Annual Medical Checkup : Part 3

by Food and Drug Administration (FDA)

(Page 3 of 3)

Not Another Cookbook

While there is broad consensus among health authorities that an annual, more-or-less uniform checkup of symptom-free, presumably healthy people is inappropriate, experts and professional organizations don't entirely agree about exactly what should take its place.

In 1991, the American College of Physicians, whose members are specialists in internal medicine, published a lengthy report comparing its own preventive service and screening recommendations with those of the U.S. Preventive Services Task Force, the Canadian Task Force on Periodic Health Examination, and other organizations. There was general agreement on routine blood pressure screening and on counseling adults about tobacco use, nutrition, exercise, sexual behavior, substance abuse, injury prevention, and dental care. All groups also recommended tetanus-diphtheria booster shots every 10 years and influenza immunization for persons 65 and older. U.S. organizations also recommended pneumococcal immunization at age 65.

The groups generally agreed that women should have an annual Pap smear beginning at ages 18 to 20 and every third year from age 20 through the mid 30s. They did not entirely agree on how often and for how long older women with no symptoms of or risk factors for uterine cancer (including a family history of uterine cancer or a succession of abnormal Pap test results) should continue to have periodic Pap tests. However, the U.S. groups recommended Pap tests at least every three years through age 65.

An annual mammogram to screen for early breast cancer was uniformly recommended for women from age 50 on, but not all the organizations surveyed agreed on how often women under 50 should have mammography screening. The American Cancer Society (ACP) specifically advises women between 40 and 49 to have a mammogram every one or two years. All agreed, however, that women should have a clinical breast exam annually beginning at age 40.

A check of serum cholesterol every five years was recommended for all men between the ages of 20 and 70 (the Canadians narrowed that to between 30 and 59). The U.S. task force suggested that cholesterol screening of women, younger men, and the elderly was "clinically prudent," meaning that the physician should base a decision on factors such as a patient's fat consumption, known high cholesterol problem, or other coronary artery disease risk factors.

After age 50, ACP recommends yearly stool screening for occult blood, but the U.S. and Canadian task forces said there was insufficient evidence to recommend for or against this test.

Also after age 50, ACP recommended procedures to check for diseases of the colon: sigmoidoscopy every three to five years or air-contrast barium enema every five years. Again, neither the Canadian nor the U.S. task force recommended for or against these tests.

A Vote for Low Tech

Many experts think the new face of the periodic health examination is at least as important as new medical technology in safeguarding people's health. Americans seem to agree. A recent Gallop poll conducted for the Pharmaceutical Manufacturers Association Foundation found that 28 percent of heads of households thought that of all health-related efforts, lifestyle modifications, such as diet, exercise, and smoking cessation, had benefited them most. Diagnostic tools — x-rays, CAT scans, and heart monitors, for example — were judged most beneficial by 25 percent of those surveyed, and 25 percent placed drugs and vaccines at the top of the list. Improved surgical techniques scored best with only 16 percent of the sample. All of which supports the idea that active participation by patients and health-care providers has a critical role in efforts not just to treat, but to prevent, human illness.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.