Published by the New York Times
By Anahad O'Connor
Many of the leading killers of Americans are chronic diseases that can be prevented with healthy habits like a good diet and plenty of exercise. But there’s a key part of prevention that should not be overlooked: At every stage of your adult life, you should undergo routine screening exams to catch any health problems so you can try to nip them in the bud. Read on for the lowdown on the routine but potentially lifesaving tests and preventive procedures that you need at every stage of your adult life.
There are some tests that come up again and again. Know when to look for them.
GET A FLU SHOT EVERY YEAR
For most people, the flu shot is an inconvenience. You might think you don’t need it because the flu doesn’t seem that serious. But every year, more than a hundred thousand people in the United States are hospitalized with the flu, and about 57,000 people die from it. The flu is a top killer of Americans. It’s the eighth leading cause of death, right behind diabetes – even though it can be prevented in most cases with a quick and easy vaccine.
Everyone who is older than 6 months of age should get the flu vaccine annually, except for people who have a rare, life-threatening allergy to it or people with a history of Guillain-Barré syndrome. For more about the flu vaccine and where to find it, you can read this primer from the Centers for Disease Control and Prevention.
GET A TETANUS BOOSTER SHOT (EVERY 10 YEARS)
Tetanus is not a common disease, in large part because most people in America are vaccinated against it as children. But for people who do contract tetanus (most of whom are not protected), the disease can be deadly. The bacteria that cause it are widely found in dirt and soil. You can contract tetanus if you’re cut, scraped or wounded by a contaminated object. According to the C.D.C., even if you got a tetanus shot as a child, you still need to get a booster shot every 10 years as an adult to stay protected. The exception to this is anyone who has ever had Guillain-Barré syndrome or a serious allergic reaction after a previous dose of the vaccine.
GET YOUR BLOOD PRESSURE CHECKED (EVERY 2 YEARS)
It’s hard to overstate the importance of preventing hypertension. High blood pressure is one of the major risk factors for heart disease, second only to smoking as a preventable cause of heart attacks and strokes. But on the bright side, it’s extremely easy to monitor. You can check your blood pressure at almost any clinic, doctor’s office or pharmacy. Or you can check it at home with a relatively inexpensive portable blood pressure monitor, which you can purchase online for less than $20.
“It’s important that we empower people to be more involved in their health care, whether it’s checking your blood pressure at home or weighing yourself at home,” said Dr. Gina Lundberg, a cardiologist and assistant professor of medicine at the Emory University School of Medicine.
For many years, the threshold for hypertension was considered a reading of 140/90 or higher. But last year the nation’s leading heart experts updated their guidelines and changed their definition of high blood pressure to a reading of 130/80 or higher for anyone with a significant risk of heart attack or stroke. (The first number is your systolic pressure, or the amount of pressure in your arteries when your heart contracts, while the second number, the diastolic reading, refers to the pressure between heart beats).
It’s estimated that more than a third of all Americans have hypertension, and at least 20 percent of these people were unaware of it. The American Heart Association recommends that all adults check their blood pressure at least once every two years. The good news is that if you do have high blood pressure, lifestyle changes and medication can help lower it or control it.
CHECK YOUR CHOLESTEROL REGULARLY
High cholesterol is a largely silent condition, one that has few noticeable symptoms. But cholesterol also plays a major role in the number one cause of death in America – cardiovascular disease – so it’s important to know if you have a problem. “Think of your blood cholesterol as your tires for car safety,” said Dr. Dariush Mozaffarian, a cardiologist and dean of the Tufts Friedman School of Nutrition Science and Policy. “It’s not the only thing that’s important to having a safe car. But it’s pretty crucial.”
The American Heart Association recommends that every adult get their cholesterol checked every four to six years beginning at the age of 20. That means looking at your LDL cholesterol, your HDL cholesterol, your total cholesterol, and your triglycerides, which are a type of fat that circulates in your blood. If you have a high risk of heart disease, however, you may need more frequent testing.
You may be at higher risk if:
You’re a smoker
You have diabetes
You’re a man older than 45 or a woman older than 55
You have a strong family history of heart disease
If you do have a problem with your cholesterol levels, don’t despair. You can improve your cholesterol with dietary and lifestyle changes. Your doctor might also prescribe an inexpensive cholesterol-lowering medication known as a statin. It’s a conversation you should have with your doctor. In the meantime, you can use the American College of Cardiology’s online calculator to assess your risk of heart disease.
