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By RANDOLPH FILLMORE
© St. Petersburg Times, published May 10, 2000
Thanks to Katie Couric, we know that by age 50 we should have a colonscopy to screen for colon cancer.
The Today show host lost her 42-year-old husband to colon cancer in 1998 and has since been on a campaign to educate Americans about detection and prevention.
But not every disease or malady has such a famous spokesperson, and that's why it's important to know as we age what screenings are needed and when.
During that yearly physical -- yes, yearly -- most physicians encourage a variety of tests, depending on your sex, age, ethnicity and family history.
For example, all men older than 50 should have a yearly PSA test (prostate specific antigen) to detect prostate cancer. African-American men, who have higher rates of prostate cancer than whites, should start PSA testing at age 45. So should men with prostate cancer in their family.
Should women have yearly mammograms to help detect breast cancer? Yes, but even the professional community is spilt over what age regular mammograms should begin. What about tests to check for Alzheimer's disease? One may be on the way. A glaucoma test to prevent blindness? A simple, yearly looking into your eyes could save your sight.
Here is a list of some of the most common, and necessary, medical screenings:
Tests for men
PSA (prostate specific antigen). The PSA test is considered the "gold standard" for diagnosing prostate cancer. It is a blood test that measures how much of a protein produced by the prostate is circulating in the blood. The protein is normally present, but the amount increases dramatically with prostate cancer. PSA counts of below 1.0 are normal, although normal for some men may reach into the low whole numbers. A PSA count of 3 is suspicious and above 6 toward 10 probably means prostate cancer. It is important to establish a baseline PSA so that increasing numbers -- and they do normally increase as men age -- can be monitored. Men with benign prostatic hyperplasia, an enlargement of the prostate but not prostate cancer, will often have borderline high PSAs.
EKG stress test. The electrocardiogram detects abnormalities in heart function. While the test should be done periodically for every adult, men are generally prone to heart disease a decade or two before women, so they should start screening sooner. If you are older than age 40 and just starting at a gym, have a precautionary stress EKG to see how your heart will handle exertion.
Depending on your weight, history of tobacco use, lifestyle, diet or family history, the sooner routine EKGs start after age 40 the better. The EKG is connected to the skin in various upper body locations by 12 sensors, which record the conduction, magnitude and duration of the heart's electrical activity.
The EKG produces a graph that details the size of the heart's chambers and, when used along with physical exertion, can monitor stress effects. The test produces tracings of the heart's wave forms, which can be analyzed to detect the onset of angina (chest pain) by tracking the abnormal function indications leading up to it.
Poor or good reactions to physical exertion will show up when a patient is monitored while walking or running on treadmill or riding a stationary bicycle. Many symptoms of cardiovascular disease do not show up as angina unless the heart is stressed by exercise. Coronary artery disease can be diagnosed almost 50 percent of the time through the stress EKG alone.
Often a thallium scan will be performed at the time of an EKG stress test. Thallium is injected into a vein during exercise and a scanner shows how it circulates through the heart. Areas where the thallium does not go suggest blockage.
Pap smear. The Papanicolaou test is a woman's best defense against cervical cancer. The test requires scraping secretions from the cervix and spreading them on a glass slide for microscopic inspection. The American Cancer Society recommends a Pap test every three years for women between the ages of 20 and 40 who are not at high risk and yearly tests for those with a family history of cervical cancer and those older than 40. While a positive Pap test is suspect for a malignancy, the test is also useful for detecting and assessing inflammatory changes in tissue as well.
The test should not be scheduled during menstrual periods. It usually takes five to 10 minutes to perform and woman should refrain from sexual intercourse for 24 hours before and from douching or using vaginal creams for 48 hours. Typically, it takes about one week to receive results.
Mammogram. Mammography is radiography of the breasts to identify growths that may be cancerous. The American Cancer Society recommends that women in their 40s who are at average risk of breast cancer should be screened every two years. Women 50 and older should be screened annually. Women younger than 40 who may be at higher risk because of a family history of breast cancer should seek medical advice about when and how often they should get screened, starting as early as age 35.
