Health screenings are a way to find diseases and health conditions before there are symptoms. Physicians recommend having certain screenings at certain ages.
"People are becoming more aware of the screenings that are in place now; often our nurses remind them," says Dr. David Gasperack, regional director of WellSpan Medical Group.
Everyone should have a colorectal screening at age 50; those with risk factors for colorectal cancer may be advised to have a screening prior to age 50. A colonoscopy is the “gold standard” for screening for colorectal cancer, say both Gasperack and Dr. Gary Gehman of Penn Medicine Lancaster General Health Physicians Family Medicine Abbeyville.
"People are having conversations about this now; that wasn't common 20 or 30 years ago," Gasperack says.
"Sometimes the gastroenterologist who performs the colonoscopy may find a polyp and remove it; polyps can become cancerous,” Gehman says. “We've seen significant reductions in colon cancer through people undergoing a colonoscopy at age 50."
If colonoscopy results are good, the next screening can be done in 10 years. Generally, screenings may stop at age 75.
There are alternatives to colonoscopy, such as fecal occult tests, which Gehman says should be done every year (every two years for a Cologuard test) or a flexible sigmoidoscopy, an examination that covers only the lower part of the colon, which Gasperack recommends be done every three years.
Another alternative is a virtual colonoscopy, which uses X-rays and computers to produce images of the entire colon for the doctor to analyze. According to ScienceDaily.com, one of the newest alternatives is PillCam™ Colon 2, a capsule containing two miniature cameras on either end. As the capsule travels through the digestive tract, it captures images and wirelessly transmits them to a recorder the patient wears on a belt.
Baby boomers, those born between 1945 and 1965, should have a one-time hepatitis C screening.
"Hepatitis C is one of the most common causes of liver failure or liver cancer,” Gehman says. “If you carry the virus, and we find it early, it can be cured. By the time you have hepatitis C symptoms, it's too late."
Lung cancer screening is recommended for adults ages 55 to 80 who have a 30 pack-year smoking history and currently smoke or have quite within the past 15 years.
(A pack-year is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked. For example, one pack-year is equal to smoking 20 cigarettes or one pack per day for one year.)
Screenings should be done annually until age 80, Gehman says, or until the person has not smoked for 15 years.
His and hers
Some screenings are gender specific. For women there are several recommended screenings:
• Mammogram: Current recommendations from the United States Preventive Services Task Force are for routine biennial screenings from age 50 to 74. The American Cancer Society recommends screening beginning at age 45. Both Gehman and Gasperack say a woman's risk factors for breast cancer, such as family history, should be considered when discussing the age to start screening mammograms and their frequency.
Gehman says 3-D imaging has become the "gold standard" in mammography since it provides a finer image for the radiologist to view.
• Pap smear: Women age 21 to 65 should have a pap smear to test for cervical cancer every three years. However women with risk factors for cervical cancer should discuss the frequency with their physician.
• Bone density: It's recommended that all women have a bone density screening or DEXA scan at age 65.
Recommended screenings specifically for men are:
• Prostate cancer: The traditional recommendation is for men to have a PSA (prostate specific antigen) blood test at age 50. However, both Gehman and Gasperack say there is some discussion in the medical community about this screening.
"The PSA number (derived from the test) in and of itself can cause unnecessary additional testing and could do more harm than good," Gasperack says.
Both he and Gehman agree that a discussion with patients about PSA testing and their specific risk factors, such as a family history of prostate cancer, should be held.
• Abdominal aortic aneurysm: Men age 65 to 75 who have ever smoked should have a one-time screening with an abdominal ultrasound.
While those are the major screening tests, both Gehman and Gasperack remind everyone to have cholesterol screenings starting at age 40 or 50, to begin blood pressure screenings at age 50 and to have their blood sugar screened periodically. All of these contribute to one's risk for heart attack or stroke, Gasperack says. If all the numbers look good, the screenings should be done every five years.
"Everyone in primary care places a high value on prevention,” Gehman says. “Screenings are a great way to start."
Other preventive measures to consider are the shingles vaccine and pneumonia vaccine. The Centers for Disease Control and Prevention recommends the shingles vaccine for anyone 60 and older and the pneumonia vaccine for anyone 65 and older.