Wellness LetterFoundations of WellnessSelf-Care / PreventionGuide to Preventive Care and Screening Tests

Foundations of Wellness

Guide to Preventive Care and Screening Tests

You are responsible, in large part, for managing your own preventive health care. It is your most important investment of time and money. Yet most Americans do not receive all the important preventive services they need—that is, screening tests for early detection of disease, immunizations, and education about healthy habits. Why not?

  • Many Americans still have no health insurance to pay for the tests, vaccines, and other medical care.
  • Many people do not get continuity of care. They may have to switch health care providers as they switch from one insurer to another, making it hard to keep track of what services they’ve had.
  • Many miss out on preventive services because they do not go to a health care provider for years, do not go for the recommended tests, or are confused about which tests to ask for. They may not know that Medicare and other insurance plans cover most of the tests and shots. They may not know that prevention is the most economical form of medicine—well worth budgeting for, even if insurance doesn’t cover it.
  • With tests for some cancers, there’s the embarrassment factor. Some people may dread being tested for colon, prostate, cervical, or breast cancer, and they are relieved if the doctor fails to mention it. Some people would simply rather not know.
  • Both health care providers and patients may be confused by contradictory recommendations. What should a medical check-up consist of? Does everybody need an annual physical? Should men get a PSA test? How often should a woman have a Pap smear? (See chart on opposite page for answers to such questions.)
  • Health care providers may fail to ask patients about smoking and drinking, not to mention exercise habits, diet, sleep, and emotional problems. Counseling patients about these matters takes time, for which health care providers may not be paid.

How about that annual physical?

In the old days people were advised to undergo a “complete physical exam” periodically. That standardized one-size-fits-all exam for seemingly healthy people has now largely been discarded, since it doesn’t pay off in terms of better health and longer life.

Starting in the 1980s, at the request of the government, an independent committee of experts known as the U.S. Preventive Services Task Force (USPSTF) evaluated the benefits and drawbacks of common screening tests and came up with evidence-based recommendations. The USPSTF continues to update and re-evaluate its advice. Thanks largely to this work, some tests that used to be routinely done, such as chest X-rays, electrocardiograms (EKGs), urine tests, and complete blood counts, are now reserved for people with symptoms or risk factors. In other words, they are not routine screening tests for healthy people (and as such are not covered in this article).

There is good evidence that “periodic health evaluations” can be beneficial because they allow health care providers and patients to evaluate risk factors and undertake the preventive services proven to be beneficial and tailored to the specific patient. For this reason, it’s a good idea to see your doctor every year or two. (It’s worth noting that life expectancy, rather than age itself, may be a more important factor in determining the efficacy of certain types of screenings.)

Health care: your role

Your primary-care practitioner should be your partner in preventive care. If you need any tests listed on the chart, ask about them.

Besides the important preventive measures listed in our chart, here are common sense steps you should take:

  • Don’t smoke, and avoid secondhand smoke.
  • Maintain a healthy weight. Measure your waist: more than 35 inches for a woman or 40 inches for a man indicates increased risk for heart disease and diabetes.
  • Get regular exercise. Even brisk walking for just half an hour most days can be a big factor in weight control and in staying healthy.
  • Limit your intake of animal fats, sodium, sugary foods and beverages, and refined-grain products. Eat plenty of fruits, vegetables, and whole grains, as well as moderate amounts of foods rich in “good” fats, such as fish and nuts. Include low-fat or nonfat dairy products if you like them.
  • Keep alcohol consumption moderate: no more than one drink daily for a woman, two drinks for a man. If you are a heavy drinker, seek counseling, and cut back or quit.
  • Examine your skin on a regular basis. Any mole that changes shape, color, or size, any sore that doesn’t heal, or any persistent patch of irritated skin may be a sign of cancer and needs professional evaluation. If you’re at high risk for skin cancer or simply have lots of moles, get a professional skin exam.
  • When driving, fasten safety belts, see that kids ride in proper restraints, and obey the law. Drive sober and defensively.
  • Brush and floss and get regular dental checkups.

Bottom line: Medical experts may disagree about a lot of things, but they all agree that good health depends on improved access to and increased use of preventive care services.

Vaccinations: a checklist for adults
  • Influenza (every fall): Everyone over 6 months of age.
  • Pneumococcal (pneumonia): Those 50 and over; younger people with certain chronic disorders, such as diabetes, cancer, and heart disease.
  • Tetanus with diphtheria booster: Everyone, every 10 years for life.
  • Pertussis (whooping cough): Adults who have never received the pertussis vaccine (it is not administered itself but with the tetanus and diphtheria vaccines) should get one as soon as feasible: The vaccine is called Tdap. This should be followed by either a tetanus diphtheria (Td) shot or Tdap shot every 10 years.
  • Chickenpox: Anyone who has never had chickenpox.
  • Shingles: People 50 and over.
  • Rubella: Women of child-bearing age, but not during pregnancy.
  • HPV (human papilloma virus): People 26 and younger; ideally the vaccine should be given at age 11 or 12.
  • Hepatitis A: Travelers to most parts of Latin America, Africa, Asia, or other areas where hepatitis A is common; those with chronic liver disease; anyone who wants to be protected. Note: Those traveling to developing countries need special advice about vaccinations—go to cdc.gov/travel.
  • Hepatitis B: All infants, all children or adolescents younger than 19 years of age who have not been vaccinated, all adults age 19 through 59 years, and adults age 60 years or older with risk factors for hepatitis B infection. Adults who are 60 years or older without known risk factors for hepatitis B may also receive hepatitis B vaccine. There’s a combined vaccine for hepatitis A and B.