More than 30 million adults in the United States have Type 2 diabetes. Yet more than seven million of those people don’t even know it. You can find out whether you are one of them with a simple blood test.
Type 2 diabetes begins with chronically high blood sugar levels, but it can lead to a number of severe and disfiguring complications, like strokes, heart attacks, blindness, amputations and peripheral vascular disease. One in 10 people in the United States has diabetes and about 80,000 people die from it every year. Yet its prevalence is growing and many of those who have it have no idea.
One of the leading risk factors for diabetes is age: The older you are, the higher your risk. That’s why the American Diabetes Association recommends that everyone who is 45 years of age or older be screened for diabetes at least once every three years. The recommended screening method is known as a fasting plasma glucose test, which is simple and inexpensive, requiring only a blood draw to examine your blood sugar levels after an eight-hour fast.
If you’re at a high risk of diabetes, then you should talk to your doctor about getting screened long before you turn 45.
According to the C.D.C., some of the factors that put you at a higher risk are:
A family history of the disease
Being overweight and physically inactive
Abnormal cholesterol levels
A history of gestational diabetes
Polycystic ovary syndrome
Belonging to a high-risk ethnic group, which includes African Americans, Mexican Americans, Asian Americans, Alaska Natives, American Indians and Pacific Islanders.
GET TESTED FOR S.T.D.S
Here’s some disturbing news: Sexually transmitted diseases are on the rise.
Researchers estimate that 20 million new sexually transmitted infections are contracted every year. But unfortunately some of the most common diseases that are contracted through sex, like chlamydia, gonorrhea and syphilis, frequently have no symptoms. That can be a big problem for silent carriers: Untreated S.T.D.s can lead to infertility, cervical cancer and potentially life-threatening complications. That’s why it’s critical that every adult undergo the right types of screening.
According to the C.D.C., here’s what you need to know:
All adults should be tested for H.I.V. at least once in their lifetimes. But people who are at higher risk should be screened more frequently.
Men who are sexually active and have sex with other men should be screened for syphilis, chlamydia, gonorrhea and H.I.V. at least once a year. Those who have multiple sex partners should be screened more frequently, about once every three to six months, according to the C.D.C.
Sexually active women younger than 25, or those who have multiple sex partners, should be tested every year for chlamydia and gonorrhea. Pregnant women should also be tested for these diseases early in their pregnancy as well as for H.I.V., hepatitis B and syphilis.
Anyone who has unprotected sex or who is an injection drug user should get tested for H.I.V. at least once a year.
Starting in Your 20s and 30s
Now's the time to follow up on HPV vaccination and start regular Pap smears if you are a woman.
GET THE HPV VACCINE (IF YOU HAVEN'T ALREADY)
Cancer is the second leading cause of death in America. But there are vaccines that can prevent some forms of it, like cervical cancer, which kills thousands of women every year. Nearly all cases of cervical cancer are caused by a group of viruses known as human papillomavirus, or HPV, which is transmitted through sexual activity. HPV is so prevalent that most sexually active men and women will be infected with it at some point in their lives. Every year 14 million Americans, most of them teenagers and young adults, are infected with HPV.
In many cases, HPV infections are eliminated by the immune system. But some strains can linger and eventually lead to genital warts, as well as cancers of the throat, mouth, anus and vagina. Two strains, HPV-16 and HPV-18, cause most cases of cervical cancer. Ideally adolescents should be vaccinated against H.P.V. before they are exposed to it.
HPV infections cause about 32,000 cases of cancer in the United States annually. But 90 percent of those cases could be prevented with the HPV vaccine. The vaccine is so effective that since it was approved by the F.D.A. in 2006, HPV infections in teenage girls fell by two thirds. That is why it is so important that people who are eligible for the vaccine get it.
The C.D.C. recommends that the following groups of people undergo HPV vaccination:
Boys and girls who are 11 or 12 years old.
Women who are 26 years of age or younger.
Men who are 21 years of age or younger.
Men under the age of 26 who are gay or bisexual, as well as men who have sex with other men or people who are transgender or immunocompromised (such as those with H.I.V. infections).
FOR WOMEN, GET A PAP SMEAR EVERY 3 TO 5 YEARS
For many years women were told to follow the old adage, “a pap smear once a year.” But in 2012 that advice was put to rest. That was when the United States Preventive Services Task Force changed its guidelines on the annual Pap smear, which involves swabbing the cervix to look for changes that could lead to cancer.
