Medical Tests & Procedures Archive

Ask the doctor

Q. I have been smashed, squashed, pulled, and tugged annually for 25 years. Why isn't there a better way to take a mammogram?

A. We hear you! Compression mammography has been the "gold standard" for decades for one reason — it works. Flattening the breast makes ductal tissue easier to distinguish and reduces the amount of radiation required to do so. Studies have demonstrated that it is the most effective approach to breast cancer screening.

The predictive powers of a cholesterol test only go so far. If your LDL is low, your C-reactive protein may be a better sign of impending heart trouble.

The gap between knowing what's good for you and actually doing it can be huge, especially when it comes to something like getting exercise. (Never underestimate the appeal of the sedentary life.) Many of us need a warning-some might say a bit of a kick in the pants-before we'll change our ways and get with a heart-healthy program.

Cholesterol Tests

For decades, cholesterol testing has served as that warning for many. An elevated level of "bad" LDL cholesterol has been just the warning people needed to change their ways. It has played that role for several reasons. People like tests because the results seem objective. Reliable measurement of cholesterol is easy and relatively inexpensive. It makes sense biologically. LDL cholesterol, a protein-wrapped package containing fat and cholesterol, tends to slip out of the bloodstream and lodge in blood vessel walls, forming the plaque that leads to clots and heart attacks.

Women with early cancer in one breast may opt to remove the other, healthy breast because they overestimate their risk of a second cancer.

Cardiorespiratory fitness may soon be considered as a vital sign on par with blood pressure and heart rate.

 Image: © iStock

Three decades' worth of solid evidence linking a sedentary lifestyle to higher risk of cardiovascular disease, cancer, and early death has silenced even the most ardent exercise deniers. Nonetheless, a metric quantifying a person's level of aerobic fitness has yet to make it into the set of tools commonly used to predict heart disease.

But that may soon change. The American Heart Association recently released a statement calling for cardiorespiratory fitness (CRF) to be considered a clinical vital sign, similar to how blood pressure, heart rate, and tobacco use are treated now. Assessing fitness level at your annual visit would help your doctor get a better picture of your underlying heart health and risk of disease down the road.

In older people, angioplasty done through an artery starting in the wrist may have fewer complications than conventional angioplasty done through a vessel starting in the leg.

If you don't mind pricking a finger, you can check your cholesterol without sitting around in a doctor's waiting room or laboratory. Devices available in pharmacies or through the Internet make this easy to do at home. But is it worth doing?

The makers of home cholesterol tests rightly tout their products as faster than visiting a doctor. You prick your finger, gently squeeze a few drops of blood onto a test strip or into a small "well," and you get the results in a few minutes, instead of waiting a few days.

There are many opportunities to join a clinical trial, and you may be surprised at what you can learn about your health.

 Image: ggustavofrazao/Thinkstock

You no doubt have seen advertisements asking people to join a clinical trial and thought they don't apply to you. But perhaps you should reconsider.

"People have a vested interest in the outcome of research trials, since these studies address many issues they want to avoid or better manage, such as cancer, diabetes, blood pressure, and dementia," says Dr. Howard Sesso, an epidemiologist with the division of preventive medicine at Harvard-affiliated Brigham and Women's Hospital.

After an artery-opening angioplasty plus a stent, a person may need bypass surgery in the future. Likewise, some people who have bypass surgery may later need a stent. Neither procedure stops atherosclerosis, the disease that clogs heart arteries.