Tests and procedures
Low LDL cholesterol and high HDL cholesterol lower your risk for cardiovascular disease. That is what the studies have always shown us. But a new study suggests that low HDL itself may not be the risk factor for heart disease we thought it was. It could merely be a sign of an unhealthy lifestyle, or other health risk factors, that also contribute to heart disease. Trying to find medications to raise HDL cholesterol may not be as effective as encouraging people to adopt healthier habits.
Researchers believe that a non-invasive screening test that can identify genetic markers for high-grade prostate cancer in urine may eventually reduce the number of prostate biopsies needed. However, experts also caution that while the number of non-invasive tests for prostate cancer diagnosis is growing, these are still early days in their development.
As imaging tests like CT scans and MRIs have become more commonplace, so have incidental findings — abnormalities picked up by the test that weren’t what the test was looking for. In some cases, such as finding calcium deposits in the blood vessels during a routine mammogram, these findings may lead to earlier, potentially lifesaving, treatment for another condition. But in many other cases, these “incidentalomas” are more stressful than helpful.
If you’ve ever fasted overnight before having blood drawn, you know how uncomfortable and inconvenient this can be. But for many people, fasting blood draws might be a thing of the past. Recent guidelines reinforce that fasting is not required to have your cholesterol levels checked. This move, along with the advent of a non-fasting test to monitor diabetes, means you might not have to skip breakfast before your next visit to the doctor.
If you’ve ever looked through your bloodwork results, you may have noticed that some of your results are barely within the normal range—or even just outside it. Many of these results simply reflect the fact that what’s perfectly normal for you doesn’t always fit within the laboratory’s “normal” range. It’s the trends in your results over time, not any one number, that tell the most accurate story about your health.
Fewer men are being given PSA tests to screen for prostate cancer. As screening rates have fallen, so have the number of prostate cancer diagnoses. This probably also means that fewer men are receiving potentially unnecessary treatment, with its attendant negative side effects. At the same time, it isn’t yet clear whether that comes at the cost of more aggressive cancers being caught at an incurable stage. Better screening tests may make the difference in helping strike the right balance between limiting harm and preventing prostate cancer deaths.
CT scans, MRIs, and PET scans are among the many advanced imaging options available to doctors and patients today. Although these tests have revolutionized medical care, they also come at a cost. But not only are these tests expensive — many of them expose patients to radiation, and all of them can reveal potential problems that turn out to be harmless, but require follow-up tests to be sure. Rather than have insurance companies act as gatekeeper, it may be more effective to have clinicians consult with imaging experts when deciding on which, if any, tests are necessary.
The age at which women should start having screening mammograms, and how often, has been controversial for some time. Reputable national organizations have differed in their recommendations. Accumulating data suggest that for women under 45, screening mammograms may bring more harm than good. As a result, the American Cancer Society has radically shifted its screening guidelines for women in their early 40s at an average risk for breast cancer.
Last month, JAMA Oncology published a study that suggests standard treatment for non-invasive breast cancer (DCIS) may be too aggressive and that perhaps some women with DCIS would do just as well without lumpectomy or mastectomy. As expected, this has generated a lot of controversy and confusion. For some women, DCIS is a “precursor” to invasive breast cancer, but in many others, it may not progress. But right now, doctors don’t understand these cancers well, and it is difficult to predict how these abnormal cells will behave in any given woman. More research is needed to determine optimal treatment for each individual woman diagnosed with DCIS. In the meantime, a woman with DCIS and her doctor should take into account certain risk factors (age and race among them), as well as that woman’s personal preferences when creating a treatment plan.
Last spring, an advisory panel for the Center for Medicare and Medicaid Services (CMS) recommended that Medicare not cover low-dose CT scans for smokers or former smokers. These scans can double the proportion of lung cancers found at an early stage, while they are still treatable. Yesterday, CMS announced that it would cover the cost of these scans for people between the ages of 55 and 74 who smoke, or who quit within the last 15 years, and who have a smoking history of 30 pack-years. (That means a pack a day for 30 years, two packs a day for 15 years, etc.) The new Medicare plan would cover scans for an estimated 4 million older Americans, at a cost estimated to be more than $9 billion over five years. In a wise addition, Medicare will require smokers to get counseling on quitting or the importance of staying smoke-free before having the annual scan.