The annual Pap smear is credited with preventing millions of women from dying of cervical cancer. But the updated guidelines reflect the fact that it does not need to be carried out so frequently and now recommend that healthy women get a Pap smear no more than once every three years beginning at the age of 21. Women over the age of 65 are advised not to continue screening if they are not high risk – for example, if they have no family history of cervical cancer and have not had any recent abnormal Pap smear results. The guidelines also state that low-risk women between the ages of 30 and 65 can opt for screening once every five years for both a Pap test and HPV screening.
The task force that issued the updated guidelines is an independent group of experts that evaluates screening tests and procedures intended to prevent and detect diseases. The task force relaxed its recommendations out of concern that the Pap smear was being overused. While it is very useful in early detection, it can also result in many false positives, which could lead to unnecessary biopsies and pregnancy complications. Many women who are used to annual Pap smears choose to continue the practice anyway. But for most women, the task force concluded, it isn’t necessary.
Starting in Your 40s
Heed some recent advice and start colon cancer screening this decade.
GET SCREENED FOR COLON CANCER
For many years, health authorities advised Americans to undergo colon cancer screening starting at the age of 50. But that changed in early 2018 when the American Cancer Society released new guidelines that called for colorectal screening to begin much earlier, at the age of 45.
The reason for this was clear: In recent years the rate of colorectal cancer has risen drastically in people under the age 50, with the highest increase in people between 40 and 49 years old. The disease strikes 140,000 Americans every year and kills 50,000. But while the vast majority of cases occur in older people, the rates among older and younger people have followed starkly different trend lines.
Colon cancer deaths and diagnoses have fallen in adults older than 55, largely as a result of the success of screening and early detection. In people younger than 50, however, the rate jumped 50 percent between 1994 and 2014.
No one knows precisely why it climbed among younger adults. Some experts thought it was a result of earlier detection. But research showed that the uptick reflected a real increase in incidence, suggesting that the disease is increasingly striking younger people.
That’s why the American Cancer Society wants people to begin colorectal screening earlier than in years past. Not every medical group agrees. The Preventive Services Task Force continues to recommend that screening begin at age 50, while other groups advocate routine screening at 45 only for groups at higher risk, such as African Americans. The cancer society however suggests something of a compromise. It does not call for everyone to have a colonoscopy, which is the most invasive procedure. Rather, it says that adults under 50 should choose from a range of screening options, including noninvasive procedures like submitting stool samples to laboratories that look for blood and biomarkers associated with colorectal cancer.
According to the American Cancer Society, here’s what you need to know:
People at average risk of colorectal cancer should begin regular screening at 45 and continue through at least the age of 75. People at average risk are those who do nothave:
A personal or family history of colorectal cancer or polyps.
A history of colitis, Crohn’s disease or other inflammatory bowel diseases.
Hereditary colorectal cancer syndrome.
A history of radiation treatments in their abdominal or pelvic areas.
If one or more of the above statements does apply to you, you are at higher risk, and you may need to begin colorectal screening sooner than 45. There are six different screening options you can choose from. They are grouped into invasive procedures, which are more definitive and less frequent, and noninvasive procedures that analyze stool samples as often as every year. Talk to your doctor about which one is best for you.
Fecal immunochemical testing, or F.I.T., which is done yearly.
An annual fecal occult blood test known as gFOBT.
A stool DNA test called MT-sDNA that is done every three years.
Structural Colorectal Exams:
A colonoscopy every 10 years.
A virtual colonoscopy every five years. This involves taking a CT scan of your abdomen and pelvis, which is less invasive than a conventional colonoscopy.
A flexible sigmoidoscopy procedure, known as FSIG, every five years.
Starting in Your 50s
Talk to your doctor about aspirin, continue regular screenings and think about the shingles vaccine.
YOU MAY NEED A DAILY ASPIRIN
Doctors have long encouraged some adults to take a daily aspirin to lower their risk of a heart attack or stroke. But aspirin has another major benefit: Colorectal cancer prevention.
A large study carried out by Harvard researchers in 2016 suggested that regular use of aspirin could prevent more than 10 percent of colorectal cancer cases in the United States. Another large trial published in the journal The Lancet in 2010 found that people with a hereditary condition that markedly increased their risk of colorectal cancer lowered their odds of developing the disease more than 60 percent by taking a daily dose of aspirin.
