Health screening
Health screening tests are done to determine the possible presence of a disease or other health problem. Health screenings often are conducted routinely as a preventive measure, or may be done when there is reason to suspect a particular health problem exists.
It should be noted that there is not universal agreement as to which tests should be performed for health screening and when they should be performed. Individual doctors and insurers may have their own philosophies about health screening tests. What follows, then, are common recommendations; individuals should consult their doctors and insurers for information specific to their needs.
Children's health screenings normally include height, weight and blood pressure checks, together with possible hearing, vision or dental problems.
Other screenings might include tests to measure learning progress, a check tomake sure the spine is straight and developing properly, and skin screeningsto check for the presence of unusual moles or birthmarks. Tests normally aredone to detect the possibility of diabetes, tuberculosis and anemia.
It is recommended that children get dental check-ups at least once a year assoon as they have several teeth; an initial vision screening by age 3; and ablood pressure check by age 10. Some pediatricians also give cholesterol checks to children if family history and circumstances warrant.
For men and women, health care providers have established a set of recommended screening tests depending on the age of the patient. (In addition, the frequency of some health screenings depends on risk factors of the patient.) Eye(every three years) and dental exams (twice a year) and hearing checks are recommended for everyone.
For women between the ages of 20 and 39, the following screenings are recommended:
- Pelvic exam: every year.
- Pap test: every year until three satisfactory tests have been completed, and then at the doctor's discretion.
- Breast: at least every three years.
- Skin: at least every three years.
For women between the ages of 40 and 49, the following health screenings arerecommended:
- Blood pressure: at least every two years
- Cholesterol test: every five years
- Skin exam: every year
- Breast exam:every year
- Pelvic exam: every year
- Pap test: every year (orat the doctor's discretion)
- Mammography: every one to two years (depending on risk)
- Fasting plasma glucose test: to check for the possibility of diabetes, every three years after age 45
After age 50, women should have the following screenings:
- Blood pressure: at least every two years
- Cholesterol: every five years (or everythree years starting at age 65
- Skin exam: every year
- Breast exam: every year
- Mammogram: every year
- Fecal occult blood test: every year
- Pelvic exam: every year
- Pap test: yearly (or atthe doctor's discretion)
- Bone mineral density test: once as a baseline
- Fasting plasma glucose test: for diabetes, every three years
- Thyroid-stimulating hormone test: every 3-5 years starting at age 65
- Colorectal cancer test: every five to ten years
For men between the ages of 20 an 39, the following screenings are recommended:
- Blood pressure: at least every two years
- Cholesterol: everyfive years
- Skin exam: every three years
Men between the ages of 40 and 49 should have screenings for:
- Blood pressure: at least every two years
- Cholesterol: every five years
- Skin exam: every year
- Fasting plasma glucose test: to check for thepossibility of diabetes, every three years after age 45
Men who are 50 years or older should have the following screenings:
- Blood pressure: at least every two years
- Cholesterol: every five years(or every three years starting at age 65)
- Skin exam: every year
- Digital rectal exam: (to check for the possibility of prostate cancer) every year
- Prostate specific antigen (PSA) test: every year
- Fasting plasma glucose test: (for diabetes) every three years
- Colorectalcancer test: every five to ten years
Health screenings are important for early detection of diseases or other possible health problems. Any suspected problems should be reported to a health care provider immediately. Health screening exams have played a principal rolein preventive health care for a wide range of common diseases and some thatare not so common. Frequently data from health screenings give scientists a way of measuring disease trends and the success of early treatment.
An estimated 1 million children in the United States have lead poisoning thatshows up as elevated levels of lead in the blood. The Centers for Disease Control and the American Academy of Pediatrics recommend that high-risk children be tested at preschool age. A study published by the American Public HealthAssociation showed children in certain categories face increased risk of lead poisoning: low income, minority, or living in housing built before 1950. The study showed only 60% of high-risk children in New York City received screening for lead poisoning and of the children tested, only 40% received the recommended follow-up care and monitoring.