There is still debate over whether women between 40 and 50 should get yearly mammograms. The debate is generally over costs per life saved. Despite these differing opinions, increasingly, women between 40 and 50 are playing it safe and getting yearly tests.
Along with mammograms, a clinical breast examination by a health care provider should be included as part of regular, routine health care. While mammography is the best screening tool available, it has limitations.
Breasts of younger women can contain many glands and ligaments that appear dense on a mammogram, making it difficult to spot tumors. About 25 percent of breast tumors are missed in women in their 40s compared to 10 percent for women in their 50s. Also, between 5 percent and 10 percent of mammograms are abnormal. Of those in younger women that are followed up with additional tests (another mammogram, fine needle aspiration, ultrasound, or biopsy) most will not be cancer.
Over the past 30 years, improved mammography has been able to detect a higher proportion of small tissue abnormalities called ductal carcinoma, abnormal cells confined to the milk ducts of the breast. Some believe these tumors are not life-threatening, while others think they are. Because there is so little data to support either view, the abnormalities are commonly removed surgically. About 10,000 mammography facilities nationwide are certified by the FDA -- for both equipment and personnel -- and are inspected annually.
The names and locations of FDA certified mammography facilities are available by calling the Cancer Information Service at 800-4-CANCER. In addition, the FDA has included a list of all FDA certified mammography facilities in the United States on its Internet home page. The address is http://www.fda.gov/cdrh/faclist.html.
New imaging technologies under development for breast cancer screening include magnetic resonance imaging, breast ultrasound and breast-specific positron emission tomography. In addition to imaging technologies, other methods to detect breast cancer with simple tests of the blood, urine or nipple aspirates, and tests to detect genetic alterations that place women at increased risk for breast cancer, are being developed.
Osteoporosis test. Bone Mineral Density testing is the best way to confirm osteoporosis for men and women. Women at high risk for osteoporosis are post-menopausal women who are not taking estrogen. Men or women being treated with steroids, or people with a history of thin bones as evidenced by past X-ray are susceptible. While women are at greater risk starting at menopause, men become at risk in their mid to late 60s.
Using dual x-ray absorpitometry, hips and spines are scanned and the density of the bone is measured and calculated for density compared to the average peak bone density of a 30 year old. Medicare reimburses for BMD testing every two years or more frequently for qualified persons age 65 and older.
Yearly tests for every adult
Lipids. Lipids is another name for fats. Cholesterol and triglycerides are lipids that need to be monitored, because high levels are associated with heart disease. High cholesterol is called "hyperlipidemia." Getting your lipid panel or total cholesterol number (HDL, LDL and triglycerides) makes sense at any age because keeping the numbers in line, even in teenagers, can help protect against heart disease decades later.
Total cholesterol. Cholesterol is a component of cell membranes, absorbed from the diet and synthesized by the liver. A diet high in saturated fats raises cholesterol, long-associated with heart disease. Total cholesterol counts of 170 to 200 are considered normal for adult men and women. Medication and change of diet can be used to lower high total cholesterol. Cholesterol comes in two kinds -- low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDLs, often called "bad cholesterol," are linked to heart disease. HDLs, or "good cholesterol," are desirable in abundance, the more the better, because HDLs keep LDLs away. Estrogen therapy is thought to protect menopausal women from heart disease because it helps raise HDLs. Studies conflict, however. Exercise is thought to raise HDLs. Triglycerides are the main storage form of lipids, and triglycerides (age and sex related) are normal at 40 to 160 for men and 35 to 130 for women.
Blood tests. The Complete Blood Count (CBC) gives a profile of the blood's elements. Two of the more important aspects of a CBC are the red and white blood counts. Normal red blood count (RBC) in adults ranges from 4.5 to 6.2 in male and 4.2 to 4.8 for women. A low RBC count may indicate anemia. White blood counts (WBC) rise in the presence of infection when the body mounts a defense. Normal is from 5.0 to 10.
