To stay healthy, what regular testing do you need? The answer is complicated, and it changes as new research improves our understanding of illness.
Preventative testing is beneficial when it provides help and not harm. The tests need to be accurate, and the illnesses need to be relatively common. Doctors don’t want patients to suffer with falsely positive screening tests – this can lead to unnecessary testing.
The decision to include a screening test in the preventive schedule is the result of a complex interplay between risk and benefit. The burden of testing and treatment is included, as well as the number needed to treat (NNT) to prevent a death from a serious illness.
Advice for screening comes in the form of statements and recommendations by the U.S. Preventive Services Task Force (USPSTF). USPSTF gives recommendations a letter grade, from A to D. “A” grade advice is the best, for everyone. “B” and “C” grade advice is okay, and “D” grade advice is uncertain and controversial. This information is available at www.uspreventiveservicestaskforce.org.
Men: Prostate Cancer
Prostate cancer is the most common type of cancer in men in the United States. Men have a 16 percent risk of prostate cancer, and the risk of death from prostate cancer is 2.8 percent.
Prostate-specific antigen (PSA) screening is quite controversial. It can reduce prostate cancer death by 20 percent. Treatments for prostate cancer, however, can cause pain, infections, urinary incontinence, bowel incontinence and erectile dysfunction. Current testing doesn’t indicate which prostate cancer needs to be treated and which doesn’t. In a recent study, the NNT=49, which means to save one life 10 years after the screening, 48 men had treatment and suffered side effects with no benefit. PSA testing can give an over diagnosis rate of 17 to 50 percent. Overtreatment results in a moderate probability of early and persistent harm from treatment.
USPSTF advises against PSA screening for prostate cancer, giving it a D grade. Men 75 and older in most circumstances should not get the screening test. However, black men and men with a family history of prostate cancer are at greater risk for prostate cancer, and the benefit of testing in this subset is unknown.
Women: Breast Cancer
Breast cancer is the most common type of cancer in women (excluding non-melanoma skin cancer). It is one of the leading causes of cancer death among women of all ages. As many as one in eight women will get breast cancer.
Mammograms are the best method of detecting breast cancer in an early treatable stage. Mammograms can be painful, and newer digital technology may be more accurate and less painful than older technology. Breast cancer screening can reduce death from breast cancer by 15 percent in women from age 40 to 70. After age 75, mammograms aren’t as beneficial because cancers are often slower growing in older individuals. New medications are available that stop the growth of most types of breast cancer with few side effects.
Women should get mammograms every other year from age 50 to 74, and USPTSTF gives this advice a B grade. Current evidence is lacking for screening women age 75 and over. Self-breast exams should not be taught – grade D advice. Current evidence is lacking for the risk and benefit of an annual breast exam.
The Medicare annual wellness visit is the best time to talk about these tests and other important screenings that are vital for your health. This annual wellness visit is a time to focus only on prevention.