Dr. Sandra El Hajj - MSc, N-MD, DHSc
In the second part of our series on preventive medicine, we outline the most important preventive tests to keep in mind during your healthcare journey. For men and women, these tests differ depending on the stage in one's life.
As you grow older, it’s expected that your normal body function will decline to a certain level as a result of the slow deterioration of the performance of your body systems. Maintaining or improving your health through early detection and screening with regular preventive care can help you stay healthy. Routine visits to your doctor and regular health screenings can help you avoid the development of serious health problems in the future.
Every woman must remain conscious of maintaining their health and well-being. When you reach adulthood, you must regularly visit a doctor who specializes in women's health for a regular assessment of your current health status, but more importantly, for evaluation of existing risks that may lead to diseases in the future. Possible diseases unique to women that can be detected and screened at an early stage include breast cancer, diabetes, sexually transmitted diseases, cervical and ovarian cancers, skin cancer, cardiac diseases and many more.
Preventive care allows your doctor to properly address all risk factors and avoid these diseases through intensive tests. An overview of commonly used tests is provided below.
Bone mineral density must be checked at least once beginning at age 65 or earlier depending on existing risk factors for osteoporosis. A bone scan is a nuclear imaging test that helps diagnose, screen and identify early problems such as bone damage that may be caused by cancer. During a bone scan, a radioactive substance called a “tracer” is injected into your vein, which will be absorbed by your bones and monitored for several hours. The results are considered normal when the radioactive substance is spread evenly throughout the body. Any darker spots in the image show damage to the bone which can be used to determine bone diseases(1).
A regular clinical breast exam by your doctor may help identify possible abnormalities or early signs of breast cancer such as lumps. However, this is only effective when signs and symptoms appear. To identify possible early signs of breast cancer, a mammogram must be done every one to two years starting between the ages 40 and 50.
The American Academy of Family Physicians (AAFP) recommends that the screening should be done every other year for women aged 50 to 74 years. A mammogram is an X-ray picture of the breast that detects for early signs of breast cancer, sometimes up to three years before signs and symptoms occur.
To complete a mammogram, you’ll stand in front of a special X-ray machine and your breast will be placed or allowed to rest on a clear plastic plate, which is firmly pressed by another plastic plate on top. Through pressure, the plates will flatten the breast to keep it in place while the X-ray is being taken. This experience can be uncomfortable and painful for many women. However, a mammogram takes only a few minutes to finish(2).
Age and other risk factors play an important role in sexual health. A Papanicolaou smear, or a Pap smear, is a test performed by a doctor that requires the collection of cells from your cervix to be analyzed to detect cancer or even pre-cancerous cells. It is recommended that women aged 21-29 have a Pap smear every three years. For women 30-65, a Pap smear with HPV testing must be done every five years. Women at average risk should not be screened more than once every three years. Testing can be halted for women over 65 years who have lesser risk. These tests determine pre-cancerous cells and other indicators that aid in early treatment or management(3).
Other tests include screening for sexually transmitted diseases, which can be detected through microbiological examination of discharges or blood work-up. All sexually active women should be tested for HIV and other sexually transmitted infections such as syphilis and hepatitis through blood tests. Chlamydia test and gonorrhea test should be done yearly until age 25 for sexually active women and older women with increased risk such as having multiple sexual partners. These tests are usually done using vaginal discharges to test for the presence of the causative agent.
Because women are more prone to using cosmetics and other beauty products, women are at higher risk for exposure to chemicals that may cause damage to the skin, leading to serious conditions such as skin cancer. Visiting your dermatologist for detection of suspicious skin abnormalities, such as worrisome moles, can help you address early signs of skin problems(4). As a measure of preventive care, your doctor can recommend safer cosmetics and beauty products.
According to the CDC, more than 50 percent of women will eventually get a urinary tract infection (UTI) at some point in their lifetime. These odds increase if the woman is diabetic(5). The presence of glucose in the urine creates a perfect environment for bacteria to grow. Also, women have shorter urethra than men, which allows the bacteria to travel faster towards the urinary tract causing more complications.
To prevent yeast infections and UTIs, regular blood glucose checks must be done such as fasting plasma glucose and HgbA1c. Routine urinalysis testing can also be done. You will be asked to collect a urine sample first thing in the morning to be tested for the indicators of urinary tract infection such as bacteria, chemical components and other indicators of inflammation.
According to the Center for Disease Control and Prevention,diabetes increases the risk of heart disease by about four times in women, as compared to two times in men. Women are also at higher risk of developing other complications from diabetes such as blindness, kidney disease and depression.
Since women may develop gestational diabetes, a type of diabetes that develops during pregnancy, they have three to seven times increased risk of developing type 2 diabetes within 5-10 years. That is why it is generally recommended that women should be screened for diabetes every three years starting at age 45. Women with increased risk for diabetes may be tested regularly starting at any age(6).
The fasting plasma glucose test checks the level of glucose in your blood after an eight-hour fasting period. For screening purposes, this is usually accompanied by other tests such as oral glucose tolerance test (OGTT) and HgbA1c test. OGTT is usually done on pregnant women between 24 to 28 weeks of gestation, which measures glucose level before and after drinking the glucose solution.
Multiple blood collections are needed because blood glucose will be tested after the eight-hour fast, typically at one hour, and two hours after drinking the glucose solution. The HgbA1C test measures your average blood sugar level over the past two to three months and serves as an effective tool for pre-diabetes detection because an HgbA1c result between 5.7 and 6.4 percent indicates you have pre-diabetes, while a 6.5 percent or higher result indicates you have diabetes.