Urinalysis. Routine urinalysis is important for screening urinary disorders or diseases -- such as metabolic diseases -- that may manifest themselves by affecting the urine. Tests evaluate the color and clarity of the urine sample as well as look at its content in terms of proteins, sugars and other cell material. It can be used to help detect bladder cancer or diabetes. Remember to go for a urine test with at least a partly full bladder. Although not much urine is needed, some tests may require "mid stream" samples. You may be required to have not had some fluids, especially coffee, for a period of time before the test.
Blood pressure. Testing your blood pressure screens for high blood pressure, or hypertension. Testing is easy. Treating high blood pressure takes some work and consultation with your doctor. Most major pharmacies have a center where you can test your own BP. A routine visit to the doctor should always include BP testing.
The test provides two sets of numbers. It measures the resting pressure between beats -- diastolic, the bottom number -- and the pumping pressure -- systolic, the upper number. Too high is from 140/90 upward. The high end of the normal range is 130/85. A "good" normal is around 120/80. Frequent readings are necessary because BP can fluctuate greatly. The systolic number, the upper number, may be the best predictor of hypertension. African-Americans are 50 percent more likely to have high blood pressure than whites or Asians, studies have shown.
Glucose. Glucose (sugar) is the body's main energy source. Blood glucose results from the conversion of carbohydrates to sugars. Insulin (produced by the pancreas) and glucagon regulate glucose. Diabetes occurs if not enough insulin is secreted. Too much insulin can also cause disruption to metabolism.
Normal blood sugar levels after fasting are 70 to 100 mg. A level of 140 often points to diabetes. The symptoms of diabetes are frequent urination, weight loss, constant thirst, and an open sore that doesn't heal. Risk factors for diabetes are obesity, family history and heart disease. You may have a low blood sugar problem if you are frequently fatigued during the day.
Glaucoma. Having an ophthalmologist look directly into your eyes with an opthalmoscope is the best way to detect glaucoma and many other eye diseases, including macular degeneration (most often in the elderly) or cataracts, all of which can lead to blindness. The doctor can look into the pupil, look at the optic nerve, and inspect the macula, a small vascular area. Direct visual inspection of the eye should take place every two years for younger people and every year for those older than 50.
HIV. Screening for Human Immunodeficieny Virus, HIV, the virus that causes AIDS, involves detecting the presence of HIV antibodies in the blood. For those in risk groups -- and risk groups have expanded to all those heterosexual and homosexual who are sexually active and engaging in unprotected sexual activity with more than one partner -- periodic HIV testing can help keep you healthy and let you live longer if HIV is detected in its early stages. Teenagers and women have greater risk than in the past when HIV was mostly associated with homosexual males.
Two tests, the ELISA (enzyme-linked immunosorbent assay) and the Western Blot, are the standard tests. The ELISA tests for HIV antibodies but is less than 100 percent accurate. Follow-up testing with the Western blot, which detects the presence of viral proteins, is the only reliable confirmation of HIV infection.
New or developing tests
Alzheimer's. The American Neurological Association says that MRI scans of the brain may one day soon be able to diagnose early Alzheimer's disease by looking at brain cells known to be related to memory. Scientists are able to look at past MRI scans of those who later developed Alzheimer's and detect abnormalities. Today you can be tested for the gene (EPo4) linked to inherited early onset Alzheimer's. The genetic defect, however, accounts for only a small percentage of those afflicted.
Peptic ulcer. The Food and Drug Administration just approved a test for H. pylori, an active infection known to be a leading cause of peptic ulcers. The test, which will be marketed under the name Ez-HBTTM, can detect active H. pylori with a simple blood test. The prior blood test in use could not differentiate old from current infection by isolating an enzyme reaction.
Painless blood test. No one likes a "Dracula" visit, where many tubes of blood are drawn after a vein is pricked by a needle. A new technique, using a hand held instrument about the size of a thermometer may be the 21st century's prescription for a painless blood test.
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