Annual Physical, which lab tests and cancer tests do you need and which are not necessary?
July 16 2018 by
Ray Sahelian, M.D.

Doctors continue to debate the worth of a time-honored tradition of health care -- the annual physical examination. Some want the once-a-year physical abandoned, based on a growing body of research that these exams don't reduce your overall risk of disease or death.
   Large studies have failed to show that annual physical check-ups provide a significant medical benefit. The potential downsides of an annual physical are cost, time wasted for the patient, time wasted for the doctor, and finding questionable results on tests that lead to more tests, additional costs, and patient anxiety and stress. People have become too reliant on technology. Many doctors neglect the value of talking with patients and performing a hands-on physical examination in favor of new tests and scans. The vast majority of the information a doctor needs to diagnose an illness can be obtained through a thorough patient history and a physical examination. Patients are much more likely to undergo unnecessary medical imaging exams if the tests are ordered by doctors with a financial interest in the imaging equipment.
   During an annual physical -- a routine medical or gynecological check-up -- many patients are routinely given laboratory tests such as complete blood cell counts or urinalyses of uncertain medical value in the absence of a specific reason. No major clinical organization advises people to get an annual medical check-up, but most adults think they should get one and most doctors recommend them. Doctors order fewer laboratory tests if they know how much the tests cost. Many people do not realize how expensive testing can be and how much it contributes to high medical costs and insurance premiums.

A majority of panel members who gather to write clinical practice guidelines have conflicts of interest. In other words they may be recommending medications or procedures that may benefit the pharmaceutical companies or lab / testing / imaging related companies with whom they have some sort of association. In general a small percentage of panel members from government-sponsored guidelines such as the USPSTF are found to have conflicts, versus more than half of non-governmental entities such as the American Heart Association and the American Diabetes Association. Therefore, the recommendations of the USPSTF appear to be less biased.

Unnecessary medical care increases costs
Unnecessary medical care, unneeded tests and treatments, are common due to concern for malpractice suits. Other factors include patient demand and doctors' impulse to increase profits.

During your visit, mention the natural therapies you are doing on your own
Doctors do a poor job of providing patients with information about vitamins, minerals, herbs and other dietary supplements. Many people take these products, which carry safety concerns -- including potentially harmful interactions with prescription drugs -- and some patients take dietary supplements in place of conventional medicines.

2017 Guidelines for cancer testing
Many older Americans are unnecessarily screened for breast and prostate cancer, which can lead to treatments they don't need.

Breast cancer. Cancer Society Urges Later, Less Frequent Mammograms. The group says women should start having mammograms at 45 and continue yearly until 54; it previously recommended mammograms and clinical breast exams every year, starting at 40. Advanced imaging or bone scans in patients with early-stage breast cancer is not necessary.

While mammograms do indeed find breast tumors when they are very small and presumably the easiest to treat, widespread breast cancer screening doesn't necessarily lower the overall death rate from breast cancer or even cut back on the number of biggest breast tumors found later.

Cervical cancer. Women 21 to 30 should have a Pap smear test every three years. Women 30 to 65 can wait every five years if they have had negative testing for human papillomavirus (HPV), the virus that causes the cancer. Those 65-plus can skip screening if they were screened regularly earlier in life. Those under 21 can also skip the test.

Colon cancer. Those 50 to 75 should get screened regularly, and older people should discuss the pros and cons with their doctor and decide. Options include a colonoscopy, which examines the entire colon, every 10 years, or a sigmoidoscopy, which looks at the lower third, every five years plus a stool test every three years, or an annual stool test. Screening those younger than age 50 is not needed unless a patient is at high risk due to a strong family history of early colon cancer.

Older people who aren't expected to live more than 10 years are still being screened for prostate, breast, cervical and colon cancer -- even though it is unlikely to benefit them.
A colonoscopy can find and remove cancerous growths in the colon, but it may not provide much cancer prevention benefit after the age of 75.

Other Cancer tests:
Bladder cancer test which is done by examining cells in the urine is of little or no benefit.
Lung cancer. The test is a low-dose CT scan which may only be helpful in smokers who have smoked cigarettes for many decades.
Skin cancer. A visual skin exam can be done by a doctor as part of a routine check-up to detect a melanoma or other serious skin diseases.
Oral cancer. A visual exam of the mouth is done by a dentist or other health care professional.
Prostate cancer. The blood test is known as PSA (prostate-specific antigen) test. No routine PSA testing is recommended for males although this is a controversial issue and many doctors still recommend a PSA test even though most studies have not shown it to provide a long term benefit.

Ovarian cancer. Tests include a blood test to look for a protein linked with the cancer, and a transvaginal ultrasound. This test is generally not recommended by anyone for the general public. U.S. Preventive Services Task Force recommends that women at average risk for ovarian cancer not get screened for the disease. The currently used blood test and transvaginal ultrasound may cause more harm than benefit for those patients.
   2016 - Screening tests for ovarian cancer are not reliable and should not be used, the U.S. Food and Drug Administration warns. Despite extensive research and published studies, there are currently no screening tests for ovarian cancer that are sensitive enough to reliably screen for ovarian cancer without a high number of inaccurate results.

Pancreatic cancer. Tests are abdominal images or genetic tests. This test is not recommended by anyone for the general public.
Testicular cancer. The test is a physical exam of the testicles and there is no proof that regular exam by a doctor makes a significant difference in diagnosis or overall survival.

Tests and treatments that are often overused:
Certain imaging tests for common health problems catch abnormalities, "incidentalomas," that create anxiety about tumors but often end up not being cancer or something serious.

