Roman Dreyer, M.D. Internist at Dreyer Medical Clinic - Fox Valley Villages

Healthy adults seeing their doctor for a routine physical have wide-ranging expectations about which preventive screening tests should be performed. Evidence-based recommendations published yearly by the U.S. Preventive Services Task Force represent the “gold standard” in preventive care. Here is a brief summary of tests that are recommended as part of a complete physical:

A one-time screening for abdominal aortic aneurysm (bulging wall of the aorta in the abdomen) should be performed by ultrasound in men aged 65 to 75 who have ever smoked. It is NOT recommended for men that have never smoked, or for women aged 65-75, because the majority of deaths from rupture occur in women aged 80 or older.

Breast cancer screening should include a mammogram every 1-2 years for women 40 and older. There is insufficient evidence to recommend either a clinical breast exam or a breast self-exam as a routine screening method, since studies have not shown an impact on breast cancer mortality with these tests.

Cervical cancer screening should be done in women who have been sexually active and have a cervix. Routine Pap tests should begin by age 18 or 21 for all women. Screening may be discontinued after age 65 if the woman has had 3 normal Pap tests in a row, and no abnormal pap smears within the last 10 years. Pap test intervals may be lengthened to every 3 years after age 30 if there are 3 normal tests in a row. Screening may be discontinued after a total hysterectomy, unless the woman has a history of invasive cervical cancer. Human papilloma virus (HPV) testing is not recommended for primary screening, but may be useful for patients whose Pap test reveals atypical cells.

Colorectal cancer screening should be done in men and women 50 years of age or older. If you had a parent or sibling with colon cancer before age 60, screening may start sooner. The most common screening options for colorectal cancer include fecal occult blood testing (FOBT), flexible sigmoidoscopy, or colonoscopy. The FOBT should be done once a year. The flexible sigmoidoscopy should be done every 5 years, and the colonoscopy every 10 years. Colonoscopy is the best test for detecting cancer and larger polyps but has slightly higher risks than the other tests.

Most physicians recommend prostate cancer screening for men aged 50 to 70, and for men over 45 who have an increased risk (African American men or men with a first-degree relative with prostate cancer). This is done using a blood test for prostate-specific antigen (PSA) or a digital rectal exam. Surprisingly, evidence to firmly recommend this screening is insufficient because the harms of testing (unnecessary biopsies and possible complications) may outweigh the benefits. The U.S. Preventive Services Task Force recommends individual discussion with each patient regarding whether this is the right test for them.

Depression screening is recommended for all adults, and involves asking a few simple questions.

Cholesterol screening is recommended for men aged 35 and older, and women aged 45 and older, with a blood test for total cholesterol, HDL (good cholesterol) and LDL (bad cholesterol). Women and men younger than the stated age may be screened if they have other risk factors for heart disease.

Evidence is insufficient to recommend for or against routinely screening healthy adults for type 2 diabetes (diabetes mellitus). However, if you have high blood pressure and high cholesterol, you should be screened. The screen is abnormal when a fasting blood sugar level is over 126.

Postmenopausal women aged 65 and older should be screened routinely for osteoporosis. Routine screening should begin at age 60 for women at increased risk for fractures. Screening is done with dual-energy x-ray absorptiometry (DEXA), and should be repeated every 2-3 years to detect changes in bone density.

A Chlamydia infection test should be done in all sexually active women aged 25 years and younger and other asymptomatic women at increased risk for infection.

A gonorrhea infection test should be done in all sexually active women if they are at increased risk for infection (that is, if they are aged 25 or younger or have other individual or population risk factors).

An HIV infection test should be done in all adolescents and adults at increased risk for HIV infection. This includes men and women having unprotected sex with multiple partners; past or present injection drug users; individuals whose past or present sex partners were HIV-infected; and persons being treated for sexually transmitted diseases (STDs). A doctor can discuss these and other risk factors during a consultation.

The following tests are not recommended as part of a routine physical in healthy adults without symptoms:

• Bladder cancer screening with a urine analysis
• Breast cancer susceptibility gene testing for women without a family history of increased risk
• Lung cancer screening with a chest x-ray - evidence is insufficient to recommend for or against this, although some doctors will screen smokers at least once
• Ovarian cancer screening with blood tests or ultrasound
• Pancreas cancer screening with blood tests or ultrasound
• Testicular cancer screening by clinical examination
• Coronary heart disease screening with EKG, exercise stress test, or CT scan for coronary calcium in adults with low or increased risk of heart disease
• Genital herpes screen with blood tests
• Gonorrhea and Chlamydia testing in men
• Hepatitis B and C screening in the general population
• Syphilis testing for those not at risk
• Thyroid disease screening with blood measurement of thyroid stimulating hormone (TSH) - the evidence is insufficient to recommend for or against this, but most physicians tend to check every 2-3 years.

Please keep in mind that these are general guidelines, and each patient requires a specific analysis of his or her risk factors which will help the physician determine the appropriate screening tests.