Harvard Women’s Health Watch
Include some of these proven health checks among your New Year’s resolutions.
We often see headlines that announce new or potential screening tests — most recently, for Alzheimer’s disease, lung cancer, and pancreatic cancer. Although these tests may sound promising, their value can take years to sort out. Will they really save lives and improve health? Who should have them? What costs and harms are involved?
Keeping up with new developments is a good idea, but it’s even more important not to overlook the many tests and screenings already available to improve our health and the quality of our lives. For 2011, take action if you’re overdue for any of these tried-and-true health assessments.
1. Height and weight
Height and weight provide important information about our health and development from infancy to old age. We lose an average of 0.4 inches in height every decade after age 40, and even more after age 70. Most of this loss is a normal effect of drying and compression in the discs between the vertebrae, but sometimes it’s caused by vertebral compression fractures that may be the first sign of osteoporosis. The National Osteoporosis Foundation suggests bone density testing if you lose more than one-half inch in a year or are now more than 1.5 inches shorter than you were when you reached your greatest height. If your doctor recommends bone density testing because of height loss, ask if a vertebral fracture assessment can be done at the same time.
Weight is even more important. Unintended weight loss can be a sign of serious illness. Excess weight, especially in the abdominal area, raises your risk for diabetes, hypertension, and heart disease. Body mass index (BMI), a measure of your weight in relation to height, indicates whether you’re overweight (a BMI of 25 to 29) — or obese, meaning a BMI of 30 or more. (To calculate your BMI, go to www.health.harvard.edu/topic/BMI-Calculator.) Measure your waist circumference (at navel level) for signs of excess fat within your abdominal cavity; a waist over 35 inches (for women) boosts risk even if BMI is normal.
How often: Periodically, at routine office visits.
2. Fracture risk
Osteoporosis, a disease characterized by low bone mass and fragility of the skeleton, can lead to hip and other fractures with minimal impact. Bone mineral density (BMD) declines with age, generally at a quicker pace in the years just following menopause. Dual energy x-ray absorptiometry (DXA) testing uses a small amount of radiation to measure BMD in the hip and spine.
To check your risk, you can plug your test results and other vital statistics into FRAX(www.shef.ac.uk/frax), a tool that calculates 10-year fracture risk. That can help you and your physician decide whether you need bone-strengthening drugs in addition to lifestyle changes and fall prevention strategies.
How often: A baseline DXA of the spine and hip in women ages 65 and older, earlier in women with one or more risk factors (steroid use, family history, previous fracture, early menopause, smoking, and being underweight). Opinions about repeat DXAs for average-risk women vary with age and baseline BMD. If you take steroids or bisphosphonates or if your clinician has any other reason to suspect accelerating bone loss, you may be screened as often as every two years.
3. Blood pressure
High blood pressure (140/90 mm Hg or higher) is present in about 70% of people having a first heart attack and 77% of those having a first stroke. But the effects on the heart can be felt even at lower levels. Today, a level of 130 to 139 mm Hg systolic pressure — or 80 to 89 mm Hg diastolic pressure — is termed prehypertension and regarded as a risk factor for heart disease. Blood pressure naturally rises with age, but there is growing recognition that this increase should be treated with lifestyle changes and, if necessary, medication.
Don’t smoke or drink caffeine before a blood pressure measurement. Wear sleeves that make it easy to apply the cuff on bare skin. Sit quietly for a few minutes before testing, and breathe normally during the measurement.
How often: At least once every two years; annually, if your blood pressure is above 120/80 mm Hg.
4. Lipid levels
First heart attacks and strokes are often fatal, especially for women, and the risk may depend on the level of fats in your blood. Total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol, and triglycerides (an especially important cardiovascular indicator in women) are easily measured with a blood test called a lipid panel or profile.
A fasting lipid panel is most accurate for triglycerides and LDLs. That means going without food, beverages (except water), and some medications for nine to 12 hours before the test — and without alcoholic drinks for at least 24 hours before.
How often: At least every five years; more often if you’re being treated for unfavorable lipid levels.
5. Blood sugar
Type 2 diabetes damages your blood vessels and can lead to heart disease, kidney failure, and blindness. It becomes more common with age, especially in the late 60s and early 70s. The key indicator is a high level of glucose in the blood, which can be tested for after you fast for several hours (fasting glucose) or at intervals after you consume a precise quantity of sugar (glucose tolerance test). A newer test, glycated hemoglobin A1c, may be more informative, because it provides a snapshot of average blood sugar levels over the preceding months.
Screening is recommended beginning at age 45 — earlier if you have heart disease or diabetes risk factors, including obesity, positive family history, high blood pressure or cholesterol, or gestational diabetes.
Make sure your primary care provider knows your gynecological history. Polycystic ovary disease, diabetes during pregnancy, or delivering a baby weighing 9 pounds or more all increase diabetes risk.
How often: Every three years.
6. Hearing evaluation
About 30% of people ages 65 and over, and 14% of those ages 45 to 65, have some type of hearing loss, which not only can be isolating but also may interfere with cognitive skills. Your clinician may have you complete a hearing questionnaire or see how well you understand words whispered from a short distance. A formal hearing test involves a 30- to 60-minute session with a certified audiologist.
Let your physician know if you’re having a harder time understanding people — or if they have complained about your hearing. Report any changes in hearing, dizziness, unusual sounds that shouldn’t be there, and ear pain or discharge.
