Ten Medical Tests to Avoid
Doctors are warning that some of the common medical tests routinely taken by Americans do more harm than good, waste billions of health care dollars annually and could endanger your health or even your life.
Among the tests targeted by prestigious panels of doctors as overused were annual Pap smears, regular PSA tests, regular EKGs and even routine yearly physicals.
Overuse of such tests leads to dangerous side effects, pain, radiation exposure, unnecessary surgery — even death, the doctors said.
The American Board of Internal Medicine Foundation asked more than 50 medical societies — of family doctors, oncologists, cardiologists and other specialties — to identify tests and treatments that are often unnecessary. AARP is a consumer partner with this campaign, called Choosing Wisely.
1. Nuclear stress tests, and other imaging tests, after heart procedures
Many people who have had a heart bypass, stent or other heart procedure feel they’ve had a brush with death. So patients — and doctors — understandably want to be reassured through a nuclear stress test or other tests that their hearts are beating strong. But performing these tests every year or even every two years in patients without symptoms rarely results in any change in treatment.
In fact, it can lead to unnecessary invasive procedures and excess radiation exposure without helping the patient improve.
2. Yearly electrocardiogram or exercise stress test
A survey of nearly 1,200 people ages 40 to 60 who have never had heart disease or any symptoms found that 39 percent had an EKG over the previous five years, and 12 percent said they had an exercise stress test. The problem: Someone at low risk for heart disease could be 10 times more likely to get a false-positive result than to find a true problem. This could lead to unnecessary heart catheterization and stents. Instead, have your blood pressure and cholesterol checked. And if you’re at risk for diabetes, have your blood glucose level checked as well.
3. PSA to screen for prostate cancer
Cancer is always scary, but the PSA test often finds slow-growing cancers that won’t kill men. As a result of the test, he says, men often have ultrasounds, repeat lab tests and even biopsies for a problem that isn’t there — an estimated 75 percent of tests that show high PSA levels turn out to be false alarms. When men do have treatments such as surgery or radiation, 20 to 40 percent end up with impotence, incontinence or both.
4. PET scan to diagnose Alzheimer’s disease
Until recently, the only way to accurately diagnose Alzheimer’s was during an autopsy. In the last few years, doctors have begun using PET scans with a radioactive dye to look for beta-amyloid protein that is found in the brains of people with the disease. Although this test has promising use for research, there are serious questions about whether it should be used on those who complain of a fuzzy memory. PET scans in older people consistently find the protein in 30 to 40 percent of people whose memories are just fine.
Although beta-amyloid plaques are present in all of those who have Alzheimer’s, it is not known if or when everyone with the plaques will develop the disease, says Peter Herscovitch, president-elect of the Society of Nuclear Medicine and Molecular Imaging. What’s more, even if a PET scan could accurately diagnose the disease, it’s untreatable. If you’re concerned about your memory, the better course is to have a complete medical evaluation by a doctor who specializes in diagnosing and treating dementia. Many other medical conditions, such as strokes, thyroid deficiencies and vitamin deficiencies, can cause the same symptoms, and these are treatable.
5. X-ray, CT scan or MRI for lower back pain
Unfortunately, back pain is incredibly common — 80 percent of people will suffer from back pain some time in their lives. It can be both excruciating and debilitating. Naturally, people want to know what’s wrong. Here’s the catch: The best imaging machines in the world often can’t tell them. Many older people with no back pain can have terrible-looking scans.
Most back pain goes away in about a month and imaging tests tend to lead to expensive procedures that often don’t help recovery. If you don’t feel better in a month, talk to your doctor about other options such as physical therapy, yoga or massage.
6. Yearly Pap tests
The yearly Pap smear is a common part of women’s health checklists, but it doesn’t need to be. Women at average risk only need them every three years, since cervical cancer generally takes 10 to 20 years to develop. If women have also had negative tests for the human papillomavirus (HPV), which is now known to cause the cancer, they only need a Pap test along with the HPV test every five years. And women older than 65 who have had several normal Pap tests in a row can stop having them altogether. Do note, however, that a yearly visit to an ob-gyn stays on the to-do list.
7. Bone density scan for women before age 65 and men before age 70
For the estimated 10 million people — mainly women —in the United States who have osteoporosis, bone-strengthening medications can lower the chances of breaking a bone. But many experts argue that for those ages 50 to 65 who have osteopenia — mild bone loss — testing and subsequent drug prescriptions may be a waste of time and money. Not only is the risk of fracture often quite low, medications such as Fosamax (alendronate) and Boniva (ibandronate) have been linked to throat or chest pain, difficulty swallowing, heartburn, muscle pain, bone loss in the jaw and thigh-bone fractures. And there’s scant evidence that people with osteopenia get much benefit from the drugs.
8. Follow-up ultrasounds for small ovarian cysts
Many women receive repeated ultrasounds to verify that ovarian cysts have not become cancerous, but current research says that these tests aren’t necessary. For one thing, premenopausal women have harmless ovarian cysts regularly. For another, about 20 percent of postmenopausal women also develop harmless cysts.
9. Colonoscopy after age 75
Most people should have screening for colon cancer at 50 and then every five to 10 years after that, if the first test is normal. By age 75 — if you’ve always had normal colonoscopies — you can stop taking this test altogether. That should be good news, because a colonoscopy can cause serious complications in older people.
10. Yearly physical
There’s little evidence that having an annual checkup can keep you healthy. Many tests that doctors regularly perform — to diagnose anemia, liver disease or urinary tract infections, for example — don’t make sense unless there’s a reason to suspect a problem. “A healthy 52-year-old does not need to see the doctor once a year,” says Jeremy Sussman, an internist for the VA system and assistant professor at the University of Michigan who was on the Society of General Internal Medicine task force for making the Choosing Wisely recommendation.
“We certainly don’t think people should never see doctors — quite the opposite. We question the value of seeing someone for the sake of seeing someone.” Your specific needs should determine how often you see your doctor, he adds. If you have an illness that needs treatment, you should see your physician. And do talk to your doctor about how often you need to have your blood pressure and cholesterol tested.