HERSHEY – Looking for the perfect gift? How about something that pays dividends for years? Not a mutual fund — a medical checkup.
More commonly called a “physical,” the checkup is a time to deal with preventive maintenance. We take our children for regular exams and immunizations, but adults need these exams, too. At each stage of life there are recommendations for screening and evaluation that evidence suggests could reduce the risk of illness and disability. People under a doctor’s care for medical problems will usually have these health maintenance activities accomplished during regular visits. For those who are not seen regularly, a periodic checkup serves to keep the body in good working order. Here are the current recommendations for health maintenance exams.
All ages
Men and women should have height, weight and blood pressure checked every two years. One vision and hearing check per decade is recommended if there are no symptoms. An examination for abnormal moles about every three years throughout life is a good idea and more often for some people at higher risk as recommended by the physician.
An often-neglected area is oral health. Everyone should have a dental exam twice a year. Good oral health is not just a matter of keeping one’s teeth. Oral health impacts other body systems.
Tetanus-diphtheria immunization is recommended every 10 years. A one-time dose of the combined tetanus-diphtheria-pertussis (whooping cough) vaccine is currently recommended instead of the regular tetanus-diphtheria vaccine if it has been five years since the last booster.
Ages 18-39
Women should have a Pap test for cervical cancer annually starting around age 21 or within three years of beginning sexual activity and should consider the vaccine for human papilloma virus up to age 26. The exam may include a test for sexually transmitted diseases. Men should perform a monthly testicular self-exam looking for lumps and have an exam by a physician every few years.
Cholesterol should be measured at least once in the 20s, and in those at higher risk, blood sugar should be checked to evaluate for diabetes. This is the age to deal with these problems, not when damage is done. Because thyroid disease is common as women age, a test for thyroid disease can be considered every five years starting at age 35.
Meningitis vaccine is important for those attending college and possibly a chickenpox booster immunization. Influenza vaccine is recommended for those who have regular contact with someone at high risk for influenza complications.
Ages 40-49
Women should continue with Pap exams every one to three years and at age 40, and begin getting mammograms every one to two years.
Men at high risk for prostate cancer might be candidates for a prostate exam and a prostate-specific antigen blood test.
Height, weight, blood pressure and blood sugar should be checked every two years and, depending on circumstances, cholesterol should be checked about every five years if not under a doctor’s care for these problems already.
People who have parents or siblings with colon cancer in their 50s should consider a screening colonoscopy at this time. This is because it usually takes about 10 years to develop colon cancer from the signs of a premalignant polyp.
Ages 50-64
Although there is some controversy over the frequency for mammography in the 40s, by this age, annual mammograms are almost universally recommended. A pelvic exam annually is still a good idea, but the Pap test could be deferred to every three years as long as the woman’s previous three Paps were normal and it’s clear that she and her partner are mutually monogamous. Because monogamy is never absolutely certain for both, some physicians continue to insist on an annual Pap.
Women at high risk for osteoporosis may be referred for bone mineral testing. Such women tend to be fair skinned, thin and may have had multiple pregnancies or other situations that reduced their estrogen levels or affected their calcium intake, such as milk intolerance or living in extreme northern latitudes.
Prostate exams and prostate-specific antigen blood testing is controversial. There is no evidence that screening for prostate cancer in general saves lives. Prostate cancer is detected earlier when screening is done, but so far, this does not seem to reduce the risk of death. Some authorities feel treatment may reduce the quality of life. Therefore, whether to screen for prostate cancer is an individual decision to be made in conjunction with the doctor.
A check for colon cancer is recommended beginning at age 50. There are three options. Colonoscopy is comprehensive and, if negative, can be performed every 10 years. An alternative is annual fecal occult blood test plus flexible sigmoidoscopy (which evaluates the lower half of the large intestine rather than the entire colon) every five years. The advantage is that the preparation is easier and no sedation is required, although some people prefer to be sedated. A third option is a double-contrast barium enema (double contrast means both liquid barium sulfate and air are used) every five to 10 years instead of colonoscopy. This has the disadvantage of requiring colonoscopy if any abnormalities are seen, but in very low risk individuals, it is an option.
In addition to tetanus-diphtheria vaccine every 10 years, annual flu vaccine is recommended now. Some physicians may recommend a one-time vaccination against shingles at age 60, but it is not yet part of the standard panel of recommended vaccinations.
Ages 65 and up
Women who have not had a bone mineral density by now should have this test. Depending on the results, it can be repeated every three years or so. Some physicians discontinue Pap testing, particularly for women who are no longer sexually active. For those who are, screening every two to three years is appropriate for women whose last three Paps have been normal and who are in a mutually monogamous relationship. Mammograms continue annually for women whose life expectancy is at least 10 years.
After age 65, the risk of dying from prostate cancer goes down while the chance of having it goes up. By age 75, screening for prostate cancer probably does more harm than good since detection may not lead to improvement in life expectancy, so it is generally not recommended.
Everyone over age 65 who has not had one should be vaccinated against pneumococcal pneumonia, a particularly dangerous type. Also, everyone over 65 should be vaccinated against influenza annually.
Even those who have never had high blood pressure, high cholesterol or diabetes at a younger age could develop them, so checking for these problems every couple years is still a good idea. The longer one lives, screening for memory, strength, ability to manage daily activities and safety become more important.
Take a loved one (and yourself)
Many of the guidelines for men and women can be found at the Centers for Disease Control and Prevention. The important thing is to schedule an exam if not already under a primary care physician’s care for medical problems. It’s too easy to put it off, blaming lack of time. Every physician has had patients come in with advanced disease because the person “never got around” to getting a checkup.
The best thing people can do for their loved ones is to help them take care of their health. It’s good for us, too. The better health they have, the longer we get to be with them.