Tests and procedures

What’s the evidence for evidence-based medicine?

Monique Tello, MD, MPH
Monique Tello, MD, MPH, Contributing Editor

The history of medicine is filled with remedies that were relied upon for hundreds of years until they were eventually proven ineffective or possibly even dangerous, while legitimate practices and treatments were disregarded or ridiculed until evidence outweighed skepticism. The bottom line is that medical interventions — from tests to treatments — should neither be recommended nor condemned without considering and weighing the evidence. A future post will discuss what physicians look for when evaluating “the evidence.”

New imaging technique may help some men avoid prostate biopsy

Charlie Schmidt
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Disease

In a British study, a specialized type of MRI test did significantly better at identifying high-grade prostate tumors than a transrectal ultrasound biopsy. It’s hoped that one day this test might help men avoid prostate biopsies and their potential complications.

Low levels of HDL (the “good” cholesterol) appear connected to many health risks, not just heart disease

Deepak Bhatt, MD, MPH

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.

New urine test predicts high-grade prostate cancer

Charlie Schmidt
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Disease

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.

Taking advantage of incidental findings

Robert H. Shmerling, MD
Robert H. Shmerling, MD, Faculty Editor, Harvard Health Publications

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.

Farewell to the fasting cholesterol test?

Naomi D. L. Fisher, MD
Naomi D. L. Fisher, MD, Contributor

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.

What to do when blood test results are not quite “normal”

Heidi Godman
Heidi Godman, Executive Editor, Harvard Health Letter

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.

Does fewer PSA tests mean less prostate cancer?

Charlie Schmidt
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Disease

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.

Imaging tests: Using them wisely

Ashish K. Jha, MD, MPH
Ashish K. Jha, MD, MPH, Contributing Editor

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.

New mammography guidelines call for starting later and screening less often

Julie Corliss
Julie Corliss, Executive Editor, Harvard Heart Letter

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.