How often should you get a lipids panel? What about a pap smear? Is it recommended for men to test testosterone levels or get a PSA test every year? Do you need to know your vitamin D levels?

These questions often confuse patients, and if they try to figure it out for themselves, it could lead to overtreatment. Doctors said the key to getting appropriate care is to learn family medical history, understand risk factors and consult with a physician about an individual plan.

Screenings are again a hot topic after Dallas billionaire Mark Cuban recently suggested on social media that anyone who can afford to should get every test or screening available every quarter.

Doctors note that this take on preventive medicine is impractical and wasteful. In fact, they say, it could lead to a cycle of anxiety and risk-filled invasive tests that may not improve or extend a patient's life.

"Our public has been educated to believe that more is better," said Dr. Roger Fowler, a family physician of 35 years and medical director of Population Health Management for Trinity Mother Frances Hospitals and Clinics. "The assumption in our culture is everything that is bigger, flashy and more expensive is better, but in health care, that's not always true."

Screenings aren't perfect and are meant to cast the net widely, when trying to find disease. That's why it's important to identify segments of the population that would benefit from certain screenings.

"My concern would be that you're spending a lot of money on things that aren't proven to change outcomes," said Dr. John English, chief executive officer at Bethesda Health Clinic.

English said a screening panel, which may include checking for anemia, blood sugar, checking the liver, kidneys, cholesterol levels and thyroid could cost around $300 to $400.

COMMON SCREENINGS

Determining which screenings to give and frequency is determined by a person's age, gender, family history, other risks and whether a patient already has a chronic disease.

"Screening is good for finding things that you're genetically prone to have, which most of the time you have a family history of," English said. "Obviously, it's a good idea to have people checking their blood pressure. That's an easy one to do."

He said genetics play a huge role in some results, such as cholesterol.

"Unless you have a major life-altering event, your cholesterol is pretty much set," he said. "Cholesterol is very genetic."

A life-altering change includes dramatic weight loss, weight gain, or developing diabetes. English said a patient with borderline high cholesterol and risk factors may be screened every year.

"If they have a normal cholesterol with no family history, you might not do it for every five years," he said.

He noted that blood sugar levels also might not change much.

"If you're eating healthy and exercising and your weight was good and the A1C and sugar was good, to check it again in three months, it's probably not even appropriate in people on medicines."

Fowler said anyone older than 50 should get a check up yearly. He added that healthy males ages 18 to 50 should be seen every three to five years and have blood pressure checks and other screenings, such as cholesterol and blood sugar.

For women, there are several other screenings to consider, although recommendations for those tests are evolving.

"New information on otherwise young healthy women say that pelvic exams just as a routine are not beneficial and are no longer recommended, if they're not symptomatic," Fowler said.

The U.S. Preventive Services Task Force recommends women ages 21 to 65 get a pap smear every three years if previous results are normal. It can be stretched to every five years in women ages 30 to 65 if accompanied with an HPV test, which detects the virus that can causes cervical cancer.

"This is based on good long-term population studies that says that what we're looking for is cancer of the cervix," Fowler said. "It's not going to develop in a woman who has a normal pap smear and no HPV in that five-year time frame."

The PSA (prostate specific antigen) test is one of the more scrutinized screenings.

"There are good studies that show using that just as a screening tool in asymptomatic men has led to more biopsies, complications from biopsies and even the treatments than lives saved by doing that test on a routine basis on every male over the age 50," Fowler said.

However, the test is still done often.

"A lot of that is the legacy of people asking for it wanting to avoid cancer, which I don't blame them at all," Fowler said. "I want to do for my patients what is indicated, but that is one test that there is still controversy with the American Urology Association disagreeing with that."

The U.S. Preventive Services Task Force also recommended against the test in 2012.

According to the American Cancer Society, most men who have high PSA levels don't have prostate cancer, and only one-fourth of those who have biopsies due to increased levels, have prostate cancer. Studies have shown that the slow-growing cancer may not ever cause a problem. Ultimately, screening for it is an individual choice men and their doctors make together.

When and how to conduct breast cancer screenings continues to be highly debated.

"There is clear evidence that say mammograms are a useful tool," Fowler said. "The frequency of that is still debated as to if it should be every year or every two years, and what age to begin, whether its 40 or 50. The importance is having a relationship with your primary provider, so they can guide you with the most recent information and to have that conversation is what's important."

As for imaging, more exposure to radiation equals more risk. MRIs may be a safer alternative to X-rays and CT scans, but it's much more expensive, Fowler said.

"Getting a back X-ray on everybody who has back pain is just not indicated," he said. "We don't need to expose everybody to that kind of radiation. We know from the past that we have created problems whenever we'd done X-rays on the necks of children many, many years ago. It created thyroid problems. That is a concern and it is being addressed in health care right now."

REAL PREVENTION

As conversations stir within the medical community, doctors say they are more cognizant of the concerns about when to screen. Fowler said doctors at his hospital have discussions about it frequently.

"Providers are being educated to that," Fowler said. "Sometimes it is not fully adopted well. Our reimbursement system is one that pays providers when tests are done. It doesn't pay providers to not do tests. As perverse as it is and non-mission driven, people have to make a living and it's hard to give up tests when it's simple to do. Our reimbursement system doesn't help us in this area right now."

While health literacy is encouraged, following advice of online sources or influential people not in the medical field can be harmful.

"People should get educated, but trusting your physician and asking questions is the right way to be your own advocate as an intelligent consumer, just like when you go buy a car," Fowler said. "You need to be prepared and look out for your interests and make sure that the tests being recommended are not going to harm you, not just going to lead to more testing for no reason and potentially lead to a good outcome for you."

Fowler and English both said the best prevention is found in an already-proven method. This includes 160 minutes of exercise weekly, a well-balanced meal, maintaining a healthy body mass index and avoiding tobacco, recreational drugs and excessive alcohol.

"Of all of the disease processes that we get after the age of 50, somewhere between 60 to 70 percent of those are directly related to lifestyle choices," Fowler said. "If we want to do something that really addresses all of our risks and ability to live optimally in our life, it's not necessarily about doing a specific test. It's about choices that lead to the best outcomes."

Twitter: @CDillard_TMT

 
 

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