SFP New Header 2012
December 2012
Current Guidelines for Preventive Testing

You may have noticed that the doctors at Seaport Family Practice recommend fewer screening tests than other doctors. Our goal is not to save you or your insurance company money. Nor are we trying to spare you an uncomfortable test. We are simply following the recommendations of the U.S. Preventive Services Task Force (USPSTF), based on the best scientific evidence on risks and benefits of preventive measures.

Diagnostic tests try to find an explanation for a problem the patient reported or we have discovered. Screening tests look for disease before any signs and symptoms appear. Sometimes our tests miss the disease we are looking for; sometimes they uncover "problems" we didn't expect to find. Sometimes the treatment for a disease is so good that early detection is unnecessary, as is the case of Life Line ultrasound testing for vascular disease. Sometimes certain abnormalities turn out to be less harmful that the "cure" we prescribe, as is the case for many breast and prostate cancers.

Guidelines from the scientific community change as new evidence emerges. For example, doctors no longer teach self-breast examination to patients for the early detection of breast cancer. The PSA blood test is no longer recommended for prostate cancer screening. Pap smears are offered less frequently. Liver testing is not needed for patients who take "statins" to lower cholesterol.

And physician groups can disagree with one another. For example, the American College of Physicians, American  Academy of Family Physicians, and National Cancer Institution support every other year mammography, while the American Cancer Society, American College of Radiology, and the American College of OB/GYN recommend annual mammography.

In short, prevention is an imperfect science. Doctors should offer recommendations based on the latest science, not the fear of disease. Our job is to provide useful information, and to respect the fact that the final decision belongs to the patient, not the radiologist, expert, or primary care physician. Patients must decide for themselves if the benefits of early detection outweigh the cost, discomfort, and risks (potentially unnecessary) treatment.

Here is a short list of USPSTF recommendations:

Breast cancer: mammography every other year for women aged 50-75 (advice for younger & older women should be individualized). Only a personal history of breast cancer, presence of a breast cancer gene, personal history of radiation therapy to the chest, or very dense breast tissue requires annual screening mammography.  See NYTimes editorial, "Ignoring the Science on Mammograms."

Cervical cancer: pap smear every 3 years for women aged 21-65, or every 5 years for women older than age 35 if coupled with a human papilloma virus test.

Colon cancer: stool tests annually or colonoscopy every 10 years in patients aged 50-75; earlier and more frequent testing may be warranted if there are personal or family risk factors.

Abdominal aortic aneurism: ultrasound for men between the ages of 65-75 who ever smoked.

Heart Disease: no tests for C-Reactive Protein (CRP), ankle brachial index (ABI), fasting blood sugar, homocysteine levels, or lipoprotein(a). Screen for diabetes mellitus if blood pressure is >135/80.

High cholesterol: a single fasting lipid panel for all men,  and for women who are at increased risk for coronary artery disease.

Osteoporosis: bone density testing at age 65 for women, or earlier if their is a strong family history of osteoporosis or osteoporotic fractures of the spine, wrist, or hip.


David Loxterkamp, M.D.

41 Wight Street | Belfast, ME 04915 | Directions

Telephone:
 (207) 338-6900
 
Office Hours:  7:30 am - 5:00 pm | Monday-Friday

                     8:00 am - 12:00 pm | Saturday

 

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