Medical Tests & Procedures Archive

A mail-order saliva test marketed to consumers may make some promises it can't deliver.

A new mail-order genetic test called StatinSmart bills itself as the first test to identify a person's risk of experiencing muscle pain from a statin. That sounds like potentially helpful information, given that up to half of people who are prescribed statins quit taking them because of perceived side effects—most often muscle pain. Others avoid statins altogether because of that worry.

But here's the rub: muscle problems can range from mild to serious, and the terms experts use to describe them can be confusing. The StatinSmart website says 29% of people who take a statin develop "statin-induced myopathy," which they define as muscle aches, pains, weakness, or cramps.

A study in the December 2015 issue of The Lancet Oncology found that a new test, called STHLM3, is more helpful at detecting aggressive cancer than traditional tests for prostate-specific antigen (PSA).

The STHLM3 test is a blood test that analyzes a combination of six protein markers, more than 200 genetic markers, and various clinical data, such as age, family history, and previous prostate biopsies.

Ask the doctors

Q: I'm expecting and want to have a vaginal delivery, but many of my friends have had cesarean sections lately. Is this a preference, or are there medical reasons to have a cesarean?

A: The health of the mother and baby, the family's personal preferences, and the hospital in which a woman delivers her baby play a role in determining whether she has a cesarean. Common medical reasons for cesareans include fetal malpresentation (when the baby is turned so that its feet or buttocks will come out first), pelvic disproportion (a birth canal that is unusually shaped or too small in relation to the size of the baby), and a past cesarean. A study published in the Journal of the American Medical Association in December 2015 suggests that such commonly cited medical issues may account only partly for high cesarean rates.

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Targeted cancer therapies have limits, but some may offer a better option than standard chemotherapy.

Mention cancer treatment, and most men think of chemotherapy—complete with hair loss and extreme fatigue. But for some men, there is another option. Targeted therapies can sometimes treat certain cancers with fewer side effects and better outcomes.

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Cardiologists expect wider use of the less-invasive technique—known as TAVR—in the near future.

The one-way valve inside your aorta opens to allow blood to surge from the heart to the rest of your body. But as you age, the valve's leaflets may stiffen and become clogged with calcium deposits, restricting blood flow. About 12% of people ages 75 or older have this condition, known as aortic stenosis. Symptoms include feeling dizzy, faint, tired, and breathless. Unless the valve is replaced, half of people with symptoms from aortic stenosis die within two years.

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Being checked for hidden colorectal cancer is a smart bet, though it's hard to say whether it will ultimately extend your life span.

Recently, the National Colorectal Cancer Roundtable—a national organization of medical groups, health care providers, government agencies, and patient advocates—launched the "80% by 2018" initiative. The goal is to convince more people to get screened for hidden colorectal cancer. Right now, about 65% of Americans do so.

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Women can devise their own breast cancer screening schedules based on their risk and preferences.

If you tend to "go by the book" for preventive health care, you probably get a flu shot each fall, have a colonoscopy every 10 years, and generally follow the experts' recommendations. But what do you do about mammograms? For decades, the two most influential expert groups—the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF)—haven't agreed about when to start having mammograms, how often to have them, or how long to keep on having them. Although the two groups come a little closer together with their most recent guidelines, they still disagree about breast cancer screening for women ages 45 through 54.

Make sure you get your blood pressure measured at least once a year.
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Screenings for cardiovascular disease, diabetes, and cancer aren't always routine.

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News briefs

The guidelines for routine breast cancer screenings are changing again. The American Cancer Society (ACS) published its new recommendations Oct. 20, 2015, in The Journal of the American Medical Association, suggesting that women at average risk for breast cancer now wait until age 45 to begin getting yearly mammograms (it had been age 40) and then get yearly mammograms until age 54. After that, the ACS now recommends that average-risk women ages 55 to 74 transition to screening every other year (instead of annually). It's a big shift for the ACS, and the recommendations are now more in line with the guidelines that came from the U.S. Preventive Services Task Force (USPSTF) in 2009, which recommended mammograms every two years for average-risk women ages 50 to 74 and advise against routine screening before age 50 in these women. The USPSTF guidelines have been controversial since they came out. But no one is saying that women at increased risk for breast cancer should wait to get a mammogram; it's a decision that must be made by a woman and her doctor, based on her risk factors. One other big change to the ACS guidelines: that women continue screening mammography only if they have a life expectancy of 10 years or longer.

Joint replacement is a complex procedure, and finding the right surgeon and hospital can make a big difference in your outcome. In general, you're likely to have a better result and fewer complications if your surgeon performs the operation frequently (at least 100 times per year) and operates in a hospital where these procedures are commonplace. Don't be surprised if this rules out the most convenient hospital for your location.

Your orthopedist, rheumatologist, or primary care physician, or a friend who has undergone successful joint replacement, may be able to recommend a specific surgeon. But keep in mind that your insurer may restrict you to certain specialists or require a larger copayment if you go outside your plan.