You can divide medical tests into two categories: the ones we’re told to take—cholesterol screenings, colonoscopies, mammograms—and the ones on the “maybe” list—i.e., maybe your
doctor tells you about them, maybe not; maybe they’re covered by insurance, maybe not.
These eight tests fall into the latter category. Some are for everyone, some aren’t, but they all have one thing in common: the potential to save lives. Maybe yours.
1. The eyes have it
One local woman recently interviewed for this magazine credited her eye doctor for discovering the swollen optic nerve that was lurking behind two life-threatening brain tumors. Now, if that isn’t reason enough to get an eye exam, what is? Performed by an ophthalmologist—an eye M.D., not to be confused with optometrist—an eye exam tells you much more than whether or not you need glasses; it also can uncover cancer of the eye and diseases that can lead to blindness, such as glaucoma, cataracts and diabetic retinopathy. How often do you need to be checked? As a general rule, the older you get and the more risk factors you’ve got—diabetes, high blood pressure or family history of eye disease, to name a few—the more frequently you should be screened, according to the American Academy of Ophthalmology. A baseline screening is recommended at age 40, that magic age when vision changes and early signs of eye disease are more likely to start occurring.
2. Skin check
We don’t mean to spoil your tanning party with this grim reminder, but skin cancer is the No. 1 form of cancer in the United States. Yet an annual full-body check is missing from the list of recommended screening tests put out by the U.S. Preventive Services Task Force. Big oversight. A skin check is the best way to catch potentially fatal melanoma (and other skin cancers) while they’re still treatable, prompting the Skin Cancer Foundation to recommend head-to-toe annual checks by a physician. You also should give yourself a monthly once-over, advises the foundation, and don’t make it a once-over-lightly: Plant yourself in a strong light, use mirrors (full-length and hand-held) and be sure to take a peek at those hard-to-see places, such as your scalp and between your toes. Learning your ABCDs is helpful, too: A is for asymmetry, B is for (an uneven) border, C is for (varied shades of) color, and D is for diameter (early melanomas usually are larger than common moles). Be especially vigilant if you’re in the high-risk group for melanoma—factors include fair skin, light eyes, many moles and a family history of the disease. If you find anything unusual or suspicious, see your doctor. Better yet, see a specialist: Studies have shown that dermatologists are better at spotting melanomas than primary care docs.
3. Self-screen for depression
More than just feeling down in the dumps, clinical depression is a serious medical illness that, left untreated, carries a risk of suicide. Yet, sadly, many people would rather put their heads in the sand than admit they might need help. Fortunately, there’s an easy way to self-screen for depression, right in the privacy of your own home: Simply go online and look for a Patient Health Questionnaire called PHQ-9. (Try depression-screening.org, a website of Mental Health America.) The free test, which asks you to gauge how frequently in the past two weeks you’ve experienced trouble sleeping, feelings of failure and other symptoms of depression, takes just moments to complete and provides immediate results and recommendations (which may or may not include getting professional help). While PHQ-9 is not considered a substitute for a clinical evaluation, it’s a good starting point, says Richard Bowdle, M.D., medical director for the Sutter Center for Psychiatry in Sacramento. “Depression and other anxiety disorders are very prevalent in the general community and lead to major life distress and disability if not detected and managed,” he says. Yet depression is as highly treatable as it is common, according to Bowdle. No one should have to go it alone, he adds, so if you think you are depressed, start with a visit to your primary care doctor’s office.
