The Checkup, Too Much or Too Little?
23 Apr 2002
What constitutes a good checkup examination? Good sense dictates that young children don’t need a Pap smear for cervical cancer, a PSA test for prostate malignancy or X-ray studies to measure bone density. So what’s done depends on the patient’s age and it can save a life or prevent serious diseases.
Today many hi-tech diagnostic tests are available, but the stethoscope is all that’s needed to spot a big killer. Since 60 million North Americans have hypertension a blood pressure check must be a part of every annual examination. It’s the second leading cause of kidney failure.
Routine blood tests help to pinpoint problems such as anemia. But today the one test everyone wants done is blood cholesterol. What’s debatable is when it should be checked. Some argue it needed as early as age 20, others say 35 is a more reasonable time. And then it should be done every five years.
What isn’t debatable is a fasting blood sugar (FBS)to detect diabetes which has reached epidemic proportions. Every 45 seconds a new diabetic is diagnosed in North America and 90 percent of cases are due to obesity. Diabetes sets the stage for heart disease, kidney failure, blindness and gangrene of the legs. FBS is a "must" test since too many people have undetected diabetes.
In the 40’s it’s important to have an electrocardiogram (EKG) even if you don’t have heart problems. Later in life if you experience chest pain and EKG changes are present it’s helpful to compare these changes with the earlier EKG.
In a perfect world at 35 to 40 years of age everyone should have a colonoscopy. This procedure examines the entire large bowel to determine if polyps (fleshy growths) are present. It takes many years before some become malignant so early removal saves lives. If colonoscopy isn’t available in your community arrange for a sigmoidoscopy which examines the lower large bowel. After age 50 a colonoscopy should be done every five years.
Breast examination should be a part of every yearly checkup. But there’s no agreement when to start mammography. Some authorities say age 40, others age 50. But after age 50 most concur it should be done every two years. Unfortunately it sometimes detects masses that turn out to be benign which causes sleepless nights. And misses cancers that are present. It’s a test that overall leads much to be desired.
Pap smears should be started as soon as a woman is sexually active. Some authorities claim that if the smear is normal three years in a row it can be done less frequently. But since Pap smears are not 100 percent accurate many gynecologists prefer an annual smear.
What is more controversial is when men should be advised to have a PSA test to detect prostate cancer. The American Cancer Society recommends prostate screening starting at age 50. Others argue that most prostate cancers grow slowly and not all are fatal. Agreeing to radical surgery or radiation treatment may result in impotence and spending the rest of your life in diapers. Only an open discussion with your doctor can solve this dilemma. But a PSA at age 70 becomes questionable. Even if it shows early prostate cancer most men survive 15 years without any treatment.
Today many adults have failed to keep immunizations up-to-date. A cut from a rusty nail may result in dying from tetanus. Or death may occur from cirrhosis or liver cancer unless protected from the hepatitis B virus. Each year 70,000 North Americans die from failing to obtain influenza and pneumoccal vaccine. And when did you last have a polio shot? The annual check-up is the best time to see what immunizations should be brought up-to-date.
Check with your doctor about supplements. All women of child-bearing age should take a multivitamin containing 400 micrograms of folic acid. It’s vital that this is started before pregnancy occurs to prevent spinal cord defects in newborns. Unless you drink milk everyone needs vitamin D to help absorb calcium. And elderly people are often lacking in B12. There’s also evidence that folic acid, B6 and B12 are needed to keep homocysteine levels normal and help to decrease the risk of coronary artery disease. And vitamins C and E , both antioxidants, help to rid the body of the waste products of metabolism called free radicals. There’s reasonable evidence that antioxidants decrease the risk of cataracts and other aging problems.
