Guide to Wellness – July 2019

Medical Tests

52 GUIDE TO WELLNESS CR.ORG

Abdominal Aortic

Aneurysm Screening

This one-time ultrasound looks

for a bulge in the aorta, the

body’s largest artery.

WHY IT’S DONE: AAAs have the

potential to burst, which can

cause life-threatening bleeding.

RECOMMENDED FOR: Men 65

to 75 who are current or former

smokers. Nonsmoking men and

women ages 65 to 75 who have

ever smoked might consider

it if they have risk factors such

as a close family member

who had an AAA. The USPSTF

recommends against screening

nonsmoking women ages 65

to 75, whose risk is very low.

What to

Know About

These 18

Screenings

WE COMBED THROUGH the research and talked

with medical experts from leading academic

centers, government agencies, and national

organizations such as the U.S. Preventive Services

Task Force (USPSTF) to assess the evidence on

the benefits and risks of these tests. (We skipped

a few, such as blood pressure, but it’s wise to have

this measured every time you see a healthcare

provider or more often if you’re at higher risk for

hypertension.)

Check with your health insurer to make sure

that the screenings your doctor advises are

covered; many are, notably those recommended

by the USPSTF. But also be aware that you might

be charged extra fees at some testing facilities.

And note that if the screening finds something

suspicious, any subsequent procedure or

diagnostic test may result in extra costs for you.

So ask about that, too.

The List

track key health markers, but other DTC offerings may

lead to overscreening. For example, the American Acad-

emy of Family Physicians (AAFP) advises against the

carotid artery scans on many mobile screening menus.

For healthy people, they can yield misleading results

that can lead to riskier follow-up tests. The American

College of Preventive Medicine cautions against full-body

CT scans because they’re costly, expose people to a lot

of radiation, and often result in false positives.

“It’s often cheaper to buy packages of many tests,

which incentivizes people to get more tests than they

need,” says Erik Wallace, M.D., associate dean of the

Colorado Springs branch of the University of Colorado

School of Medicine.

Those who represent DTC testing companies say their

services are valuable. Ari Cukier, the chief operating

officer of Elitra Health, says the firm offers efficiency—

multiple screenings in one day—and the chance for con-

sumers to have more tests than they would through their

own doctors. “People are not getting the comprehensive

testing they want,” he says.

He says Elitra’s staff discusses overscreening and false

positives with clients. “They are capable of weighing risks

and possible benefits for them,” he notes. “We have had

cases of false positives, absolutely. And cases of real posi-

tives. That winds up for us proving the benefit of a test.”

Life Line Screening did not respond to our requests

for comment.

How to Test Wisely

When recommending screenings, your doctor should

generally rely on scientific evidence and guidelines from

the government and expert organizations. But stud-

ies have found that many doctors aren’t up-to-date on

guidelines, says López of the ACP. For instance, a recent

review of 25 studies in the journal Preventive Medicine

found that up to 45 percent of cervical cancer screenings

failed to follow the USPSTF guidelines that were updated

in 2012. And López notes that it can be simpler for a

harried doctor to agree to a patient’s request for a test

than to discuss the pros and cons.

But guidelines aren’t everything. “Maybe a patient is at

higher risk and should be screened sooner,” says López.

That’s why, after talking to her doctor about her family

history, Lynne Milliron had colon cancer screening a

younger age than is typically recommended. In addition

to her father, an aunt had died of the disease at age 52.

Choose a doctor who will discuss all of the factors with

you: guidelines, your medical and family history, the pros

and cons of various screenings, and where the results

might lead. You’ll be able to make smart decisions if you go

into those talks informed. Our guide to 18 common screen-

ings, at right, is a good place to start.