Screening Tests for Men Archive

A cardiac stress test can determine your risk of heart disease, but often requires follow-up testing.

What can a cardiac stress test tell me about my heart? Once it was common for a man middle-aged or older to get an annual exercise stress test to make sure his heart was still ticking like a fine watch. But expert guidelines now discourage such "just in case" stress testing.

Is this trend against stress testing healthy for older men? We asked Dr. Deepak Bhatt, a professor of medicine at Harvard Medical School and chief of cardiology for the VA Boston Healthcare System, for insight into what an exercise stress test can and cannot tell you about your heart. With caveats, the procedure still has a valuable role to play in diagnosing worrisome symptoms like chest pain—especially in older men with risk factors for heart disease. "An exercise stress test is not 100% accurate—no medical test is," Dr. Bhatt says. "But it helps decide what the next step should be."

They often lead to follow-up appointments and more testing.

Modern medical imaging saves lives: it can find a blocked artery, a bulging blood vessel, or a suspicious mass. But many times, an x-ray, CT scan, MRI scan, or ultrasound exam looking for one kind of problem can reveal an anomaly that's unrelated and unexpected. Such incidental findings can lead to more testing, more medical bills, and a great deal of anxiety.

"Frequently radiologists will point out something and say it's probably benign, but recommend an MRI. Once you've been told something might be abnormal, you might feel nervous until you know what it is," says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center.

The once-a-year appointment can reveal vital health information for both you and your doctor.

It's usually covered by your health insurance, it doesn't take much time, and it's a great way to learn about your present and future health.

While men often call it the yearly physical, the annual ritual is better named a wellness visit or preventive health appointment. Whatever you call it, men should still have one every year as it remains an important part of primary care, according to Dr. Asaf Bitton, executive director of Ariadne Labs and primary care physician at Harvard-affiliated Brigham and Women's Hospital.

Here is what men need to know to minimize discomfort of a prostate biopsy and get the best results.

Q. I have always had my blood tests taken the first thing in the morning, before I've had breakfast. We've just moved to a new home and I'll have a long commute to the hospital, so I'd like to eat before I start out. My cholesterol has always been great, so my doctor said a light breakfast won't interfere with cholesterol tests. But he didn't know if eating would change my PSA result. What do you think?

A. At last — a PSA question with a simple, un-equivocal answer: Breakfast will not affect your PSA result, nor will lunch or dinner. In June 2005, doctors proved the point by measuring PSA levels three times over the course of a single day in 80 patients with an average age of 62 years. The samples were obtained before breakfast, after breakfast, and after lunch — and there were no changes in the PSA results.

Q. How often should a healthy 55-year-old woman have a colonoscopy? Do the benefits outweigh the risk of complications, such as bowel perforation?

A. Colonoscopy is one of several tests used to screen for colorectal cancer, the third most common cancer and cause of cancer mortality (after breast and lung cancer) in American women. In 2018, some 140,000 Americans were diagnosed with the disease, and 50,000 died of it. Experts believe that adequate screening could have prevented perhaps 60% of those deaths.

Direct-to-consumer tests may help predict risks to your future health. But are they worth the cost and trouble?

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Direct-to-consumer (DTC) genetic test kits are a popular way to identify a person's ancestral history, but the technology may also reveal whether someone is at risk for specific diseases and conditions, like Alzheimer's disease, heart disease, and even cancer.

"More and more people want to explore their own medical data, and a DTC genetic test is one way to begin to understand some aspects of your future health," says Dr. Robert Green, a medical geneticist at the Harvard-affiliated Brigham and Women's Hospital and director of the Genomes2People Research Program. "Yet it is important to realize that DTC testing is not the same as genetic testing in a medical context, and is not a comprehensive examination of your DNA."

In the journals

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The U.S. Preventive Services Task Force recently updated its guideline for prostate-specific antigen (PSA) screening for prostate cancer.

The group now recommends that for men ages 55 to 69, screening should be an individual choice, and a man should discuss the pros and cons with his doctor before making a decision. The report, published online May 8, 2018, by The Journal of the American Medical Association, differs from the 2012 guidelines that recommended against screening for all men.

On call

Q. I am 65 years old and in good health, and I see my doctor once a year for an annual exam. Should I request a stress test at my next physical?

A. Although heart disease is common in men, routine cardiac stress testing is not recommended for otherwise healthy men. It may seem counterintuitive not to look for heart disease in healthy men, especially when many people know someone who unexpectedly had a heart attack or even died suddenly from a heart problem. Yet, stress testing does not accurately identify men at risk for sudden cardiac death.

Coronary artery calcium tests can reveal early signs of heart disease. But they're not appropriate for everyone.

 Image: © Monkey Business Images/Thinkstock

A special x-ray scan can show specks of calcium inside the walls of the heart's arteries within a matter of minutes. Known as a coronary artery calcium (CAC) scan, it offers one way to predict a person's future risk of heart disease.

However, having this test makes sense only if the results would affect a person's medical treatment. For the most part, that means it's useful primarily for people who are wavering about whether to take a cholesterol-lowering statin drug, says Dr. Ron Blankstein, a cardiovascular imaging specialist and preventive cardiologist at Harvard-affiliated Brigham and Women's Hospital.