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Do You Need These Tests?

Can you tell me what tests we all should have as we get older? Which ones do you recommend?

Answer (Published 1/6/2006)

As we get older, a variety of medical tests can warn of impending problems, with hearts, bones and other chronic disorders. As long as you're in good health and have no unusual symptoms, I don't necessarily recommend an annual physical exam. But here's a list of the tests I do think everyone should have periodically as they age:

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  • Cholesterol: This simple blood test can give you an idea of your heart disease risk. Have your cholesterol tested every five years beginning at age 20 and have your HDL ("good") cholesterol and LDL ("bad" cholesterol) checked if your total cholesterol is over 200. You should also request measurement of serum homocysteine and C-reactive protein, other indicators of heart disease risk.
  • Bone density: Any woman at high risk of osteoporosis (because her mother had it or because she is light boned and fair-skinned) should have this DEXA scan to determine her bone mineral density and keep track of how it is declining over time. All women age 65 and older should have at least one DEXA scan to gauge the condition of their bones. We have good drugs to halt and reverse osteoporosis and reduce risk of hip fractures in old age. You should know, however, that DEXA tests also identify bone weakness (osteopenia) that is nowhere near the range of osteoporosis. As a result of these findings, women may be put on the same strong drugs used to treat osteoporosis - not a wise move, in my judgment.
  • PSA: This test for prostate specific antigen, a protein produced by prostate cells, can warn men of prostate cancer. However, false positives are common, and even when the test does detect cancer, it provides no information about how aggressive it is or how likely it is to spread. Until we have a reliable follow-up test to show whether or not a tumor is aggressive, I doubt the wisdom of using PSA as a screening tool, except for men at high risk of prostate cancer on the basis of family history or lifestyle. A newer test, the pro-PSA, may do better. Discuss prostate screening with your physician.
  • Mammogram: Every one to two years for all women over 40 to detect early (and curable) breast cancer. Women with a positive family history of breast cancer may want to start screening earlier.
  • Colonoscopy: A test for early signs of colon cancer; every 10 years starting at age 50, earlier if there is a positive family history.
  • Blood pressure: Every two years after the age of 18 as long as your blood pressure is normal.
  • Eye exams: Every two to four years between ages 40 and 65; every one to two years after age 65. If you wear glasses or contacts, you should have your eyes checked annually, regardless of age.
  • Dental exams: Everyone, regardless of age, should have a dental check-up once or twice a year.
  • Full body skin exams: Check yourself monthly for moles; an annual skin exam by a physician regardless of age; follow your doctor's recommendations for more frequent exams if you've had any type of skin cancer.
  • Thyroid tests: All adults, particularly women, should be screened for thyroid disorders at the age of 35 and every five years thereafter.
  • Pap smears: Women need Pap smears to detect abnormalities that may precede cervical cancer every one to three years.
  • Diabetes screening: Fasting blood sugar and insulin levels should be checked if you are overweight or have a positive family history.

Andrew Weil, M.D.

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