You may think you know all the health checks you need; whether or not you actually visit the doctor to get them is another matter. But because many recommendations have changed recently, you should know what the experts' latest advice is. An annual checkup remains important for the prevention or early detection of health concerns — it also gives you the chance to talk to your doctor about your weight, lifestyle changes, and what to expect over the next five years, and to update your vaccinations — but experts no longer agree that there is an annual need for certain specialized tests. Here's a list of tests you should have this year and in the future:
Blood-pressure checks are essential, because most people who have high blood pressure don't know it. If your blood pressure is normal for your age at your annual checkup, many physicians now believe you can wait two years for another check. But if you have heart disease, diabetes, kidney problems, or certain other health issues, you'll need to have it checked more frequently.
Like high blood pressure, high cholesterol doesn't come with any warning symptoms, so the American Heart Association suggests we all have our physicians determine our total and HDL blood-cholesterol levels. This is particularly important for people with a family history of heart disease, high blood pressure, or stroke.
The U.S. Preventive Services Task Force recommends getting a baseline measure at least once for men, ages 35 to 65, and women, ages 45 to 65, with a schedule for further testing based on the results of the initial test. If your cholesterol levels are within normal range, the rule of thumb that the National Cholesterol Education Program recommends is to have it retested in five years. However, if your doctor suggests testing for cholesterol more frequently, there may be an advantage. Studies show that when patients know they'll be tested more often, they're more likely to stick to a heart-healthy diet (or to take their cholesterol-lowering medication).
Sorry, there's no way around this one: An annual checkup is a must not only for detecting and preventing tooth decay and gum disease, but for a professional cleaning, too.
Everyone (with or without eye problems) should have regular eye exams every two years after the age of 40; once you are 45, make sure that you have a check for glaucoma, too.
Ask your physician if you are up-to-date with immunizations. There are new vaccinations recommended for people in your age group, and new recommendations for re-vaccinating in certain cases. Discuss your own needs with your physician, but here are some general guidelines:
* You should receive a flu vaccine every year after age 50.
* You should inquire about a vaccine to reduce your risk of pneumonia.
* You should ask if you need a tetanus-diphtheria booster vaccination, which is usually given every ten years.
* Your doctor may want you to get a booster vaccination for shingles or herpes once after age 60.
How frequently women should have mammograms is a source of much debate. Some medical groups suggest that it is most beneficial (and cost-effective) to have the test once every two years, but The American Cancer Society still recommends an annual mammogram starting at age 40. Women at higher risk (defined as a greater than 20 percent lifetime risk) should get an MRI with their mammogram every year. Women with moderately high risk (a 15-to-20 percent lifetime risk) should talk with their doctors about the pros and cons of adding MRI screening to their yearly mammogram. Annual MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15 percent.
Physicians do recommend that women do a breast self-exam monthly starting in their twenties, and that they contact their doctor immediately if they notice a change. A complete clinical breast exam by a gynecologist or appropriate health-care provider is recommended every year for women older than 40, and every 3 years for patients in their twenties and thirties.
Screening for cervical cancer should begin about three years after women begin having vaginal intercourse, but no later than age 21. From that point, women should have an annual screening with the traditional Pap test, or a biannual screening using the newer, liquid-based Pap test. But the American Cancer Society's guidelines now suggest that beginning at age 30, women who have had three normal Pap-test results in a row can have a screening every three years, instead of annually, unless their doctor determines that they have special risk factors. And women older than 70 who have had three or more normal Pap tests in a row and no abnormal results in the last ten years may choose to stop having cervical-cancer screening completely.
One last note: For women going through menopause, the American Cancer Society now recommends that regular checkups include information about the risks and symptoms of endometrial cancer, and strongly encourages women to report any unexpected bleeding or spotting to their doctors.
Colon and Rectal Cancer
According to the American Cancer Society, both men and women at average risk for developing colorectal cancer should use one of the screening tests below starting at age 50. Talk to your doctor about which test is best for you, but you may need to start screening earlier if you have a family history of hereditary colorectal cancer syndromes or any other risk factors.
Tests that find polyps and cancer include: a flexible sigmoidoscopy every five years; a
colonoscopy every ten years; a double-contrast barium enema every 5 years; and/or a CT colonography ( or "virtual colonoscopy") every 5 years.
Tests that mainly find cancer include: an annual fecal occult blood test (FOBT); an annual fecal immunochemical test (FIT); and/or a stool DNA test (sDNA), for which the best frequency is yet to be determined.
There's some controversy about the most-effective frequency of prostate checks. The American Cancer Society does not support automatic, routine testing for prostate cancer; it does, however, suggest that health-care professionals should discuss the pros and cons of early-detection prostate-cancer testing with men and offer annual testing, starting at age 50, with the prostate-specific antigen (PSA) blood test and digital rectal exam (DRE). Those patients who choose that option should be tested, but men who have an immediate ("first-degree") relative with prostate cancer ought to be tested even earlier.
All women older than 65 should have a bone density test (DEXA scan); all postmenopausal women with fractures should have a bone-density test; and women younger than 65 who have risk factors for osteoporosis should have the test. Speak to your physician about the right amount and type of exercise and calcium intake you need to help prevent osteoporosis. (All men older than 70 should also have a DEXA scan.)
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