The evidence from these and other studies was so persuasive that the Preventive Services Task Force recently issued guidelines recommending a daily aspirin for both cardiovascular and colorectal cancer prevention. But the group focused its recommendation on people it considered likely to get the most benefit with the least amount of side effects. It defines them as people between the ages of 50 and 59 who have a 10 percent or greater risk of having a heart attack in the next decade and a low risk for bleeding. You can find out your 10-year-risk of a heart attack by using the American College of Cardiology’s online calculator.
The task force noted that people between the ages of 60 and 69 who have an increased risk of heart disease are also likely to benefit. But it stopped short of issuing a strong recommendation because the likelihood of serious bleeds rises with age, and aspirin can further increase the risk of internal bleeding. People in this age group should discuss the pros and cons of a daily aspirin with their doctor to determine if it makes sense for them based on their personal circumstances.
GET THE SHINGLES VACCINE
One of the unfortunate things many Americans have to look forward to as they get older is shingles, a painful, blistery rash that can occur anywhere on the body, but usually crops up on the torso. Shingles stems from the same virus that causes chickenpox, known as varicella-zoster. After it causes chickenpox, the virus can burrow into your nervous system and lie dormant, only to be reactivated years or decades later when your immune system is weakened.
Shingles can strike anyone who has had chickenpox. But the risk rises with age. About one third of Americans eventually get shingles, and experts estimate that half of people who are 80 or older will have a shingles outbreak. That’s a serious problem because shingles is more than just a rash: It can lead to chronic pain, blindness, neurological damage, facial paralysis and hearing loss.
But you can protect yourself with a shingles vaccine. There are currently two varieties. One, called Zostavax, was approved by the Food and Drug Administration in 2006. It offers protection against shingles for about three years and then starts to lose its effectiveness. That’s one reason the second vaccine, called Shingrix, is the preferred one. The F.D.A. approved it for use in 2017 after studies on thousands of people showed that it was far more effective at preventing shingles than Zostavax.
Here’s what you need to know.
If you are a healthy adult age 50 or older, the C.D.C. recommends that you get two doses of the newer shingles vaccine, Shingrix, separated by two to six months.
Even if you were previously immunized with the older vaccine, Zostavax, you should still get the Shingrix vaccine
If you are allergic to Shingrix or if it is unavailable, get the older vaccine, Zostavax.
FOR WOMEN, GET A REGULAR BREAST EXAM
Much like the Pap smear, breast exams that screen for cancer, known as mammograms, can save lives. They are especially critical because breast cancer is the second leading cause of cancer deaths in women. But mammograms can also produce a lot of uncertain results, leading to further tests that are invasive and potentially unnecessary, like biopsies.
For that reason, experts encourage women to be diligent about getting routine mammograms while also being careful to not overdo it. Up until a decade ago, women were told to get screened every year beginning at the age of 40. Then in 2009 the Preventive Services Task Force relaxed its recommendations, saying women who have an average risk of breast cancer should get screened every other year beginning at age 50 and continuing until the age of 74. In 2016, the task force updated its screening guidelines for breast cancer, but its advice for women remained unchanged. It based its advice in large part on research showing that women can reduce their likelihood of a false positive diagnosis by beginning screening at 50 and doing it every other year.
The task force noted that for women under 50 and older than 74, there may be cases where routine screening makes sense. But that is a conversation women in those age groups should have with their doctors. Women who are at high risk of breast cancer for example may need to begin screening earlier than 50. Those in the higher risk category include:
Women with a strong family history of breast cancer, such as those who have two close relatives, like an aunt and a grandmother, who developed the disease prior to 50.
Women who have gene mutations that are known to increase breast cancer occurrence, such as harmful mutations in the BRCA1 or BRCA2 genes. (If you have a strong family history of breast cancer, testing for these mutations can be done with a blood test and interpreted with the help of a genetic counselor.)
FOR MEN, BEGIN PROSTATE CANCER SCREENING AT 55
Prostate cancer is a serious concern for many older men. About one in nine men in America will develop the disease in their lifetime, and one in 41 will ultimately die from it. Prostate cancer is the second leading cause of cancer death in American men, right behind lung cancer.
But screening for it does not come without some significant caveats. Screening for the disease involves measuring levels of a protein called Prostate Specific Antigen, or PSA, which the prostate gland typically produces at elevated levels when cancer is present. But increased PSA can also be caused by a number of benign, noncancerous conditions that might otherwise cause no problems or symptoms at all. And over-diagnosis can lead to unnecessary treatments that carry the risk of life-changing side effects such as impotence and incontinence.