Nearly all emergency room doctors order pricey MRIs or CT scans their patients may not need, mainly because they fear malpractice lawsuits.
Early imaging for most back pain.
Brain scans for patients who fainted but didn't have seizures.
Antibiotics for mild- to-moderate sinusitis unless symptoms last for seven or more days or worsen.
Stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present.
Many patients get heart tests called echocardiograms unnecessarily. These noninvasive ultrasound tests that reveal how well the heart is functioning. They are safe, but most patients who get them see no change in treatment. Therefore, they are not clinically useful.
Doctors need to make sure patients understand the radiation-related risks of heart imaging tests, heart scans, before sending them for such procedures. With technological improvements, medical imaging has become an increasingly vital tool in diagnosing and treating patients with heart disease, but the rising use of the tests has led to increasing radiation exposure over the past two decades.
Routine cancer screening on dialysis patients with limited life expectancies
Chemotherapy for sickest cancer patients
Having multiple cardiac and chest CT scans increases the chances of breast cancer.
I have previously discussed these topics in the November 2012 Natural Healing Secrets newsletter.
Doctors should stop performing routine pelvic exams, a key component of regular physicals for women, according to the American College of Physicians, June 2014. There is no evidence that such pelvic exams are useful and plenty to suggest that the procedure provokes fear, anxiety and pain in many women. The college’s guideline was published in the Annals of Internal Medicine. The recommendation applies only to routine checkups for healthy women, not to women who visit the doctor’s office with medical complaints or who are pregnant.

Cellular damage occurs when people undergo CT scans, but whether or not this causes cancer or any other health problems is unclear. The use of medical imaging for heart disease has exploded in the past decade. These tests expose patients to a non-trivial amount of low-dose radiation but it is unclear exactly how much damage this low-dose radiation does to the patient.

An abnormal troponin T level of 14 ng/L or higher, as measured using a high-sensitivity assay, doubles the risk of cardiovascular events and death among patients who have stable ischemic heart disease and type 2 diabetes.

If you are over the age of 75
According to current U.S. Preventive Services Task Force guidelines, routine screening for breast, colorectal, and prostate cancer are not advised once patients reach age 75 years, and routine screening for cervical cancer is not advised once patients reach age 65 years.

Blood studies
I'm a man and 55 years old. Please suggest a blood-test regiment that would help me determine a quality list of herbs and supplements.
    I am not aware of any research that indicates blood testing for levels of nutrients in the body leads to an accurate determination of which vitamins, minerals, amino acids, hormones, herbs or other dietary supplements one should take.

Carotid artery stenosis testing
There is no evidence that testing for carotid artery stenosis in those who have no symptoms increases longevity or decreases mortality.

Heart disease testing
Simon Griffin of the epidemiology unit of Britain's Medical Research Council assessed data from almost 17,000 European men and women between the ages of 40 and 74 who had no heart disease or diabetes at the start of the study. He and his staff looked at several different screening strategies to determine which ones were most effective: Inviting all 40-74 year olds for vascular screening (as the British program does); inviting 50-74 year olds for screening; inviting overweight people for screening, asking patients to complete a heart disease risk questionnaire and inviting those with high scores for screening; and inviting only patients whose records would flag them up as high risk. Simon Griffin found that final strategy - using medical records to pick out high risk patients - was just as effective as the government's screening program at preventing new cases of heart disease and would save costs. Starting screening from age 50, rather than 40, would also get similar results. BMJ, online April 26, 2010.

Clinicians should not screen for cardiac disease in asymptomatic, low-risk adults using resting or stress electrocardiography, stress echocardiography, or stress myocardial perfusion imaging.

Nutritional screening
Vitamin D testing is being heavily promoted by many doctors and nutritionists even though there is no evidence that such testing has health benefits. I prefer people take an additional 400 units to 2000 units a day of the vitamin based on sun exposure and diet rather than get tested.

Evidence Brief: Role of the Annual Comprehensive Physical Examination in the Asymptomatic Adult. Bloomfield HE, Wilt TJ. VA Evidence-based Synthesis Program Evidence Briefs [Internet]. Washington (DC): Department of Veterans Affairs (US); 2011-.VA Evidence-based Synthesis Program Reports.2011 Oct. The routine annual comprehensive physical examination (PE) became a fixture in American medical practice in the 1940's. By the 1980's many influential professional groups, including the American Medical Association, the American College of Physicians, the United States Preventive Services Task Force (USPSTF) and the Canadian Task Force on Periodic Health, recommended that this approach be replaced by periodic screening, counseling and PE tailored to a patient's age, sex, risk factors, and symptoms as elicited by the medical history and review of systems (Oboler 2002). Furthermore, these recommendations tacitly or explicitly endorse the concept that, for screening purposes, only those components of the PE that accurately and effectively detect conditions for which early diagnosis is known to lead to improved patient outcomes should be routinely offered. Consistent with this tailored and evidence-based approach, Medicare currently offers a free initial “Welcome to Medicare” visit which includes a medical history, recommended immunizations and screenings and “further tests depending on your health and medical history”. The only components of the PE recommended for everyone are measurement of blood pressure, vision, weight and height. Nevertheless, most adults in the US believe that annual comprehensive physical exams are important; a 2002 study showed that more than 90% endorse the value of routine examination of the heart, lungs, abdomen, reflexes and prostate (Oboler 2002). Moreover, as recently as 2005, many physicians also endorse the complete annual physical examination for a variety of reasons including perceived benefits to the physician-patient relationship, patient expectations for a yearly “physical,” fear of malpractice litigation, and compensation.

USPSTF reaffirms need for folic acid supplements in pregnancy
The U.S. Preventive Services Task Force continues to recommend that all women planning or capable of pregnancy should take a daily supplement of 0.4-0.8 mg of folic acid to prevent neural tube defects in their offspring.

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