HOW TO TALK TO YOUR DOCTOR ABOUT TESTING
Modern blood-testing technology makes it possible to perform more than two dozen tests on a single vial of blood in just a few hours. Since its debut in the 1960s, physicians and consumers alike have viewed extensive blood testing as an indispensable part of a routine checkup for healthy adults. Those tests were needed to catch disorders that might otherwise go undetected—and perhaps also to provide legal backup for the doctor in case of a malpractice lawsuit.
In recent years, however, managed-care organizations have been pushing physicians to perform less lab work. Medicare and many HMOs now restrict doctors from ordering lab tests unless disease symptoms have been identified or a diagnosis has already been made. The Preventive Services Task Force, an influential government panel of preventive-care experts, and the American College of Physicians also advise physicians to order lab work only when the results will lead to a life-saving finding or a dramatic reduction in sickness.
While largely a cost-saving move, the effort to curtail routine lab work does have some medical justification. More tests mean more chances of spurious findings, especially “false positives” that often lead to other, sometimes hazardous tests. And three years ago a Mayo Clinic study concluded that, for several types of routine tests, roughly 100 people would have to be screened to come up with a single test result that would lead to a change in treatment.
Though everyone agrees that lab work should be used judiciously, I believe that the current trend toward cutting back on routine testing has gone too far. Certain tests (including some not sanctioned by the Preventive Services Task Force) help diagnose diseases that can cause needless suffering or even premature death if allowed to go undetected and untreated.
REASONS TO ROLL UP YOUR SLEEVE
Listed below are the blood tests that I think should be part of a routine adult checkup. Unless otherwise specified, these tests should be done once every one to three years.
Fasting lipid panel. This blood test detects elevated LDL-cholesterol and low HDL-cholesterol levels, disorders that raise the risk of coronary heart disease and stroke. With proper treatment, however, those disorders can be controlled. Cholesterol tests help identify a significant number of people whose cholesterol levels require medical intervention.
Fasting blood-glucose test. This test identifies an elevated blood-sugar level, an indication of type 2 (adult onset) diabetes. Most physicians used to believe that patients with type 2 diabetes wouldn’t benefit from early detection. But now we know otherwise, thanks to convincing studies showing that assiduously controlling the blood-sugar level can help prevent diabetes-related complications. And new diabetes drugs can control the blood-sugar level in nearly all patients with type 2 diabetes.
Liver-function tests. These tests can help detect hepatitis. Early detection may not help those with hepatitis A or B, since there is still no treatment for those diseases. But symptoms associated with hepatitis C can now be treated with the ribavirin-and-interferon drug combination (Rebetron). Whether that therapy saves lives is not yet known.
PSA test. An elevated blood level of prostate-specific antigen is a marker for prostate cancer. For years I’ve contended that all men should have an annual PSA test (along with a digital rectal exam) beginning at age 50—and at 40, if they’re African-American or have a strong family history and thus are at higher risk. The Preventive Services Task Force has argued that the test makes too many mistakes and that treatment for prostate cancer has not been shown to save lives. But PSA testing makes early detection and treatment possible, which may translate into a lower death rate, as is the case with mammography and breast cancer.
Thyroid-function tests (TSH and Free T4). Since thyroid disease may produce few if any initial symptoms, regular blood screening is necessary for early diagnosis. Early detection and treatment of thyroid disease can prevent heart arrhythmia, osteoporosis, dementia, eye disease, and premature death.
OTHER IMPORTANT LAB TESTS
In addition to blood work, three other types of lab tests should be performed as part of a routine checkup:
Urinalysis. This test checks a sample of your urine for microscopic amounts of blood, a possible sign of kidney or bladder cancer. Both diseases are best treated when caught early. A urinalysis should be done once every one to two years.
Cervical Pap smear. By examining cells gently scraped from the cervix, a laboratory technician can spot precancerous changes. If all women had regular Pap smears, almost all the nearly 5,000 deaths from cervical cancer in the U.S. each year could be prevented. Sexually active women should have a Pap smear every two years.
Fecal occult-blood test. In this test, a stool sample is tested for hidden blood, indicating possible colon cancer. An annual test, starting at age 50, can save lives by leading to the detection of colon cancer while it’s still curable.
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