Screening Tests for Women Archive

Q. My senior center is sponsoring a test to check for "peripheral artery disease." The test is free, and they say it's safe and painless. Do you think it's a good idea?

A. Peripheral artery disease (PAD) is a form of atherosclerosis. In this case, cholesterol deposits produce blockages in the arteries that carry oxygen-rich blood to your legs. Mild blockages don't cause any symptoms, but more substantial disease can cause leg pain when you walk, which is called intermittent claudication. And severe narrowing will produce pain at rest or, worst of all, critical tissue damage that requires urgent surgery or even amputation. If that's not bad enough, PAD also indicates an increased risk for heart attacks and strokes.

The electrocardiogram (ECG) is one of the most common, enduring, and important tests in all of medicine. It's easy to perform, noninvasive, produces results right away, and is useful in diagnosing dozens of heart conditions. The ECG has taken on even more importance lately because a particular ECG pattern, called ST elevation, is a strong indication that a serious heart attack has occurred, and there's more emphasis than ever on treating heart attacks as soon as possible. An ECG isn't necessarily going to be part of a routine physical, but if you need medical attention because you have chest pain, sudden unexplained shortness of breath, or other symptoms that suggest a possible heart attack, you will almost certainly get an ECG.

The ECG is a reading of the electrical impulses in the heart that activate the heart muscle and its blood-pumping action. Twelve electrodes affixed to the skin on the chest, arms, and legs sense those impulses from various vantage points. Part of the reason the ECG has had such staying power is that the output is visual: a line graph with peaks and valleys, not a stream of numbers. As a result, reading an ECG is a matter of pattern recognition, not computation. There are many permutations, but someone can be trained to recognize the most common patterns relatively quickly.

Q. I am a 72-year-old male in excellent health. I have been diagnosed with a 3.7-centimeter aortic aneurysm. My doctor recommends an ultrasound every six months. Are six-month checks adequate? And when should surgery be considered?

A. I assume this is an abdominal aortic aneurysm (AAA) and that it was detected by a screening exam, not because you had a symptom such as back pain. Indeed, the U.S. Preventive Services Task Force recommends screening all men who have ever smoked and are between 65 and 75. The test is a simple, entirely safe abdominal ultrasound, and it need not be repeated if it's normal.

Q. Every time I open a newspaper, I seem to read about another VIP with cancer of the pancreas. It sounds like a dreadful disease. Is there some way I can be tested to see if I'm at risk?

A. Cancer of the pancreas is relatively uncommon; only about 43,000 cases are diagnosed in the United States each year, putting it far behind prostate cancer (218,000 a year), breast cancer (209,000 a year), and colorectal cancer (143,000 a year) — yet because pancreatic cancer is so hard to treat, it has a much higher mortality rate than any of these more common malignancies. It is indeed a dreadful disease, and its poor prognosis explains why it gets so much publicity.

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.