How often: It depends on your age and other factors, such as exposure to hazardous noise levels at work. Don’t undergo formal testing unless you’re willing to use a hearing aid. Don’t go to a hearing aid dealer for screening even if it’s offered for free.
7. Eye examination
Aging is a risk factor for several sight-robbing conditions, including glaucoma (increased pressure inside the eye that damages the optic nerve), cataract (clouding of the lens), macular degeneration (the breakdown of cells responsible for central vision), and diabetic retinopathy (which damages the light-sensitive cells at the back of the eye). A comprehensive visual exam screens for all these disorders. If you’ve undergone LASIK surgery, pressure readings can be low even when you have glaucoma, and an ophthalmologist should check your optic nerve for signs of damage.
How often: Start at age 50 and return as often as your clinician advises — generally every two to four years until age 65 and every one to two years after that.
8. Colorectal cancer screening
Everyone over age 50 should be screened for colorectal cancer. Colorectal cancers and precancerous growths called polyps can be detected with colonoscopy, an inspection of the entire colon with a viewing tube inserted through the rectum, and abnormal growths can be removed during the same procedure. Flexible sigmoidoscopy is similar but permits inspection only of the rectum and lower two feet of the colon. Another screening method is virtual colonoscopy, which uses CT scanning instead of a colonoscope to detect polyps and cancers. The disadvantages: it requires considerable radiation, it must be followed up with colonoscopy if abnormal growths are detected, and it often reveals small abnormalities of uncertain significance that may lead to unnecessary further testing. For all these tests, the colon must be cleaned out beforehand with dietary restrictions and strong laxatives, enemas, or both.
Colon cancers and larger polyps have fragile blood vessels that leak easily, causing blood to appear in the stool. To detect this blood (fecal occult blood), you use a home kit to sample stool. You’ll need to avoid red meat, certain fruits and vegetables, vitamin C–enriched foods and beverages, and nonsteroidal anti-inflammatory drugs for a few days before the test. The standard screens don’t pinpoint where or why the bleeding has occurred but do indicate whether there is a need for further testing. Newer stool tests are designed to detect specifically blood from the colon, and they don’t require the same elaborate preparation.
Choose a screening method that works for you and be sure to follow through: most stool sample kits are not returned, and many people don’t get the extra testing they need if results are positive.
How often: For people over age 50 who are at average risk for colorectal cancer, stool testing annually, sigmoidoscopy or virtual colonoscopy every five years, or colonoscopy every 10 years.
9. Breast cancer screening
For women over 50, professionals agree that mammography, a specialized x-ray of compressed breast tissue, helps detect breast cancers at their earliest and most treatable stage. In addition, a breast exam by your physician, called a clinical breast exam (CBE), may find a lump not visible on x-ray. (Not all health experts agree on the value of CBE.)
If possible, have digital mammography. It detects more tumors than standard mammography (especially in dense breasts) and may deliver less radiation per examination. If you find a breast lump, tell your doctor, even if you’re scheduled for a mammogram soon or have recently had one.
How often: Mammography every one to two years; CBE annually. The American Cancer Society recommends mammograms as long as you’re healthy enough to be treated, but the U.S.Preventive Services Task Force recommends stopping at age 75, because, explains Margaret Duggan, M.D., director of the Faulkner Sagoff Breast Center, “if you have other significant medical problems, early cancers caught on a mammogram are unlikely to progress far enough to shorten your survival.”
10. Cervical cancer screening
Screening for cervical cancer is a major preventive medicine success story. A Pap smear taken from a swab of the cervix can detect cancerous or precancerous cells, and those cells can be removed. A test for cancer-causing strains of the human papillomavirus (HPV) has become available and can be performed at the same time as the Pap test in women who need it. Cervical cancer doesn’t become more aggressive or common with age, but mortality from the disease is highest in women who’ve never been screened. You don’t need Pap tests after a hysterectomy, unless your uterus was removed because of cancer or your cervix was left intact.
How often: Pap every two to three years if you’ve had three normal annual Pap tests in a row. You can stop at age 70 if you’ve had three normal Pap tests in the last 10 years.
11. Mood and behavior screens
Some valuable health checks come in the form of questions from your clinician. She or he may ask how much sleep you get and how often you exercise. You may also be asked about your mood and your use of alcohol.
Depression can be debilitating and worsen other medical conditions. Clinicians can often determine whether a more detailed assessment or referral is necessary simply by asking two questions: “Over the past two weeks, have you felt down, depressed, or hopeless?” and, “Over the past two weeks, have you felt little interest or pleasure in doing things?”
Moderate alcohol intake has health benefits, but that means no more than one drink a day for women, and problem drinking increases as women age. A clinician may try to identify potential alcohol problems with questions such as the four-item CAGE test (do you ever feel the need to Cut down, are you ever Annoyed by criticism of your drinking, do you ever feel Guilty about your drinking, and do you ever feel the need to take a morning Eye-opener?). There are also single-question screens, such as “How many times in the past year have you had more than three drinks?”
Answer your clinician’s questions frankly and accept help if you need it. If your doctor doesn’t ask, speak up anyway if you have concerns about these or other sensitive issues, such as violence in your home or possible exposure to sexually transmitted infections.
How often: Periodically at routine office visits.
