The Essential Health Tests You May Not Realize You Need
If your doctor isn't screening for skin cancer, STDs or vitamin B12 deficiency, you need to speak up for a better checkup
There has been considerable debate among health experts in recent years about the value of annual or even biennial checkups for adults. The tests, critics say, are medically and financially inefficient and can lead to more trouble than they're worth by prompting patients to undergo expensive, potentially invasive follow-up procedures they may not need.
Some people in midlife and beyond have embraced this school of thought as justification for avoiding doctors and lab tests as long as possible.
That approach would be wrong.
In reality, people in their 40s and 50s need regular health checks at least as much as any other age group. A recent study in the American Medical Association's journal Internal Medicine found that boomers have higher rates of hypertension and high cholesterol, and are also less active and more likely to be overweight than members of their parents' generation were at the same age. Thanks to improved medical techniques, the study concluded, we are living longer than our parents, but in worse health.
Given our increased risk factors for a range of ailments, lax monitoring may delay the discovery of problems until it's too late to successfully treat them. That doesn't mean you must get a traditional physical every year, though. "There is little evidence they have lasting benefits," says Dr. David Lipschitz, director of the Longevity Center at Saline Memorial Hospital in Benton, Ark.
The trouble, Lipschitz says, is in how most physicals are conducted. The key to improving them? You. A doctor may take your blood pressure, listen to your heart and lungs, check your eyes, ears, nose and throat and send you on your way — unless you speak up. Patients need to be proactive about their health and ask their doctor questions.
Bring a checklist of questions to each office visit and take notes detailing all tests that are given or recommended. The National Institutes of Health does support specific baseline health screenings at certain times. For example, all Americans between 40 and 64 years old should have their blood pressure tested every two years or, if it's high, annually. Men should have their cholesterol checked every five years starting at age 34; women should start at 44. Your doctor may suggest having these tests more frequently if you have diabetes, heart disease, kidney problems or a family history of those conditions.
Additionally, the NIH advises people between 50 and 75 to have regular colon cancer screenings. Lipschitz recommends a colonoscopy every 10 years for healthy adults and every five years for those with a family history of the disease.
Men and women over 40 should also get a flu shot every year, a tetanus-diphtheria booster once a decade and a shingles vaccination after age 60. Everyone should have an annual dental checkup and an eye exam every two years (with a glaucoma test for women starting at age 45).
(MORE: Yes, You Need a Colonoscopy)
Healthy women over 40, the NIH says, should also have a Pap smear every two to three years, a complete breast exam annually and a mammogram at least once every two years, depending on their risk factors for breast cancer. Men over age 50 (45 for African-Americans) should discuss prostate-cancer testing with their physicians. Men and women should also ask about osteoporosis screenings; Lipschitz advises women to be checked every three to five years after menopause.
But beyond these primary exams, Lipschitz and other experts say, there are other screenings you need to keep on your radar, some of which you may not realize ought to be diagnostic priorities. That includes tests for:
The older you are, the more time you've spent exposed to the sun, accumulating damage from ultraviolet rays. Between 40 and 50 percent of Americans who live to age 65 will have either basal cell carcinoma or squamous cell carcinoma at least once. Skin cancer rates are rising — and people in their 60s and 70s may be five times as likely to have melanoma diagnosed as people of the same age 30 years ago. Fortunately, skin cancer can often be successfully treated if caught early.
The Test While your primary-care physician may identify suspicious spots during a routine checkup, a dermatologist can perform a more thorough head-to-toe exam to check for any irregular spots or oddly shaped or discolored moles. (If you have a history of skin cancer or have numerous moles, you should see a dermatologist every three to 12 months.) The American Academy of Dermatology offers some free skin cancer screenings as well as guidance online for performing monthly checks yourself. Typically, the specialist will biopsy anything suspicious.
The hepatitis C virus can live for decades in your body, slowly damaging your liver while causing no physical symptoms until it reaches an advanced stage — and boomers are five times more likely to have hepatitis C than other adult Americans, Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, has said. This is why the CDC suggests getting a one-time blood test for the virus that causes hepatitis C.
(MORE: A Generation Comes Together — for Hepatitis C Tests)
The Test A standard blood test can measure liver enzyme levels and identify the presence of antibodies against the hepatitis C virus, which reveals whether you have been exposed. You can get results in as soon as 20 minutes.
SEXUALLY TRANSMITTED DISEASES
People age 50 and older represent almost one-quarter of Americans with HIV/AIDS. As long as you are sexually active, particularly with multiple partners, you should get checked for HIV as well as other STDs like chlamydia, gonorrhea and syphilis. Many of those infected unknowingly carry an STD for years without experiencing any symptoms.
The Tests All women 25 and older who are at risk of STDs (meaning anyone with a new partner or multiple partners) should be screened annually for chlamydia and gonorrhea, as should all men who have sex with men, according to the Mayo Clinic. Chlamydia and gonorrhea screening can be done through a urine test or a swab inside the cervix or penis. You can also perform a home test that can be sent to a laboratory for analysis.
The CDC encourages all adults under 64 to be tested for HIV and syphilis at least once, and recommends annual tests for people who've had more than one partner since their last test, anyone who has tested positive for gonorrhea or chlamydia and men who have had sex with men. HIV testing is done through a blood sample. Your doctor can test for syphilis either through a blood test or a swab from any genital sores you might have.
VITAMIN B12 DEFICIENCY
B12 deficiency is the most common nutritional deficiency in the developing world — and possibly the United States. The risk is especially high for those over 50 because 30 percent of people in the age group have atrophic gastritis, a thinning of the stomach lining that reduces the amount of B12 absorbed by the small intestine. Most people don't realize they are low in B12, as they associate the often subtle neurological effects of the deficiency — like balance problems and numbness or weakness in the arms and legs — with normal aging. More serious cases can result in dementia or anemia. Vegetarians and vegans are generally at higher risk of B12 deficiency because the only reliable sources of the nutrient, aside from fortified cereals, are animal-derived products.
(MORE: The Fiftysomething Diet: 5 Nutrients You Need Right Now)
The Test A simple blood test can measure your B12 level and should be taken at every regular physical. Your doctor will ask you not to eat or drink for six to eight hours before the test, and you'll need to disclose if you're taking any over-the-counter or herbal medications, as they may affect the results. Normal B12 values are 200 to 900 pg/ml (picograms per milliliter). A count lower than 200 is a sign of deficiency, but seniors with a count between 200 and 500 are also considered at risk.