Screening for prostate cancer is more complicated that performing a test. Prostate cancer is the second-leading cause of death of men in the United Statesand many physicians and insurers ask patients to have a screening test withserum prostate-specific antigen (PSA). However, patients and their physiciansmust proceed with caution. A PSA test can produce false-positive results ina patient who does not have cancer. Even though prostate cancer kills many men, it spreads slowly and an elderly man might actually be at greater risk ofdying of something else. Some of the common treatments for prostate cancer, such as surgery and radiation, can cause incontinence, impotence, pain and emotional trauma.
Colon cancer is the nation's second-leading killer of patients of both sexesand information gathered by the National Cancer Institute shows the difficulty of moving patients from health screening into preventive care. Identifyingpatients with colon cancer is urgent because it is much more difficult to cure in the later stages. To identify the importance of screening and follow-up,researchers studied records gathered from over 24,000 people age 65 or olderwho underwent initial screening for colon cancer. About 10% of the originalgroup went for follow-up testing, but only 34% of this smaller group had bothof the recommended follow-up procedures. Of the 774 patients who had both procedures, 241 were diagnosed with colon polyps and 32 patients had colon cancer. The majority of the patients studied did not complete the testing, so there is no way of knowing how many diagnoses of colon cancer were missed. Medicare started covering colorectal screening in 1998, so more patients are expected to have this testing.
Many Medicare patients do not receive screening tests that are covered by their insurance. For example, only 28% of eligible women ages 65 to 69 had a mammogram 1995-1996, even though doctors recommend that women in that age groupreceive be screened every two years. Immunization against pneumonia is recommended once every 10 years for patients 65 and older. Statistics vary in different parts of the country, but the highest immunization rate was 38%. Elderlypatients with diabetes risk many complications and should eye exams and monitoring for glucose markers every year. The percentage of Medicare patients actually receiving annual eye exams was never higher than 60 percent. Older patients with diabetes should also receive semiannual cholesterol screening. Forinformation on screening tests covered by Medicare, call the toll-free hotline (800-633-4227) or visit the Medicare web site (www.medicare.gov).
Advances in medical research have made more unusual forms of screening available. In 1999, the American Academy of Family Physicians reported on genetic testing for susceptibility to breast cancer. The report stressed that genetictesting can never replace medical checkups and breast self-examination. Genetic testing for susceptibility to breast cancer is only done after a genetic counselor or a physician evaluates the patient's family history of cancer. Women who receive the genetic screening are advised to follow up with a physician or genetic counselor with formal training in cancer genetics.
Additional genetic screening is available for individuals who are exposed toworkplace chemicals such as benzene and beryllium, but researchers at the University of California, Berkeley, concluded that in most cases, the screeningwould be too expensive to be cost effective.
Researchers in Israel are searching for a way to screen for schizophrenia. This form of mental illness affects an estimated 2.7 million Americans and is rarely detectable until it is full-blown. Israeli researchers were given databy the Israeli Draft Board Registry, which conducts compulsory screening of 16- and 17-year-olds. The screening tests measure the teens' intellectual, medical and psychiatric fitness for military service. While the data is still being collected, researchers hope to eventually use their findings to secure early treatment for schizophrenics.
Some health screening initiatives focus on reaching people at work. Boston city employees receive four hours off each year for health screening, without any time being deducted from employee leave. The federal government is studying the Boston program to see whether it could serve as a model to offer compensated time off for 1.8 million federal employees to receive routine health screening.
