Answers to some Common Questions about Health Screening Tests

| Posted On Jul 19, 2011 | By:

I’m healthy and scheduled a checkup.  What “routine” blood tests do I need?

Surprisingly, few blood tests are recommended on a “routine” or screening basis.  Everyone should have their cholesterol levels (a “lipid profile”) checked at least every five years, even if it’s normal.  Your doctor or nurse will request that you do this fasting, meaning nothing to eat or drink for about 8-12 hours beforehand  (water, black coffee, and black or green tea are all okay.)  As long as your cholesterol levels are okay, every five years is often enough; however, people on cholesterol-lowering medications need more frequent lipid profiles. 

Starting at age 45, we recommend screening for diabetes at least every three years.  People who have high blood pressure, are overweight or obese, or who have a strong family history should be screened before age 45.

The CDC recommends a baseline HIV test – even in people with low-risk sexual practices – for everyone 13 and older.  In Massachusetts, paperwork for “informed consent” is necessary prior to an HIV test.

When I explain all of this to my patients, they often say, “In the past, I’ve had panels of blood tests done.”  Doing “panels” of blood tests – groupings of tests run all at once – increases cost and increases the possibility of incidentally uncovering an abnormal value that by itself does not indicate a concern.  This sometimes requires further testing that can be costly and invasive.  People who are sick or who have chronic diseases such as diabetes or kidney disease (among others) may need more regular “panels” of tests, but these are not recommended for screening healthy people who show no symptoms of an underlying condition.  Your clinician will know what you need, and you should always feel comfortable talking to your doctor about why a test is or is not recommended for you.

From time to time, I’ve heard about other tests that friends or family members have had.  Should I have any of these tests done?

Thyroid level.  We often check thyroid function based on symptoms: fatigue, changes in weight, or palpitations, among others.  There is no indication to regularly check thyroid function in healthy people, but if you have concerns, talk to your doctor or nurse.

Vitamin D.  Checking vitamin D levels is not recommended “routinely,” though we do often check it in patients with moderate to severe kidney disease and bone disorders such as osteoporosis.  While we recognize that low vitamin D levels may be associated with a higher incidence of cancer and heart disease, it has not been shown that correcting low levels of vitamin D helps; there is correlation, but there may not be causation.  Furthermore, testing vitamin D levels is a fairly expensive undertaking.  It is far more cost-effective for most people to supplement their diets with approximately 600-1000 IU daily.

C-reactive protein.  C-reactive protein (CRP) is a nonspecific inflammatory marker in the bloodstream, meaning it measures general levels of inflammation in the body but cannot pinpoint where the inflammation is or what is causing it.  While high levels of CRP have been associated with an increased risk for heart disease, it is not recommended as a screening test.  Some studies suggest that cholesterol-lowering medications can lower CRP.  However, we know that these medications can also reduce risk of heart disease independent of CRP levels.  If you’d be interested in taking a cholesterol-lowering medication to reduce risk of heart disease, talk to your doctor or nurse; a CRP may not be necessary.

Urine Analysis (UA).  Routine urine testing is not necessary in otherwise healthy people.  If you have symptoms such as back or abdominal pain, or any difficulty with urination, your doctor may recommend a UA to look for signs of a urinary tract infection (UTI) or other conditions.

Are there other screening tests or preventive tests I should have?

There are several other recommended tests.  The most commonly encountered are:

Also, keep in mind that people with other medical issues – even asymptomatic ones – may be advised to do more frequent testing and evaluation.

What about PSA to screen for prostate cancer in men?

There are no well-accepted guidelines for PSA testing in men, and organizations vary widely in their recommendations about who should or should not have a PSA screening, and at what age.  Major groups such as the American Cancer Society and the American Urological Association advise starting at age 50, but some studies still question whether PSA screening improves health outcomes.  Some people do benefit from screening starting at age 40, particularly if there is a family history of prostate cancer.  Talk to your clinician about what’s most appropriate for you.

Are there other common “screening” tests that I don’t need?

Yes!  While your doctor or nurse may recommend these tests based on symptoms or prior medical problems, healthy and asymptomatic people do not need “routine” or “screening” stress tests, chest X-rays, coronary calcification tests, angiograms, MRIs, vascular ultrasounds, or any other tests that you may have heard about.

I feel like it’s been a long time since I had a “checkup.”  How often do I need one?

It depends on your medical issues, but for people without chronic diseases such as diabetes, heart disease, and asthma, most people in their 20s and 30s need a complete physical exam every 3 years.  Most people in their 40s should have one every other year, and people 50 and up should have an annual physical exam… which is now also covered by Medicare.  Most clinicians use the physical exam or “checkup” as a chance to meet you when you’re feeling well, identify concerns that you (and they) have about your health, and review your interval medical history.  They also will help you schedule any outstanding tests.  If you have questions, you can access this information through MyHealth in “My Medical Record” under “Preventive Care.”

Of course, all of these guidelines are about screening for and preventing disease.  Patients who don’t feel well, or who have a personal or family history that puts them at above average risk for health problems, may need other tests done.  If you have questions for your primary care team, be sure to ask so that we can address your concerns and help you better understand what we can do to keep you healthy!

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About Dr. David Rubin

Dr. David Rubin joined Atrius Health in 2005. He practices adult internal medicine at our Wellesley office. Prior to his career in medicine, he worked with an interactive advertising and marketing agency designing web sites for companies such as AT&T and John Hancock. His interests include preventive medicine, medical informatics, and clinical process improvement.

Comments

  1. You have provided a most useful and readable guideline. Thanks!

    Comment by Judith Hill on September 22, 2011 at 4:58 pm
  2. Thanks for listing tests,their comprehensive descriptions; and when/who/why people should or should not have them.

    Comment by Fran Vena on September 22, 2011 at 10:43 pm

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