That’s why the Preventive Services Task Force had for many years a very cautious stance on prostate cancer screening, urging men to skip it. But in 2017 the task force changed its stance and released new guidelines. It now recommends that men between the ages of 55 and 69 discuss prostate cancer screening with their doctors. The group revised its guidelines after clinical trials involving thousands of men showed that those who were offered screening significantly reduced their risk of dying from prostate cancer or developing metastatic disease.
But even in this age group, it is not right for everyone. Some men may be at higher risk of the disease because of their family history or their race (black men are more likely to develop the disease) and thus more open to screening. Others may be reluctant because of their concerns about the potential side effects from invasive biopsies and aggressive treatments. That’s why it should be considered on a case-by-case basis. But the task force was very specific about the age range where screening is advisable. For men who are 70 or older, the harms outweigh the benefits, the task force concluded, and therefore screening in their cases should be avoided.
In Your 60s and Beyond
These are the years to get your bone density tested, and get the pneumonia vaccine.
GET YOUR BONE DENSITY TESTED
After the age of 65, one of the biggest threats to your health is osteoporosis. Half of all people 50 or older are at risk of breaking a bone. Among the most debilitating consequences of osteoporosis are hip fractures, which can lead to loss of independence, poor quality of life and increased mortality.
That is why being diligent about your bone health, especially as you get older, can be crucial. And yet most people fail to take proper precautions. Studies show that only about a third of people at highest risk for osteoporosis undergo screening for the disorder. In June 2018, the Preventive Services Task Force issued its updated osteoporosis guidelines. The group recommended that all women 65 and over get their bone density checked through a procedure known as a DEXA scan, which is inexpensive, noninvasive and covered by Medicare.
The task force added that women who are younger than 65 and past menopause should consider screening as well if they have certain risk factors. These include tobacco use, heavy alcohol consumption, low bodyweight and a parental history of hip fractures. Ultimately, women who are found to have low bone density have many treatment options, including several drug therapies that have been shown to build and preserve bone mass.
The guidelines, published in JAMA, focused on women, who tend to be at greater risk of osteoporosis because they have smaller, thinner bones than men. Menopause plays a role in this. Estrogen protects bones, so when women reach menopause, their rate of bone loss accelerates as their estrogen levels decline.
But while osteoporosis has historically been considered a disorder of postmenopausal women, men are also at risk. Studies show that one in five men over 50 will suffer an osteoporotic bone fracture in their lifetimes. And when men break a hip they are twice as likely to die within a year as women. So for men, the consequences of osteoporosis can be particularly deadly.
In an editorial accompanying the updated screening guidelines in JAMA, Dr. Jane A. Cauley, an epidemiologist at the University of Pittsburgh, said it made sense for men 70 or older who are high risk to undergo DEXA screening as well. Men at higher risk are those for example who smoke, drink heavily, don’t exercise or have a family history of osteoporosis. The National Osteoporosis Foundation takes an even more proactive stance. It recommends that all men 70 or older get their bone density checked regardless of whether they have any risk factors or not.
GET THE PNEUMONIA VACCINE
One of the unfortunate consequences of aging is a weakened immune system. Older adults have a harder time fighting off pathogens, and as a result they are more susceptible to infections. One of the most serious infections for Americans over 65 is pneumonia, which is a major cause of death for seniors. According to the C.D.C., more people die from pneumonia each year than from car accidents.
Pneumonia doesn’t get as much attention as heart disease and other leading killers of adults. But every year in the United States, more than 16,000 adults 65 or older die from it, and thousands more are hospitalized because of complications from the infection, such as meningitis. The best way you can protect yourself against pneumonia is to get vaccinated. The C.D.C. recommends that all adults 65 or older get two different pneumococcal vaccines a year apart.
The first vaccine is PCV13, also known as Prevnar 13. It protects against 13 strains of pneumococcal bacteria. The second one, called PPSV23, or Pneumovax 23, protects against 23 strains of the bacteria. If you are 65 or older, you should do the following:
Get one dose of the PCV13 vaccine.
One year later, get a dose of the PPSV23 vaccine.
If you already had the PCV13 vaccine at a younger age, then you don’t need it again. But you’ll still need to get a dose of the PPSV23 vaccine.
The pneumonia vaccines can cause side effects, but they are generally mild ones, like soreness at the injection site or mild swelling.
If you’ve ever had a serious or life-threatening reaction to a previous vaccine, then you may need to hold off on the pneumonia vaccine. Talk to your doctor to help you decide.