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Annual Exams and Select Screenings Are Crucial
Dr. David Lipschitz
you are over 50, it is time to have an annual physical. At an earlier
age, provided there are no known medical conditions, a screening
every two to three years may be adequate. Not every 50-year-old receives
an annual physical, and when they do, they often receive more testing
than needed. It is important, therefore, that everyone know what
should and should not be included in the examination.
An annual physical includes a careful history and physical examination during
which any problems and complaints are documented, as is a history of hospitalizations,
surgeries, allergies, medical conditions and medications taken.
A family history is needed to determine if there is an increased risk of heart
disease, cancer, diabetes or Alzheimer’s, as well as a sociological assessment
(marriage, education, religious preferences, habits). The examination seeks to
gauge high blood pressure and heart, lung, abdominal, vascular and neurological
An assessment of mood is important and if older, a screening test for memory
loss may be done. Calculating the body mass index identifies obesity. (There
are many BMI calculators online.) A value above 30 is considered obese. No examination
is complete without counseling on how to stay healthy and manage obesity. A referral
to smoking cessation programs can also be recommended, if needed.
Perhaps the most confusing and over-utilized portion of the annual physical is
the screening tests needed to exclude or prevent disease. Most recommendations
come from the United States Preventive Services Task Force. Its approach is based
on a meticulous analysis of all available scientific information by a panel of
experts in public health.
To prevent heart disease, high blood pressure is measured two to three times
annually and cholesterol levels in the blood should be evaluated every two to
three years after age 50. Some experts suggest that elevated cholesterol should
be excluded for the first time as early as age 20. Blood pressure can be measured
at home or at a drugstore.
Electrocardiograms, stress tests or CT scans of the heart should not be done
solely as screening tests in healthy individuals. Blood tests are obtained to
evaluate liver, kidney and thyroid function and to exclude anemia. Unless a medical
condition warrants it, there is no need to perform screening tests every year.
The preventive task force only recommends screening for diabetes in healthy patients
with elevated blood pressure. However, most other groups suggest that screening
should be obtained every 2-3 years in obese individuals or those with a family
history of diabetes.
Most contentious are recommendations for cancer screening. The task force recommends
mammograms every two years for women in the 50-75 age group. Mammograms should
be done annually for women 40 to 50, only if there is significant increased risk.
A routine pap smear to screen for the human papillomavirus and cervical cancer
should be done every three years in sexually active women up to age 65. The task
force states that screening for ovarian or bladder cancer is of no proven value.
For men and women, a colonoscopy should be done at age 50 and every five years
thereafter until age 75, and screening the stool for microscopic amounts of blood
should be done annually. Of all the screening tests available, those to identify
colorectal cancer are the most effective. Recently, the task force recommended
against the PSA (prostate-specific antigen) blood test to screen for prostate
cancer in healthy men of any age. Like the mammogram, this remains contentious
with many experts recommending that prudent use of this test continue.
As part of the annual physical examination, vaccinations must be reviewed. Today,
teenage boys and girls should receive the vaccine for the human papillomavirus
to decrease the risk of cervical and penile cancer. Everyone over age 50 should
be vaccinated against shingles and over age 65 the pneumococcal vaccination should
be given. Flu vaccination is required annually.
Strive to be as educated as possible about what it takes to stay healthy and
prevent disease. Go into the doctor’s office armed with information so
that you are able to ask the necessary questions to get the best care possible.
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