A guide to more efficient medical screenings whether you're 35 or 75
What you probably should be asking to be tested for and what can probably wait.
In 1976, the government formed the Canadian Task Force on the Periodic Health Examination. The task force was given a daunting task: come up with a comprehensive plan for protecting the health of Canadians.
After 3 years of deliberation they concluded, "…that the annual check-up, as practiced almost ritualistically for several decades in North America, be abandoned."
Yet forty years later, we're still doing it.
The main issue with the routine, annual check-up is that it's an inefficient way to screen for disease and casts too wide a net. Medical check-ups should not be a one-sized-fits-all strategy. Intuitively this makes sense, since people in their 20s have different issues and priorities than people in their 70s. A better way is an individualized risk-based strategy that depends on your age and sex. Routine annual blood tests, chest x-rays and ECGs for otherwise healthy people are neither necessary nor beneficial, and in fact they don't seem to reduce mortality. Finally, it's important to remember that over-testing leads to false positives, which can lead to more invasive tests like biopsies that carry risks. Do enough unnecessary tests, and you may eventually cause a complication.
So what should be checking when you go to your doctor? Here's what you should be asking your doctor to be checked for throughout the various stages of your life.
Your 20s and 30s
While heart disease remains one of the top killers in Canada and North America, the risk of heart disease for young adults is very low. In fact, routine ECGs and stress tests are not recommended for this age group or any other in the absence of any symptoms. Other tests like ultrasound screening of the arteries or CT scans to measure coronary calcium are also not recommended despite their increasing popularity in private labs.
Blood pressure checks should start at age 18 and continue throughout adulthood. However, even though most people get their blood pressure checked routinely at every doctor's visit, otherwise healthy people under 40 probably only need to get their blood pressure checked every 3-5 years.
Cancer checks usually start later in life, but there is one exception. Cervical cancer screening, usually with PAP smears, should start at age 25, or age 21 if you follow the U.S. guidelines. But while cervical cancer screening is recommended, routine pelvic exams in asymptomatic women are not.
Vaccinations may seem like something you're done with in childhood but some diseases like tetanus require booster shots in adulthood. Also, if you plan to travel, you may need vaccines to protect you from diseases like cholera, yellow fever or typhoid. You may also need anti-malaria medication if you plan to travel to warmer climates.
Finally, while most people can be blasé about the risks of sex, screening for sexually transmitted infections like Chlamydia and gonorrhea is recommended for women starting at age 25, or earlier if they are sexually active.
Obviously, people who have a medical condition or risk factors need to be seen more frequently than the general population. And your doctor is likely the first place to go when you have issues regarding mental health, birth control, quitting smoking, and any acute illness like a sudden bout of bronchitis.
While it's not quite downhill after 40, several health prevention strategies do start to kick in.
Before age 40, checking on your blood pressure was the only cardiac factors that merited any attention. Afterwards, some additional testing is recommended. Age 40 is when people should start checking their cholesterol, although U.S. guidelines recommend age 35 for men and 45 for women. Both guidelines acknowledge you should start earlier if you have other risk factors.
Screening for diabetes should also begin at age 40.
If initial tests are normal, then cholesterol can be checked every 3-5 years and diabetes every 3 years or so. While yearly blood tests as part of the normal check-up are common, they are not technically recommended.
Blood pressure checks should start to occur yearly after age 40.
Starting at age 50, a number of cancer societies recommended screening for cancer. Breast cancer screening with mammograms should start at age 50 with mammograms every 2 years, although U.S. guidelines do add the caveat that if risk factors are present, then starting at age 40 may be reasonable.
For men, prostate cancer screening with PSA testing is more uncertain. Although some groups advocate for it, both Canadian and U.S. guidelines recommend against it. The problem with PSA testing is that things other than cancer can cause PSA levels to rise, which leads to more unnecessary biopsies and potential complications.
However, both men and women should start screening for colon cancer at age 50. While this used to be done with colonoscopies, recently tests to detect blood in the stool have started to replace colonoscopies as the first line screening test.
Men and women over the age of 55 who have a recent history of smoking should be screened for lung cancer with low dose CT scans, because x-rays have been shown to be ineffective.
After age 65
Osteoporosis screening, however, is recommended for all women over 65, although women with risk factors may need to start earlier. Interestingly, the Canadian guidelines include men in their recommendation while the U.S. guidelines do not.