Health Screening Tests

By David A. Johnson MD, Medical Director, Signature Care

Tuesday, November 14th, 2005; Posted: 2:21 p.m.

In recent years, from the vantage of consumers of medical services, healthcare providers, and from the perspective of health insurance plans, our views of how to maintain good health have undergone enormous changes. In the past, people tended to seldom consider the effects that their diet, level of exercise, and habits like smoking and drinking had on their health. There was a tendency to just wait for symptoms to appear before seeing a doctor. Doctors tended to see patients only after pronounced symptoms developed. Thankfully, there is now much more emphasis on prevention, including education about diet and exercise, and a strong movement to decrease exposure to known carcinogens and harmful consumer products.

Along with this new awareness of health, developments in health screening tests have enabled us to detect diseases before symptoms occur. The combined effect of improved education and health awareness along with the use of health screening tests has saved countless lives and healthcare dollars.

But, we need to do an even better job preventing disease and detecting it early in its course before it can do real harm. It just makes good sense to find and treat potentially harmful conditions in their infancy. For insurance plans and employers, it makes economical sense to spend a smaller amount of money to detect an illness in its early stages than spending extraordinary amounts of money to try and contain a full-blown medical catastrophe.

Given this logic, it seems very worthwhile to encourage health screenings for consumers. But, which screening tests are appropriate for a given individual? Which should be covered by health plans? What makes a good screening test?

First, let's look at some examples of screening tests that are typically recommended by doctors and some that exist but may not be recommended. Then, we'll look at what makes a good test.

EXAMPLES OF HEALTH SCREENING RECOMMENDATIONS

Screens Recommended for Symptom-Free Adults:

1. Blood sugar testing for diabetes
2. Blood pressure testing for hypertension
3. Lipid profile with HDL to assess cholesterol
4. Obesity screening with height & weight
5. Routine pap smears for women
6. Sexually transmitted disease testing in at-risk individuals
7. Mammograms in women over age 50
8. Osteoporosis screening for women over age 60
9. Colonoscopy for individuals age 50 and older

Screens which may be beneficial but have questions or issues in symptom-free adults (I'll explain some of the issues later in this article):

1. PSA blood tests for prostate cancer screening
2. Mammograms in women under age 50

Screens which are not generally recommended in symptom-free adults:

1. CA-125 blood tests for ovarian cancer
2. Routine chest x-rays
3. EKGs, treadmills, or coronary calcium scoring
4. Full body scans to check for cancers

This is just a partial list of possible health screens. It is up to each individual and his/her doctor to decide what is best for that individual.

Now, let's talk about some of the qualities that make a screening test a good test.

1. A test should be screening for a disease that has significant morbidity (serious disease) or mortality (death) risk.
2. A test should be reliable.
3. A test should look for a disease that has effective treatment.
4. Early treatment of a disease should lead to a better outcome than if treatment was initiated at a later time when symptoms would have led to a diagnosis
5. Cost effectiveness for the society should be demonstrated.

This is not an all-inclusive list, but keep these points in mind to help evaluate the myriad of screening tests available.

Some screens, such as blood pressure checks and blood sugar tests are "no-brainers" and are strongly endorsed. Other tests, such as yearly mammograms for women over age 50, have been shown in studies to fulfill the above criteria and are encouraged by doctors and health plans alike.

There are, however, a large number of health screens that do not meet the above criteria - either logically or in clinical studies. It is this group of tests that oftentimes generates the most publicity and controversy. Screening tests such as full body scans for malignancies and the CA-125 blood test for ovarian cancer are popular topics in the media and around the water cooler but are not considered by the medical community to be appropriate tools for screening the general population.

With the huge growth of genetic testing that can now be done to check for disease potential, the controversies and debates about screening tests will only increase and intensify. It is important to recognize that just because a screening test is available, that by itself does not make it necessarily appropriate for general use.

You can ask your doctors and your insurance plan administrators for the specific rationale that is used to either recommend or discourage a particular screening test. Scientific breakthroughs must be tempered with sound judgment and research to ensure the best, most cost effective healthcare possible.

Also, be sure to ask your doctor about any preventative measure you can take regarding your diet, exercise, and lifestyle habits. With proper prevention and appropriate use of health screening tests, you are much less likely to develop serious medical conditions.