Preventive services for healthy adults

These are the major screening tests (that is, routine tests for average-risk people without symptoms). Our advice is based largely on the recommendations of the U.S. Preventive Services Task Force (USPSTF). Medicare and many insurers cover nearly all of these services. Infants, children, and pregnant women need other kinds of preventive care not covered here.

Blood pressure measurement (to detect hypertension)
Who Needs: All adults.
How Often: Once every 2 years for those with normal blood pressure.
Comments: More frequently for those over 60 and anyone with readings over 120/80.

Cholesterol measurement (including LDL, HDL, and triglycerides)
Who Needs: All adults.
How Often: Once every 5 years. More often if any results are abnormal or there are other risk factors.
Comments: Those at high risk for heart disease need medical advice about lifestyle changes and possibly drug therapy.

Cervical cancer screening (Pap or HPV test)
Who Needs: All women, starting at age 21. Most should stop after 65. Women who have had their cervix removed do not need to be tested.
How Often: Ages 21 to 30, Pap test every 3 years. Ages 30 to 65, Pap test every 3 years, HPV test every 5 years, or both tests (using cells collected at same time) every 5 years.
Comments: Women at high risk need more frequent testing. Women over 65 can stop if they have had normal results in recent years, unless they are at high risk.

Breast cancer screening (mammography)
Who Needs: Women at age 40 should start discussing screening with their doctor. Others may opt for screening, depending on their risk factors and preferences.
How Often: USPSTF advises every 2 years age 40 to 75. American Cancer Society advises annual screening age 45 to 54, then every two years.
Comments: Women should start discussing screening with their doctors at age 40 Certain women at high risk should also have annual MRI scans starting at 30.

Colorectal cancer screening (stool test, sigmoidoscopy, or colonoscopy)
Who Needs: Everyone 45 and over; earlier for hose at high risk. American Cancer Society suggests starting at age 45. Most people should stop at 75.
How Often: Stool test annually; sigmoidoscopy every 5 years; or colonoscopy every 10 years.
Comments: People with abnormal results need more frequent colonoscopies. Fecal immunochemical tests (FIT) are the most accurate stool tests.

Prostate cancer screening (prostate-specific antigen, or PSA, test)
Who Needs: At about age 50, men should discuss the pros and cons of screening with their doctors, earlier if they are at high risk.
How Often: On professional advice; some research suggests every 2 to 4 years if PSA level is low.
Comments: Men should discuss PSA screening with their doctors and decide based on their values and preferences. Most men can stop at age 75.

Lung cancer screening (low-dose CT scans)
Who Needs: Long-term heavy smokers (current or former) ages 55 to 80.
How Often: Annually, or on professional advice.
Comments: If you have a strong history of smoking discuss the pros and cons of screening.

Diabetes screening (fasting blood glucose test)
Who Needs: Everyone 45 and older; earlier for those at high risk.
How Often: Every 2 to 3 years.
Comments: Blacks, Hispanics, Asians, Native Americans, obese people, and those with a strong family history need earlier and more frequent screening.

Thyroid disease screening
Who Needs: Women 50 and over; those with high cholesterol, family history, or other risk factors.
How Often: On professional advice.
Comments: Routine screening remains controversial. Talk to your doctor about risk factors.

Bone-density testing
Who Needs: Women starting at age 65; men, age 70. Those at high risk for bone loss should start earlier.
How Often: On professional advice.
Comments: Risk factors include being small-boned, sedentary, a heavy drinker, or a smoker, or having a personal or family history of osteoporosis.

Chlamydia screening
Who Needs: Sexually active women 24 and younger; older women at increased risk (such as multiple partners).
How Often: Annually, or more often.
Comments: Men who have unprotected sex should also be tested.

Glaucoma screening
Who Needs: People at high risk: those over 40, very nearsighted, or who have diabetes; Blacks over 40; those with family history of glaucoma.
How Often: On professional advice of eye specialist.
Comments: Benefits of routine screening remain unproven. Still, most eye specialists advise testing all adults 40 and over every 3 to 5 years.

Abdominal aortic aneurysm (ultrasound)
Who Needs: Men 65 to 75 who ever smoked (at least 100 cigarettes lifetime)
How Often: Once.
Comments: Some experts think women 65 to 75 who smoked and anyone over 75 who smoked should also be tested.

Dental checkup
Who Needs: All adults.
How Often: Every 6 months, or on professional advice.
Comments: Should include cleaning and exam for oral cancer.