By Dr. J. Marvin McBride, MD
Dr. McBride is a geriatrician with the Center for Aging and the Division of Geriatric Medicine, University of North Carolina at Chapel Hill.
In the mid-1980s, when I entered practice, regular physical exams and screening tests were routinely recommended for most individuals.
Young children were expected to see their doctor every few months for the first several years of life, then annually. Women of child-bearing age were expected to perform breast self-examination every month and have an annual physical with a pelvic and breast exam and Pap smear, with annual mammograms after age 45. Adolescent males were expected to perform monthly testicular self-examinations; on entering adulthood, annual physical exams including a digital rectal exam and blood tests for PSA after 50.
What has changed in the last 30 years is medicine as a discipline is attempting to move beyond a consensus of experts to truly evidence-based recommendations. We have a much better understanding today of the causes of some conditions and a better understanding of each test and the consequences of errors. We’ve also found that early treatment doesn’t always result in improved outcomes as the negative side effects may be significant.
Literature on this topic is complicated. A lot of us are struggling to adjust to the newer recommendations, understanding that any recommendation may become obsolete as new data is published. Some of the current recommendations of the U.S. Preventive Services Task Force (USPSTF), an independent panel of non-Federal experts, composed of primary care providers, are published in the form of “Recommendation Statements” for older adults at average risk and without specific medical problems. The recommendations for older adults with specific problems may be different.
You can easily find other opinions from other sources; however, I prefer the USPSTF guidelines because they have no conflicts of interests, as some special interest groups may have, and they rate their recommendations by the quality of evidence supporting each one.
Recommended Exams and Tests
Women and Men 65 years of age and older:
Lifestyle: Review with your physician regularly alcohol and
tobacco use, depression, and weight.
Vaccines:
Influenza (“Flu”) – yearly in the fall;
Pneumococcal (“Pneumonia”) – once after 65 years;
Zoster (“Shingles”) – once after 60;
Tetanus – every 10 years -“Td” – at least once,
this should include pertussis (whooping cough); TdaP
Blood Pressure: Yearly – if normal (and not on medication)
Colorectal Cancer Screening:
(for those at average risk) up to age 75*:
Either: Annual high sensitivity fecal occult blood tests
(FOBT), or Flexible sigmoidoscopy every 5 years with
FOBT every 3 years, or Colonoscopy every 10 years
Lung Cancer Screening: Annual low-dose chest CT for
individuals between 55 and 80 years of age who have
smoked at least 30 pack-years and are currently smoking
or have quit less than 15 years ago. (One pack per day
for one year equals one “pack-year” – either two packs
per day for one year or one pack per day for two years
equals two “pack-years.”)
Cholesterol and Diabetes Screening: Regularly for those at
increased risk
Women 65 years of age and older:
Bone Mineral Density: Once after 65 years of age
Mammograms: (for average-risk women) – every 2 years until
75 years of age. Women over the age of 75 may benefit from
continued screening based on expected longevity.
Pap smears: Not needed for women with adequate prior screening
Men 65 years of age and older:
Abdominal Aortic Aneurysm Screening: Once between 65 and
75 if you have ever smoked