Based on their anatomic features, men are often perceived to have a strong physique. However, being a man does not exempt you from developing diseases as you grow older. Even if you’re in the best shape of your life, there is still a possibility that serious diseases with no signs or symptoms may put your health at risk.
According to the Center for Disease Control and Prevention, 12 percent of men in the United States who are 18 years and older have fair or poor health(7). Men are also 24 percent less likely to visit their doctors and 22 percent less likely to get their cholesterol checked as compared to women. Some diseases that men should watch out for during adulthood include hypertension, prostate cancer, liver cancer, lung cancer, colorectal cancer, coronary diseases and many more.
Through preventive examinations and routine health screenings, your doctor can determine your health status and detect early warning signs that identify certain diseases. Early detection of these warning signs can be done through certain tests, which are covered below.
According to the CDC, a greater percentage of men have high blood pressure compared to women, and increased blood pressure increases the risk of heart disease and stroke.Hypertension, a blood pressure that is higher than normal, usually shows no symptoms unless it is extremely high, so the only way for you to detect an increased blood pressure is through measurement. This is the simplest, easiest, and most painless procedure that can be done for preventive care.
In fact, this test can be done at home or in health facilities since the machine utilized in this test (called sphygmomanometer) can be accessed in pharmacies as automated machines or manually operated. Having a consistently elevated blood pressure must be referred to your doctor since it can cause damage to your arteries and organs that can lead to heart attacks and strokes. The National Institute of Health recommends a consistent screening of at least once every two years for men between the ages of 18 and 64(8).
Screening for colorectal cancer can be done through a presumptive test called the fecal occult blood test, which checks the feces for occult (hidden) blood that may indicate cancer. For this test, small amounts of stool are collected on cards that contain dry reagents. Here, chemical reactions occur to indicate the test result. If the results are positive, a colonoscopy will be needed to investigate further. However, results are often inconclusive because blood in the feces can also be caused by other conditions such as ulcers, hemorrhoids or other conditions(9).
There are several testing options for colon cancer including
Through preventive care, early detection of tumors or markers of colon cancer leads to earlier treatment which can slow further complications of colon cancer.
According to many healthcare professionals, men are actually two to three times more likely to get non-melanoma basal cell and squamous cell skin cancers than women, and their risk increases as their exposure to sun increases. This can be due to women using sunscreen more often than men, and many occupations of men requiring longer sun exposure compared to women. It would be wise to visit your doctor regularly for early screening and detection of skin abnormalities that may indicate these types of cancer.
In the United States, smoking tobacco, drinking alcohol, hypertension and obesity are all risk factors for heart, lung and liver diseases. Consider the following statistics gathered by the CDC between 2013-2016:
Through preventive medicine, you can determine the presence and the effects of these risk factors. An intensive interview with your doctor can identify risk factors that may lead to chronic diseases. Screening through different tests such as X-rays, CT scans, biopsies and blood tests can also determine the early signs of complications of these risks. X-rays and CT scans are non-invasive procedures that use machines to capture an image of the organ of interest. These tests can be done any time of the year or as recommended by your doctor.
Biopsy procedures for lung and liver tests are more invasive. These require surgery, where your doctor obtains a tissue sample from these organs to be tested for the presence of malignant cells. Early detection of malignant tumors can lead to better treatment response. Blood tests that are ordered during your visit for preventive care can be done any time and do not require fasting. Blood tests needed for the screening of the liver include enzymes such as AST, ALT, ALP, Bilirubin, hepatic viral tests and many more.
Blood tests needed for lung function usually require blood gas analysis. Screening of the heart can be done through an echocardiogram, 2D-Echocardiography, or through cardiac marker analysis in the blood which includes AST ALT, lipid profile, CK-MB, troponins and other enzymes.
The primary method of screening for prostate cancer is through the detection of prostate-specific antigen (PSA) which is measured through your blood. It is a protein released by cells in the prostate gland from both normal cells and cancer cells. When prostate cancer develops, the PSA result usually exceeds four ng/mL. Another type of examination that can be done during your visit is the digital rectal exam (DRE), a procedure where the doctor inserts a gloved, lubricated finger into your rectum to feel for any tumor or hard areas on the prostate that might be indicative of cancer. This exam can be uncomfortable especially for those with hemorrhoids, but it is not painful and usually done in a few minutes.
Uncontrolled and poorly managed diabetes can lead to heart disease, stroke, kidney disease and blindness. Because men are less likely to visit their doctors, this puts them at risk of having undetected diabetes. When early warning signs are detected, possible complications can be prevented. You should visit your doctor for screening tests such as fasting plasma glucose and HgbA1c tests.
The fasting plasma glucose test checks the level of glucose in your blood after an eight-hour fasting, while the A1c test can be done anytime and does not require fasting. Plasma glucose higher than 126 mg/dL and an A1c result higher than 6.5% may indicate diabetes. With preventive medicine, early treatment of the disease can be done through the recommendation of lifestyle changes and medications.
With a fast-evolving world, the incorporation of industrialization and the wide spread of toxins everywhere, the body has been given a difficult task that is to withstand it all. Men and women are at higher risks of illness and injuries than any time before. That’s where the world of preventive medicine comes in handy. When comparing preventive and curative, it is essential to understand the added values offered by prevention. Primary prevention is the best option, but secondary and tertiary-level preventions are the best way to maintain a good quality of life with optimal health and well-being. Preventive medicine has to be, without any doubt, part of every individual’s lifestyle.