• Catherine Hansen MD, MPH

An Ounce of Prevention

Updated: Jan 28

“Hey doc, I want a complete check up, just tell me nothing is wrong with me and I’ll be fine for another year”.


At this point, Dr. Curall gets out her star-trek scanner and begins moving it slowly over her patient’s body, starting at the head and working toward the feet. At the end, she reassures her patient that all is good and there is nothing to worry about for another year. In fact, Dr. Curall offers to sell a similar scanner for a small fortune and sets up a payment plan so the patient can scan herself at home regularly. Sound ridiculous? If you think so, then you must agree it would be difficult for a health care provider of any sort (conventional MD, DO, chiropractor, naturopath, wellness center etc.) to find every possible medical ailment that may strike us. And even more ridiculous to be sold expensive non-proven screening tests or treatments with the accompanying promise that they will extend our years or quality of life. Futuristic medicine may make this type of check-up possible but, for now, we are limited to carrying out the most evidence based and cost-effective screening tests that will tell us the most information and, hopefully, find the conditions that will cause harm AND be treatable (otherwise, finding them has been shown to decrease quality of life by inciting worry while doing nothing to extend longevity). We also need to do this in the context of a healthcare system that is not a bottomless pit of resources.


So what SHOULD you have checked and how often? Here is what the current evidence tells us*:


Preventing Cardiovascular Disease (Heart Disease):

  • Monitor and treat high blood pressure

  • Monitor and treat high cholesterol starting at age 20

  • If cholesterol is normal, check it every 5 years

  • If cholesterol is elevated or you have risk factors for high cholesterol (diabetes, obesity), check it more often.

  • Low dose aspirin for those at moderate to high risk

  • One time abdominal ultrasound for men ages 65-75 who are current or former smokers to check for abdominal aortic aneurysm

  • Quit smoking!

  • Maintain a healthy weight and physical activity

  • NOT RECOMMENDED: EKG, CRP, stress testing, homocysteine levels


Preventing Cancer**:


Prostate Cancer:

  • Discuss screening with your doctor

  • Research does not show benefit from PSA blood test or digital rectal exam, however, some think these tests are better than nothing

Lung Cancer:

  • Quit smoking!

  • Not recommended: Chest Xray

  • Possibly recommended (research underway): Chest CT scan for highly selected population

Colon Cancer:

  • No family history: Colonoscopy at age 50 and every 10 years after

  • Family history: Colonoscopy 10 years earlier than first family member had colon cancer and every 5 years after

  • Stop screening at age 85

Diabetes Screening:

  • Screen if your blood pressure is high

  • Screen if you are overweight

  • Screen if you are over 45 and have risk factors for diabetes, such as family history

Osteoporosis Screening:

  • Check bone density for all women ages 65 and older

  • Check bone density for women ages 60-64 if there are risk factors for osteoporosis (family history, smoking, Asian ancestry)

  • If bone density is normal, repeat in 10-15 years

Infection Screening:

  • HIV testing for all people ages 13-64, in particular for those at high risk

  • Hepatitis C testing for all people born between 1945 and 1965

  • Chlamydia testing for sexually active women ages 15-25 and those with behavioral risk factors

  • Gonorrhea testing for sexually active women ages 15-29 who live in areas of high prevalence

Immunizations:

  • Flu shot for all people ages 6 months and older on a yearly basis

  • Pneumonia vaccine (Pneumovax) for all people with chronic illnesses and all people age 65 and older

  • Shingles vaccine (Zostavax) for people ages 60 and older whether or not you have had shingles already

  • Tetanus and diptheria vaccine (Td) for all adults every 10 years

  • Acellular pertussis (Tdap) is given one time as an adult in place of Td

*Screening guidelines change according to new and emerging research, talk to your doctor for the most up-to-date evidence. For Women's Healthy screening information and a printed reference chart refer to this webpage: https://www.womenspreventivehealth.org/

**Screening for breast and cervical cancer will be addressed in a separate blog post. Stay tuned as a member of Dr. Hansen's Empowered Women's Circle: https://www.ewcircle.com/

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