New Rules for Mammograms, Other Tests

How many times in your adult life have you had this bizarre dream? You dream you have overslept, and realize that you have missed your final exam in a key college course. Of course, you’ve been out of college for 10, 20 years or longer, so the dream makes no sense. According to, many people have this very same dream, waking up in a cold sweat because they missed their final Biology or Accounting exam. Now, for a dose of reality: How many times have you had a bad dream that, as a mature adult, you missed a big physical exam, say a colonoscopy, or a mammogram? Unfortunately, too many people ignore the importance of these vital tests in promoting good health. To make matters worse, the guidelines for some of these tests have changed in recent years, and there is confusing and contradictory information circulating about how often these vital tests are needed. Here are three critical health tests for adults.

Prostate-Specific Antigen (PSA) Test
This simple blood test measures the level of PSA, a protein produced by the prostate gland. The higher the PSA level, the more likely it is a man has prostate cancer. When this test first became available for diagnostic use in the mid-1990s, many doctors recommended annual PSA tests for all men 50 and older. That thinking has changed. Studies have shown that PSA testing is not cost effective, and doesn’t save lives. It’s also prone to false-positive results; many men who have elevated PSAs don’t have prostate cancer, while some men who have prostate cancer do not have elevated PSA levels. I still recommend PSA tests once a year for men ages 50 to 65. However, I recommend against having them after age 65. For men ages 65 or older who are diagnosed with prostate cancer, in many cases I recommend not treating the disease. The treatment is often based on a sort of chemical castration. You don’t want to spend your final years suffering from that condition. The simple fact is, prostate cancer is generally a slow-growing cancer, and studies have found that many men die with prostate cancer, not from it. In other words, at that age, you’re better off taking your chance with the disease, rather than suffering from the debilitating treatment. With treatment of androgen deprivation (testosterone blockade), while fewer men died from prostate cancer, their morbidity and mortality from fractures and cardiovascular disease significantly increased due to the treatment itself!

I know this is the procedure no one looks forward to having done. As much of an inconvenience and uncomfortable as a colonoscopy may be for some people, colorectal cancer is far worse. The death rate for colon cancer has steadily declined in the past 20 years, thanks in large part to these tests, which can detect polyps before they develop into cancer (and polyps can be removed during the test). The American Cancer Society recommends colonoscopies every 10 years for persons ages 50 or over, although those with a family history of colorectal cancer should begin testing in their 40s, and be tested more frequently.

These procedures, which examine the breasts for possible cancerous growths, used to be recommended every year. While that did help with early detection of this deadly cancer, it also had an unwanted side effect — it caused cancers. Researchers believe that all the radiation that people get during mammograms, CAT scans and X-rays, causes 2 to 3 percent of cancers. Some doctors still recommend annual mammograms for some of their patients. Insurance companies and Medicare will cover annual mammograms, but in low-risk patients with no family history, biannual mammograms along with monthly self-breast exams and annual clinical breast exams at the doctor’s office should suffice. Higher risk patients with personal or family history of breast cancer or with prior abnormal mammogram may need semi-annual mammograms.