The health screenings you need
Once you reach your 40s, your career path is most likely established and your kids are more independent, and yet it’s still a busy and often stressful time. We often put our own health on the back-burner; chances are you’re more on top of the healthcare of your children and pets than your own. But the fact that you are holding this magazine is a good sign you’re looking after your body with the right fuel and know that exercise is the number-one contributor to good health for the decades to come.
Preventive health is more important than ever in these days of busy doctors’ offices and a generally overburdened healthcare system. For the third straight year in a row, life expectancy in the US has declined; here in Canada, it has plateaued despite advances in modern medicine, technologies, and knowledge. There are many factors at play, including the opioid and obesity crises and higher suicide rates; however, there is still an important role that primary healthcare teams and individuals can take in addition to optimizing fitness, nutrition, and lifestyle choices. Health screenings are essential when it comes to detecting illness or disease earlier so that treatment is more effective, preventing worse problems, or early death and disability.
Health screenings of today
Screenings traditionally took place in the family doctor’s dreaded annual physical, which was often associated with uncomfortable poking, prodding, and blood tests. Studies have actually found that these carte blanche visits did nothing to improve the health and morbidity/mortality in the general population and perhaps even caused some harm. Screenings should be done more methodically and thoughtfully on a population basis, by selecting the right test and the right time for the right patient. The “physical” has been replaced with a periodic health exam, which encompasses more tailored discussions about your stage in life, what things should be checked for, and what your current lifestyle habits and risks are contributing to possible conditions. There is a dark side to “over” screening in terms of costs to the system but more importantly, potentially diagnosing conditions that are not even present— called “false positives”—or, missing the discovery of important things we call “false negative” (giving a false sense of security). Screening has to be useful on both a population and individual basis—but if used too frequently, it can waste healthcare dollars and also lead to further unnecessary tests, procedures, and harm.
Cancer accounts for 30 percent of all deaths in Canada yearly, followed by heart and stroke at 19.7 percent and 5.3 percent respectively. The ability to detect cancers earlier, and prevent complications of cardiovascular disease, are thus very important. According to the Canadian Cancer Society, 565 Canadians were diagnosed with cancer every day in 2017. The risk of dying at some point in your life from cancer is about one in four for both men and women. The most common cancers are breast, colon, lung, and for men, add in the prostate.
Breast cancer screening is still a controversial area and the Canadian Task Force on Preventative Health Care has just updated its current recommendations: For women 40 to 49, no routine mammograms and physical examination is recommended unless the patient has a strong wish to do so and/or strong family history. The risk of false-positive is quite high and this emotionally charged topic can lead to further tests, biopsies, surgeries, and, frankly, heartache and stress. In women 50 to 69, it is currently recommended that screening mammography be done every two to three years. The breast self-exam or even clinical breast exam by a physician has limited use as a screening tool. It is useful to know your own breast tissue and watch for changes in the texture and colour over time, but anything unusual is going to be picked up earlier with a mammogram starting at age 50. For women with higher risk factors, such as known family history, Ashkenazi Jewish heritage, longer exposures to estrogen via early menarche/late menopause, use of HRT, and genetic BRCA1 and BRCA2, mammograms could be considered at an even earlier age.
Cervical cancers are still picked up with the Pap smear, which looks at cells scraped from the cervix for pre-cancerous changes. These are suggested at every three years in ages 25 to 69 but more often if there has been HPV present, a very common virus that triggers cancers, especially cervical. The new HPV-DNA test can be added in at some point at any age but this is not currently covered by provincial health plans. It can further streamline how often you need to get the Pap test.
There is no routine reliable screening test for ovarian or fallopian tube cancer and it’s been traditionally lumped into the reason for the yearly pelvic exam. Good news though: the routine use of pelvic exams in asymptomatic non-pregnant women is not currently recommended. There is no reliable use of the blood test CA-125 as an initial screening for gynecologic or other cancers but it can be used as a marker for those already diagnosed whether they are responding to treatments.
Colon cancer is not generally screened for until age 50 unless you have a first-degree family member, such as a parent or sibling, who had colon cancer at an early age. If so, you should start screening for that 10 years before that family member presented; the best test is the colonoscopy versus the fecal occult blood test (FOBT). The FOBT, or, poop-on-a-stick test, needs to be done every two years but has a high incidence of error. On the other hand, the colonoscopy requires more resources and has long wait times but it is more thorough and only needs to be done every 10 years for the average person.
Lung cancer should be screened for in smokers age 50 or more, who smoked for more than 30 years, and who are currently smoking or quit less than 15 years ago. This is done with low-dose CT scans, and routine chest X-rays are not useful unless there are other symptoms present.
These days the incidence of cardiovascular disease is still very high, and we now know it is also “sneakier” in women as we tend to have a more atypical presentation of heart disease. The risk is also increasing as our society gets more obese and has associated issues of diabetes. Every health visit should measure your blood pressure and BMI, and, if elevated, further screen for diabetes and high cholesterol in the blood at any age. Using a tool called the Framingham risk calculator with these numbers can help determine if further investigation and therapy are required. The EKG is not routinely used for screening unless there have been symptoms. Fatty liver is also a concern in the heavier set and can lead to life-shortening liver dysfunction. Bloodwork to consider is the liver function tests and often a kidney function test is done in diabetics. If you had not had a lipid test by age 50 then now is a good time to see where you are at.
Don’t forget screenings for your skin, eyes, bones, and mental health
Check your moles and skin every year; take pictures, watch the skin in between your toes and even in your scalp. Have your eyes checked every two to three years starting at age 40 for silent problems like glaucoma; plus your eye doctor can view blood vessels at the back of the retina and spot problems earlier from high blood pressure, diabetes, and even early stroke. Diabetics need their eyes checked yearly. Hearing tests are also suggested above age 65.
Screening for bone density should start at age 65 unless there are unusual osteoporosis-induced fractures at an earlier age.
Mental health-related topics are very important and a huge reason for illness and work absenteeism in our society. Mood, energy, sleep, and stress should be generally discussed at the periodic health visit, and sexual health, drug and alcohol use, mood, domestic abuse, gambling, and social media and video games usage be assessed. This should be done in a non-judgmental way to open up an opportunity for further discussion and extra support and resources be given where needed.
Make health screenings and living a healthy lifestyle a priority
Living longer and better should be everyone’s goal. There are hidden menaces to watch out for that need to be detected early and could save your life. It is easy to take good health for granted but we have to remember our bodies need regular maintenance and checks much like the ones we get for our vehicles. Preventive health includes screenings, but the ultimate disease prevention is the choices we make daily in lifestyle and diet. A good discussion with your doctor comes with education, and counselling can be an additional motivational factor to help you meet your own quest of maintaining great health now and in the years to come. Don’t wait for the engine light to come on...