En español l Doctors are warning that some of the common medical tests routinely taken by Americans do more harm than good, waste billions of health care dollars annually and could endanger your health or even your life.
Among the tests targeted by prestigious panels of doctors as overused were annual Pap smears, regular PSA tests, regular EKGs and even routine yearly physicals. Overuse of such tests leads to dangerous side effects, pain, radiation exposure, unnecessary surgery — even death, the doctors said.
The American Board of Internal Medicine Foundation asked more than 50 medical societies — of family doctors, oncologists, cardiologists and other specialties — to identify tests and treatments that are often unnecessary. AARP is a consumer partner with this campaign, called Choosing Wisely.
John Santa, former medical director at Consumer Reports, another Choosing Wisely partner, says these screening tests often yield false-positive results that lead to a spiral of unneeded invasive procedures, medications and even surgeries. If you have symptoms or certain risk factors, these tests can be valuable — even lifesaving — but they're performed on far too many people.
1. Nuclear stress tests and other imaging tests after heart procedures
Many people who have had a heart bypass, stent or other heart procedure feel they've had a brush with death. So patients — and doctors — understandably want to be reassured through a nuclear stress test or other tests that their hearts are beating strong. But performing these tests every year or even every two years in patients without symptoms rarely results in any change in treatment, says William Zoghbi, immediate past president of the American College of Cardiology. "More testing is not necessarily better," he says.
In fact, it can lead to unnecessary invasive procedures and excess radiation exposure without helping the patient improve. Instead, patients and doctors should focus on what does make a difference in keeping the heart healthy: managing weight, quitting smoking, controlling blood pressure and increasing exercise.
2. Yearly electrocardiogram or exercise stress test
A survey of nearly 1,200 people ages 40 to 60 who have never had heart disease or any symptoms found that 39 percent had an EKG over the previous five years, and 12 percent said they had an exercise stress test. The problem: Someone at low risk for heart disease could be 10 times more likely to get a false-positive result than to find a true problem, says John Santa of Consumer Reports, which conducted the 2010 survey. This could lead to unnecessary heart catheterization and stents. Instead, have your blood pressure and cholesterol checked. And if you're at risk for diabetes, have your blood glucose level checked as well.
3. PSA to screen for prostate cancer
Cancer is always scary, but the PSA test often finds slow-growing cancers that won't kill men. "The evidence is extremely convincing that in a man with usual risk and no symptoms, the PSA test causes more harm than benefit," says Reid Blackwelder, president of the American Academy of Family Physicians (AAFP). As a result of the test, he says, men often have ultrasounds, repeat lab tests and even biopsies for a problem that isn't there — an estimated 75 percent of tests that show high PSA levels turn out to be false alarms. When men do have treatments such as surgery or radiation, 20 to 40 percent end up with impotence, incontinence or both.
Not all doctors agree with AAFP's recommendation against routine PSA screening, but many agree that the test is overused. Even the American Urological Association, which supports the use of PSA testing, says that it should be considered mainly for men ages 55 to 69. The American Society of Clinical Oncology recommends against PSA testing for prostate cancer screening in men with no symptoms when they are expected to live less than 10 years. A recent study published in the journal Cancer found that Medicare spent almost $450 million a year on PSA screenings, one-third of which was for men over age 75.
4. PET scan to diagnose Alzheimer's disease
Until recently, the only way to accurately diagnose Alzheimer's was during an autopsy. In the last few years, doctors have begun using PET scans with a radioactive dye to look for beta-amyloid protein that is found in the brains of people with the disease. Although this test has promising use for research, there are serious questions about whether it should be used on those who complain of a fuzzy memory. PET scans in older people consistently find the protein in 30 to 40 percent of people whose memories are just fine.
Although beta-amyloid plaques are present in all of those who have Alzheimer's, it is not known if or when everyone with the plaques will develop the disease, says Peter Herscovitch, president-elect of the Society of Nuclear Medicine and Molecular Imaging. What's more, even if a PET scan could accurately diagnose the disease, it's untreatable. If you're concerned about your memory, the better course is to have a complete medical evaluation by a doctor who specializes in diagnosing and treating dementia. Many other medical conditions, such as strokes, thyroid deficiencies and vitamin deficiencies, can cause the same symptoms, and these are treatable.
5. X-ray, CT scan or MRI for lower back pain
Unfortunately, back pain is incredibly common — 80 percent of people will suffer from back pain some time in their lives. It can be both excruciating and debilitating. Naturally, people want to know what's wrong. Here's the catch: The best imaging machines in the world often can't tell them. Many older people with no back pain can have terrible-looking scans.
Most back pain goes away in about a month and imaging tests tend to lead to expensive procedures that often don't help recovery. One study found that people who got an MRI during the first month of their back pain were eight times more likely to have surgery than those who didn't have an MRI — but they didn't get relief any faster. If you don't feel better in a month, talk to your doctor about other options such as physical therapy, yoga or massage. But if your legs feel weak or numb, you have a history of cancer or you have had a recent infection, see your doctor as soon as possible.