Another approach is to bring the testing to the work site. A 1998 survey showed that 91% of the employers studied offer some sort of on-site health promotion. Industries with older, longer-service workers often favor early detection of health problems as a way of keeping costs down. For example, the Kodak company in Rochester, New York, began offering mammography to 6,000 employeesat the job site. Early-stage breast cancer costs about $15,000 to treat, as compared to a $150,000 bill for a woman with advanced breast cancer. On-site mammography is cost effective when at least 20 or 30 exams can be scheduled atone location. The company conducting the exams bills the employees' health insurance, which is under contract to cover on-site screening. Employers findthat on-site mammography takes about 15 minutes, while an employee who has toleave work to be tested might need to take off as much as half a day for travel and waiting time. The Coors Brewing Company permitted on-site mammographyand figures for the first eight years of the program show the company saved$2.4 million. Twelve thousand mammograms were done of Coors employees, with aparticipation rate of 83%. A 1996 analysis reported in Business and Health magazine showed that on-site screening reduced both direct and indirect treatment costs. For cancers detected by on-site screening, treatment costsand short-term disability time off were one-half the amount needed for employees who were not participating in the screening program.
Another approach to health screening involves setting up a community wellnessprogram. One community built an alliance of a television station, a marketing firm, a grocery store chain and a local medical center. The program was funded by television and grocery advertisements promoting free blood pressure, cholesterol and body fat screenings offered four times a year. The community wellness program distributed information on wellness and nutrition, and 8,000people were screened.
The community wellness program raises some delicate issues in health screening. Who pays the bill and who decides what tests a patient will have, and when? Health maintenance organizations (HMOs) in Florida generally cover screening tests for cholesterol, bone density and depression. Women's health risks rise after menopause, but these commonly covered screening tests are not automatically offered to women over the age of 50. The HMOs argue that they are already offering educational information to patients and physicians about women's increased risks with aging. The insurers say it is more cost effective forphysicians to order screening tests based on their own clinical judgment, rather than having the HMOs impose universal screening requirements. The American Hospital Association (AHA) says ideally, there would be a nationwide systemto notify patients and physicians when it is time for a screening exam. Thenext-best solution, says AHA, is for patients to play an active role, preparing a checklist of screening tests with notes on the doctor's recommended timeline for repeating the tests.
These debates highlight a philosophical change in health screening at the endof the twentieth century. Health screenings were viewed as the gateway to preventive medicine but the trend is slowly shifting. In the 1980s, researchersstarted looking at the scientific value of health screenings. Just how effective were health screenings in detecting early signs of common serious illnesses? Did screening tests actually offer information leading to prevention ortreatment? What were the true risks and benefits of screening tests? After analyzing these questions, researchers concluded that only five screening testswere worth administering to every adult: cholesterol, blood pressure (whichwould include height and weight), fecal occult blood for colorectal cancer, and mammogram and Pap smear for women.
The researchers concluded that in place of automatically ordering a series ofscreening tests that might not be automatically linked to preventive healthbenefits, physicians would have better success if they worked directly with patients to change negative health habits. One analysis showed that as many ashalf of all premature deaths in the United States could be prevented with achange in negative health habits. The most influential change would come about if patients stopped smoking, which could save an estimated 400,000 lives.
The National Council on Patient Information and Education recommends that health-care providers conduct a complete physical exam on each patient each year, with twice-yearly exams for seniors. The standard medical encounter at theend of the twentieth century lasts 15 minutes or less, and two-thirds of Americans do not get yearly physicals. The ideal physical exam would include a complete review of all prescription and over-the-counter medications, as well as dietary supplements and immunizations. Physicians are urged to take a detailed medical history, including the family history of illnesses such as diabetes, heart disease and cancer. Patients are often unaccustomed to discussing eating habits, physical activity, alcohol use, physically transmitted diseases(including HIV), depression, seat-belt use and domestic violence with a physician. However, the emerging trend at the end of the twentieth century is touse the review of life circumstances to realistically weigh all risk factorsfaced by the patient. Health screening tests play a role in the overall planning, but the role of the physician-patient relationship is starting to receive more emphasis.
I was curious if there was a federal or Colorado state mandate that would not allow insurance companies from giving out free screenings, then raising premiums based on the results of those screenings? (e.g. high cholesterol, etc.)