Ask About These Lifesaving Medical Tests

Are your health screenings up to date?

by Peg Rosen
Photograph: Illustrated by Bryan Christie

To get the best possible medical care, you may need to speak up. “The key is knowing your own health history and risk factors and determining with your doctor what’s right for you,” says New York cardiologist Nieca Goldberg, MD. Here, the tests to discuss with your doctor during your next visit.

Glomerular Filtration Rate Screen

This blood test, which gauges how well kidneys remove waste from the body, can detect early signs of renal disease, which is on the rise in the U.S. 

Who Should Get It? Adults with risk factors for kidney disease, which include: a family history of diabetes, heart disease or high blood pressure; chronic use of anti-inflammatory medicines like ibuprofen.

How Often? Every three to f?ive years

Next Steps If results show mild dysfunction, your MD will probably monitor you and encourage
lifestyle changes. For advanced cases, drugs can help. Go to kidney.org for more information.
 

25-Hydroxy Vitamin D Test
Most Americans don’t get enough D, which is a problem because sufficient quantities are necessary to ward off osteoporosis. The blood test determines how much 25-hydroxy—a precursor to vitamin D—is in your system. 

Who Should Get It? Anyone who lives north of Atlanta, uses sun block, is a person of color or spends a lot of time indoors. Over-40 women should consider the test, since osteoporosis risk increases as estrogen ebbs.

How Often? Every six months unless otherwise specified

Next Steps OTC supplements are used to boost levels. “If levels are very low, prescription-strength doses might be necessary,” says Larisa Connors, MD, of Harvard Medical School in Boston.

Hemoglobin A1c
Unlike blood glucose tests, which give a snapshot of blood sugar levels, A1C reflects a three-month average. “It helps catch early cases of diabetes,” says Lauren Golden, MD, of Columbia University Medical Center in New York. 

Who Should Get It? Diabetes experts suggest screening at age 45—and earlier if you have a family history of diabetes or a personal history of gestational diabetes, being overweight or hypertension.

How Often? Twice a year, or more frequently if necessary

Next Steps If A1C results are elevated, the test may be repeated to confirm a diagnosis. “In many cases, diabetes can be controlled with lifestyle changes instead of medication,” Golden says.

DNA with Pap Test
While regular Pap smears detect abnormal cells, this test can identify the human papilloma virus (HPV) before precancerous cellular change occurs, says Mindy Goldman, MD, at the University of California, San Francisco.

Who Should Get It? All women over 30, since HPV can lurk undetected for decades. HPV-vaccinated women should also be screened, as the shot only protects against some cervical cancer–causing strains.

How Often? Every three years when results are normal (plus annual pelvic exams)

Next Steps A positive HPV test with a normal Pap result may indicate a need for repeat testing. If your DNA test is positive and your Pap is abnormal, you may need a colposcopy and a biopsy.

Baseline Electrocardiogram
A baseline picture of the healthy heart’s function can help physicians track negative changes later in life. Electrodes on your chest collect information. 

Who Should Get It? “Everyone will likely have cardiac issues eventually, so it’s good to get a
baseline by 50,” Connors says. (Earlier if you’re at risk.)

How Often? As symptoms, such as shortness of breath, occur

Next Steps If the doctor finds abnormalities, she might order further testing. Otherwise, results will be used as a reference when you’re retested.
 

Comprehensive Glaucoma Screening: “Everyone deserves a comprehensive glaucoma exam,” — the precise measurement of internal eye pressure with a device that comes in contact with the eye (not that perfunctory puff of air that only roughly gauges pressure), according to Nancy Fan-Paul, M.D., M.P.H., at Columbia University Medical Center in New York. Ophthalmologists (who are M.D.s) and some optometrists offer this service.Who Should Get It/When: Experts recommend a baseline glaucoma screening by age 40; earlier if you have a family history of glaucoma or other risk factors, such as nearsightedness and diabetes.

How Often: Every 1-3 years

Next Steps: There is no cure for glaucoma, but medication (usually in the form of eye drops) and in severe cases, surgery, can limit optic nerve damage and help avert blindness.

High Sensitivity C-Reactive Protein Test: Hailed several years ago as a major new tool for detecting heart disease in the general population, this simple blood test that gauges inflammation in the body hasn’t quite lived up to expectations, due to high false positive rates and questions about whether it brings anything truly new to the picture. HsCRP can, however, tip the balances for your doctor if she’s on the fence about treating you for borderline high cholesterol. It is also often recommended for people who have two or more risk factors for heart disease, such as a family history and smoking.

Full Body Skin Exam: If your dermatology visits are limited to Botox and dermabrasion, you and your doc are both missing the boat. “Skin really is the mirror of your health. In 25 years, you wouldn’t believe the diagnoses I’ve made while doing a screening exam,” says Debra Jaliman, MD, assistant professor of dermatology at Mt. Sinai School of Medicine in Manhattan. Jaliman isn’t just talking about melanoma and other types of skin cancer, which is in itself reason enough to go. Everything from our scalp to our nails can provide telltale signs of diseases and disorders ranging from lymphoma to anemia. “A thorough exam is not a door-on the-handle affair,” says Jaliman, noting that a derm who means business will ask you to strip naked and will use magnifiers to check you from head to toe, including your scalp, between your toes, and—in some cases—on your vulva and between your buttocks. “I found breast cancer on the nipple of a woman that her own breast doctor missed. Truly, there are ways a good dermatologist can save someone’s life that most people will never think of.”
Who Should Get It/When: Anyone old enough to have skin should have a regular dermatological exam, says Jaliman only half kiddingly. For sure, adults over 40 should go at least yearly; more often if they have a personal history of skin cancer or history of sunburn and moles.
Next Steps: If a lesion is considered suspicious, a dermatologist may biopsy it in her office. Depending upon results, more of the lesion may have to be removed or further treatment may be needed.

Transferrin Saturation Test: Hemochromatosis, a disease that causes a potentially deadly buildup of iron in the body, is the single most common genetic disorder among Americans. But early symptoms, which include joint pain, fatigue and low sex drive, can be so vague that doctors miss the diagnosis. Interestingly, women often don’t develop signs of the disease until they reach menopause, since monthly periods have until that point naturally help clear the body of excess iron. “The transferrin saturation is a screening test for iron overload. Many would argue it’s a test everyone should have at least once in their lifetime,” says Faubion. 

Breast MRI: MRI’s can detect masses in the breast before they are big enough to be picked up by mammograms and sonograms. However, false positive rates are high and can lead to unnecessary biopsies. “It’s not a good idea for all women, but for those with a family or personal history of breast cancer or are BRCA I or II positive, MRImay still be a very worthwhile test,” says William Parker, M.D., clinical professor of ob/gyn at UCLA School of Medicine.

First Published Fri, 2010-02-26 15:18

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