6. Yearly Pap tests
The yearly Pap smear is a common part of women's health checklists, but it doesn't need to be. Women at average risk only need them every three years, since cervical cancer generally takes 10 to 20 years to develop. If women have also had negative tests for the human papillomavirus (HPV), which is now known to cause the cancer, they only need a Pap test along with the HPV test every five years. And women older than 65 who have had several normal Pap tests in a row can stop having them altogether. Do note, however, that a yearly visit to an ob-gyn stays on the to-do list.
7. Bone density scan for women before age 65 and men before age 70
For the estimated 10 million people — mainly women —in the United States who have osteoporosis, bone-strengthening medications can lower the chances of breaking a bone. But many experts argue that for those ages 50 to 65 who have osteopenia — mild bone loss — testing and subsequent drug prescriptions may be a waste of time and money. Not only is the risk of fracture often quite low, medications such as Fosamax (alendronate) and Boniva (ibandronate) have been linked to throat or chest pain, difficulty swallowing, heartburn, muscle pain, bone loss in the jaw and thigh-bone fractures. And there's scant evidence that people with osteopenia get much benefit from the drugs.
To help keep your bones strong, try walking and weight-bearing exercises, says Blackwelder. Get enough calcium and vitamin D in your diet. If you smoke, quit.
8. Follow-up ultrasounds for small ovarian cysts
Many women receive repeated ultrasounds to verify that ovarian cysts have not become cancerous, but current research says that these tests aren't necessary. For one thing, premenopausal women have harmless ovarian cysts regularly. For another, about 20 percent of postmenopausal women also develop harmless cysts.
"The likelihood of these small simple cysts ever becoming cancer is exceedingly low," says Deborah Levine, chair of the American College of Radiology Commission on Ultrasound and a professor of radiology at Harvard Medical School.
In postmenopausal women, only cysts larger than 1 centimeter in diameter need a follow-up ultrasound. For premenopausal women, who typically have benign cysts every month when they ovulate, cysts smaller than 3 centimeters aren't even worth mentioning in the radiologist's report, says Levine.
9. Colonoscopy after age 75
Most people should have screening for colon cancer at 50 and then every five to 10 years after that, if the first test is normal. By age 75 — if you've always had normal colonoscopies — you can stop taking this test altogether. That should be good news, because a colonoscopy can cause serious complications in older people.
"Just the preparation for colonoscopy can be exceptionally harsh," says James Goodwin, director of the Sealy Center on Aging at University of Texas Medical Branch, who studies overuse of colonoscopies. Some patients become incontinent or experience weeks of pain, diarrhea and constipation. In worst cases, the procedure can perforate the colon. Despite such risks, recent studies have found that substantial numbers of people over 75, even over 85, are still getting screening colonoscopies.
To protect your colon, eat plenty of fruits, vegetables and whole grains for fiber. Cut down on fatty foods, red meat and processed meats. Lose weight if you're overweight and exercise. Sound familiar? It should, because that's the best advice for protecting the rest of your body — and mind — as well.
10. Yearly physical
There's little evidence that having an annual checkup can keep you healthy. Many tests that doctors regularly perform — to diagnose anemia, liver disease or urinary tract infections, for example — don't make sense unless there's a reason to suspect a problem. "A healthy 52-year-old does not need to see the doctor once a year," says Jeremy Sussman, an internist for the VA system and assistant professor at the University of Michigan who was on the Society of General Internal Medicine task force for making the Choosing Wisely recommendation.
"We certainly don't think people should never see doctors — quite the opposite. We question the value of seeing someone for the sake of seeing someone." Your specific needs should determine how often you see your doctor, he adds. If you have an illness that needs treatment, you should see your physician. And do talk to your doctor about how often you need to have your blood pressure and cholesterol tested. "Our real point is, don't do these things for the sake of a calendar," he says. "Do them for the sake of your health."
Elizabeth Agnvall is a writer and features editor for AARP Media.
THE HIGH COST OF OVERTESTING
Each year in the United States, an estimated $225 billion is wasted on unnecessary medical tests and services, according to Rosemary Gibson, coauthor of The Treatment Trap.
Consider that nearly two-thirds of women who have had hysterectomies and half of women over 65 with no cervical cancer history — 14 million women — report having recent Pap tests, even though the American College of Obstetricians and Gynecologists recommends against them for these women.
An estimated $3 billion is spent on PSA screening for prostate cancer, which many doctors groups say does more harm than good. Nearly a fourth of $1,000 colonoscopies performed in older people are most likely inappropriate.
That's just the cost of the tests. Add in the amount spent on additional unnecessary biopsies, surgery and other procedures and the amounts are staggering.
MRI scans and other imaging tests for lower back pain are notoriously misleading. Yet those tests lead to more than $80 billion a year in treatments — painkillers, surgery and spinal injections — that often don't fix the problem. PSA screening leads to an estimated $12 billion a year in prostate cancer care, including radiation biopsies and prostatectomies — much of it unnecessary.