Screening Tests for Women Archive

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Heart scans: Why and when you might consider one

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.

Why isn't there a more comfortable mammogram procedure?

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.

Cholesterol testing at home: It may be faster, but is it better?

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.

The family history of cancer

If cancer runs in your family, there is much you can do to recognize your potential risk and catch the disease before it strikes.


Image: filipefrazao/Thinkstock

You may remember stories of your father's military service and your mother's hometown, but how much do you know about your family's medical history? In particular, do you know whether anyone on your mom or dad's side ever had cancer?

"Family history can be one of the first lines of defense in preventing cancer," says Dr. Huma Q. Rana, clinical director of the Center for Cancer Genetics and Prevention at Harvard-affiliated Dana-Farber Cancer Institute.

Screening tests you probably don’t need

Some tests that are widely offered for screening aren't advised for generally healthy people and may lead to unnecessary procedures.


 Image: alptv/Thinkstock

You've probably had more than a few screening tests—blood pressure and cholesterol checks, mammograms, Pap smears, and colonoscopies. However, health fairs and clinics often promote screening tests you might not have had. If you've wondered whether they're a worthwhile investment in your health, the United States Preventive Services Task Force (USPSTF) can help you. The USPSTF is a panel of primary care physicians and epidemiologists appointed and funded by the U.S. Department of Health and Human Services. Its role is to develop clinical practice guidelines—recommendations for clinicians about the care of patients with specific conditions. Other health organizations also develop guidelines.

"We've known for some time that there is a wide variation in the way medicine is practiced across parts of the country," says Dr. Mark Aronson, professor of medicine at Harvard Medical School. "Guidelines are based upon the best available research evidence and practice experience and are meant to give guidance to doctors for best practices."

Beware of low diastolic readings when treated for high blood pressure

New research has linked heart tissue damage to blood pressure treatments that drive diastolic pressure (the bottom number in a reading) too low. 

Top screenings to avoid cancer

Talk to your doctor to nail down your cancer risk, and check this list to see which tests may help save your life.


 Images: Monkey Business Images/Thinkstock

Recommendations for cancer screenings sometimes change, and it can be confusing about which tests you need and when. "It's best to talk to your doctor about your cancer risk factors and family history, learn which screenings are right for you, and then develop and stick to a screening schedule," says Dr. JoAnn Manson, chief of preventive medicine at Harvard-affiliated Brigham and Women's Hospital.

Routine screenings

Other screening tests

Some screenings are not recommended routinely but may be important based on your cancer risk.

Lung cancer. The American Lung Association recommends low-dose computed tomography to detect early signs of lung cancer for heavy smokers ages 55 to 74 who have a 30 pack-year smoking history (equivalent to one pack per day for 30 years) and who have smoked within the past 15 years. The USPSTF extends the screening age to 80. If you're not in this group, you should not have routine screening; the risk from radiation exposure and potential unnecessary follow-up testing is not worth the small chance of benefit.

Skin cancer. The USPSTF says there's not enough evidence to recommend regular visual skin exams by a doctor to screen for skin cancer, and that screenings increase the risk for unnecessary biopsies, overdiagnosis, and overtreatment. The American Academy of Dermatology suggests that all people conduct skin self-exams and report any unusual spots on their skin to a dermatologist.

People with an increased risk for melanoma, the deadliest form of skin cancer, should talk to a dermatologist about how often they should get a skin exam.

What about a PSA test?

One of the most debated screenings is the blood test used to look for prostate cancer in men. It measures the level of a protein in the blood called prostate-specific antigen (PSA), which can rise when prostate cancer develops. In 2012, the USPSTF recommended against routine PSA tests, saying they raise the risk of unnecessary follow-up testing and treatment, which can cause problems such as incontinence and erectile dysfunction.

Recent evidence shows that fewer men are being screened as a result. "The sentiment among many physicians now is against offering routine PSA testing for men, especially when nearly every study has not shown any tangible benefits for those who have undergone testing and treatment," says oncologist Dr. Marc Garnick, editor in chief of Harvard's Annual Report on Prostate Diseases.

The American Cancer Society suggests that men 50 or older (at average risk for prostate cancer) make the decision about screening with their doctor, but only if they have a life expectancy of at least 10 years, and only if they have been advised about the uncertainties, risks, and potential benefits of prostate cancer screening.

 

A new look at colon cancer screening

Don't be intimidated about screening tests. The latest guidelines suggest you can choose from multiple strategies.


Image: Bigstock

Colon cancer continues to be the country's second leading cause of cancer-related deaths and the third most common cancer in men, according to the CDC.

It almost always develops from precancerous polyps (abnormal growths). Screening tests, which are recommended for men ages 50 to 75, help find and sometimes aid removal of polyps before they become cancer. (Men older than 75 may still benefit, depending on their health.)

Dense-breast notification letters are confusing, study shows

Letters notifying women that they have dense breasts are difficult to understand. Women receiving them should contact their doctors.

Mammograms identify heart disease risk

Research We’re Watching


 Image: Frans Rombout/Thinkstock

When specks of calcium appear in ductal tissue on mammograms, they can indicate a small cancer. But when calcifications are found in the breast arteries, they haven't been a cause for concern. However, in recent years, physicians have begun to suspect that arterial calcifications in the breast, like calcifications in the coronary arteries of the heart, can be an early sign of cardiovascular disease.

A team of researchers at Mount Sinai St. Luke's Medical Center in New York City studied the test results of 292 women who'd had digital mammography and non-contrast CT chest scans within a year. None of the women were known to have heart disease. They found that 42.5% of the women had evidence of breast artery calcifications on mammography, and of these, 70% also had evidence of coronary artery calcification on their CT scans. Moreover, 63% of those whose CT images revealed coronary artery calcifications had breast artery calcifications as well. Over all, the results indicated that women with breast artery calcifications are three times as likely as those who don't to have coronary artery calcifications. The study was published online March 24, 2016, by JACC Clinical Imaging.

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