Unnecessary screening pushes up costs, and you as a patient waste your time and energy, as well as any cash you spend. Here are some tests you don’t need.
We all want to avoid serious illness, so it seems sensible to undergo a harmless test towards that goal. But when an entire nation takes more and more tests that save few lives, something has gone wrong. Unnecessary screening pushes up costs, and you as a patient waste your time and energy, as well as any cash you spend. Even worse, your test may lead to unnecessary procedures that interfere with your life for more than an afternoon.
Here’s our short list of medical tests you don’t need unless your doctors believe they’re important for you in particular. (Do ask your doctor about recommended prevention guidelines and follow them.)
Heart disease scans. Given the rising numbers of people with heart disease, it’s tempting to include heart screens in a routine physical. But unless you are considered to be “intermediate risk” and are debating whether to take or continue a statin drug, you may not need a calcium scan checking for plaques, deposits of calcium that cause the lining of the coronary arteries to stiffen or swell. These scans expose you to radiation, which it’s best to avoid. A computed tomography (CT) angiogram, designed to detect blockages in the chest or major blood vessels is also on many lists of medical tests you don’t need while bathing you in radiation.
Heart disease exercise stress test. Do this only if your doctor suspects that you already have heart disease. The results tend to be unclear, and the advice remains the same: do what you can to reduce your risk factors, like smoking and high-cholesterol.
Pre-operative chest x-ray. Many hospitals insist on this x-ray before surgery. But according to Tanveer Mir, MD, chair of the Board of Regents of the American College of Physicians, nobody really knows why. They’re only necessary if you have heart or lung disease, are having surgery in your chest, or are older than 70, she says.
Prostate cancer screening. In a much-noted 2009 study, nearly 77,000 men at 10 U.S. medical centers were divided between a group that were offered a test or examination for prostate cancer annually over 8 years and a control group. The researchers concluded that the rate of death from prostate cancer was low, and testing didn’t help.
Lung cancer screening. Some 10 to 15 percent of lung cancer patients never smoked. You can protect yourself by testing your home for radon and avoiding secondhand smoke or exhaust on the job or elsewhere. If you develop symptoms, such as a lingering cough or chest pain, see a doctor who may order a CT scan. However, the American Cancer Society recommends routine lung cancer screening only for people ages 55 to 74 who smoked heavily within the previous 15 years. In one large study, about a quarter of the people screened had to undergo additional tests to discover that their abnormalities weren’t cancer.
Colonoscopy after 75. The U.S. Preventive Services Task Force (USPSTF) recommends tests for colon cancer from age 50 to 75 for most people and only for those with risk factors through age 85. The Task Force found that the evidence for CT colonography and fecal DNA testing screens is inconclusive.
Cervical cancer screens after 65. The USPSTF recommends against screening for cervical cancer in women older than 65 as long as they were screened previously and don’t have a special reason, such as HIV infection or a history of precancerous lesions.
Skin tests for tuberculosis (TB). This test is useful for someone who has spent time with a TB patient, illegal drug users, people with weakened immunity, or those who have traveled in countries like Russia, where TB is common. Unless you fall into one of those categories or have symptoms, such as a fever and weight loss, don’t waste the effort.
MRIs for every little thing. Injured athletes and exercisers are often referred for an MRI, or magnetic resonance imaging, when they complain of pain. James Andrews, MD, a Florida sports medicine orthopedist and researcher, suspected that the test led to unneeded surgeries. He scanned the shoulders of 31 professional baseball pitchers who had no complaints. Based on the scan results, nearly all of them had abnormal shoulder cartilage and rotator cuff tendons, he told The New York Times.
Patients may ask for an MRI or expect one, and doctors reap big fees for each scan. When they own their own machines, which is common, they might get $1,100 from an insurer for an MRI of the knee to identify a torn ligament, for example.
Doctors often order up MRIs for patients who complain of back pain — yet another medical test you don’t need, says Mir, unless you have other symptoms, which might include a burning pain down your leg, numbness, muscle weakness, or a loss of bladder control.
CT scan for headaches. About one in eight patients who complains about a headache or migraine to a doctor winds up getting a scan, even though the scans rarely change the diagnosis or treatment options. The scans also may turn up unimportant abnormalities that you’ll need to check out on further tests. According to Mir, get a scan if you had a sharp blow to your head or have symptoms beside head pain: a seizure, or change in speech or coordination.
Pelvic exam. Your gynecologist is used to doing these exams, but there isn’t much evidence for them, as long as you don’t have symptoms and aren’t pregnant, according to a review for the USPSTF. You can safely stick to a Pap smear and HPV test every five years after the age of 30, or every three if you have a family history of cervical cancer or other risk factors.
Do skip health screenings you don’t need, but that isn’t a reason to avoid the doctor or go without health insurance. Spend your time and money on getting good advice and motivation to do everything you can to maintain or improve your health.
March 31, 2020
Janet O’Dell, RN