 1 to 3 years if you have ever been sexually active, or are between the ages of 21 and 65. However, the AHRQ doesn't recommend Pap smears for women who have had a total hysterectomy for a noncancerous condition such as fibroids nor do they suggest this screening for women older than 65 who have had three or more normal smears in the past 10 years and who have not had cervical cancer. The AAFP strongly recommends that a Pap smear be completed at least every three years to screen for cervical cancer for women who have ever had sex and have a cervix.
  • Chlamydia and Other Sexually Transmitted Infections (STI): If you're 25 or younger and you are sexually active, AHRQ says your doctor should screen you for Chlamydia and other STIs. The AAFP recommends screening for Chlamydia infection for all sexually active non-pregnant young women aged 24 and younger, and for older non-pregnant women who are at increased risk.
  • Gonorrhea and Syphilis: The AAFP recommends clinicians screen all sexually active women, including those who are pregnant, for gonorrhea infection if they are at increased risk for infection.
  • Congenital Rubella Syndrome: The AAFP recommends screening by assuring rubella immunity through history, serology, or vaccination in women of childbearing potential.
  • Breast Cancer: The genetic test for the breast cancer susceptibility gene (BRCA) is not recommended by AHRQ unless you have a history of breast or ovarian cancer, or a relative who has tested positive for the mutation. The AAFP recommends that women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing.

Recommended Tests for Pregnant Women

  • Tobacco Use: The AAFP recommends clinicians screen all pregnant women for tobacco use and provide 5-15 minutes of smoking cessation counseling to smokers.
  • Rh (D) Blood Typing and Antibody Testing: Recommended for all pregnant women during their first visit for pregnancy-related care. The AAFP recommends repeated Rh (D) antibody testing for all unsensitized Rh (D)-negative women at 24-28 weeks' gestation.
  • Hepatitis B Virus (HBV): If you're pregnant, expect to be tested for this at your first prenatal visit, the AAFP says.
  • Iron Deficiency Anemia: The AAFP recommends screening in asymptomatic pregnant women.
  • Bacteriuria: The AAFP recommends screening with urine culture for pregnant women at 12 to 16 weeks' gestation or at the first prenatal visit, if later.

Women Age 40-49

  • Breast Cancer: Have a mammogram every 1 to 2 years starting at age 40, AHRQ says. The AAFP recommends that the decision to conduct screening mammography before age 50 should be an individual decision and take into account the patient's risks as well as "her values regarding specific benefits and harms."
  • Cholesterol: Have your cholesterol checked regularly starting at 45. Ask for a test at a younger age if you have diabetes or high blood pressure, if heart disease runs in your family, or if you smoke. The AAFP recommends screening women age 45 and older for lipid disorders if they are at increased risk for coronary heart disease.

Women Age 50-65

  • Breast Cancer: The AAFP recommends a biennial screening mammography for women between ages 50 and 74.

Women Age 60 and Up

  • Osteoporosis: Get a bone density test beginning at age 65, the AHRQ says. If you are between 60 and 64 and weigh 154 pounds or less, talk to your doctor about an osteoporosis screening.

-Jim Sloan