4. Coronary Artery Screen
Someday, the coronary artery screen—also known as a calcium score or heart scan—will be just as common as an electrocardiogram, or EKG, predicts Dennis Breen, M.D., a cardiologist with Sacramento Heart & Vascular Medical Associates. “Of all the tests we do, none does a better job of detecting the early stages of coronary artery disease—and saving lives,” says Breen. “I’m an unabashed enthusiast.” The high-tech, noninvasive test uses a 64-slice CT scanner to calculate your calcium score—the amount of calcified plaque in your arteries—to determine your risk of heart attack or other coronary “events” while there’s still time to do something about it, explains Breen, making it far superior to the stress test. “The stress test is a good test and is still the accepted standard of care, but will only indicate a problem when coronary disease is advanced,” he says. “That’s why you hear stories about people passing a stress test and then dropping dead of a heart attack a week later.” So who should consider the coronary artery screen? Anyone with the classic risk factors of heart disease—family history, high blood pressure, high cholesterol, overweight, etc.—especially those older than 50, stresses Breen. “If you want to know your future, this test is kind of a technical crystal ball,” he says. The test costs $349 out-of-pocket at Sac Heart and includes a cardiology consultation. For more information, visit sacheart.com or call (916) 830-2045.
5. BMI for infants and children
You can never be too rich or too thin—or too young for a body mass index test, apparently. Beginning at age 2, all children should have this free, simple height/weight calculation that measures body fat, says Gregory Janos, M.D., a pediatric cardiologist and medical director of the Children’s Center at Sutter Medical Center in Sacramento. What’s the point, you ask? Simple: Determining and treating an obesity issue early on potentially can prevent an early death, according to Janos. But even though the test is recommended by the American Academy of Pediatrics and the Centers for Disease Control and Prevention, not all doctors are hopping on the bandwagon. “Compliance is far below 100 percent,” says Janos. If a child’s BMI is in the danger zone, the first step is to rule out underlying medical causes such as endocrine or metabolic abnormalities. But in most cases, he adds, the cause of obesity is dietary, in which case early intervention is key. “The success rate of treating childhood obesity is inverse to the age, so the earlier you identify it, the better,” says Janos. “A BMI is very cheap and simple and gives us a very big bang for the buck.”
6. Breast MRI
If you’re at high risk for breast cancer, an MRI test is as good as it gets. “It’s a very powerful test—better than any other test we have for identifying breast cancer,” says Charles McDonnell III, M.D., of Radiological Associates of Sacramento. The MRI’s ability to detect the disease can be as much as twice that of mammograms and ultrasounds, he adds. That’s why it’s indicated for patients who are determined to be at increased risk. So how do you know if that’s you? Your doctor and/or a genetic counselor should be able to help, he says, but you also can self-assess by using a risk calculator, such as the one on the National Cancer Institute’s website: cancer.gov/bcrisktool. If you are found to have a lifetime risk of 20 percent or higher, says McDonnell, insurance will cover the cost of an MRI; those in the 15 to 20 percent range are in what he calls the “gray area,” and those with a risk below 15 percent probably don’t need an MRI. The test’s extreme sensitivity is both its upside and its downside; while it has an extraordinary detection rate (95 to 100 percent, according to McDonnell), it also has a high potential for false-positive results. “It shows up a lot of spots that aren’t cancer, which is why it’s not considered a screening test for the general population,” he says. (It’s also expensive.) “But I’m a big fan of MRI. Believe me, I see it hit home runs every day.”
7. Vascular health screening
Sure, your blood and stress tests might look great. But a vascular health screening can reveal life-threatening artery blockage when those other tests can’t—“anything from mild blockage to a full-blown aneurysm,” says Ken Rogaski, manager of the Mercy Heart & Vascular Institute, where the screening is offered. “I’ve seen some patients go to the ER for surgery right after the test.” Despite the screening’s ability to uncover a heart attack, stroke or aneurysm waiting to happen, it typically is not covered by insurance or ordered by a doctor; Rogaski says 80 percent of the patients he sees come in voluntarily. Mercy’s three-test screening costs $95 and includes two ultrasounds (to check carotid arteries in the neck and the abdominal aorta) and an ankle-brachial index, which measures blood pressure in arms and legs to check for peripheral arterial disease. Rogaski says the tests are a good idea for anyone older than 55 or with risk factors for heart attack or stroke, including a family history. For more information about Mercy’s Vascular HealthScreen, call (916) 733-6245 or visit mercygeneral.org.
8. Oral cancer screening
Dodging the dentist is a bad idea for a bunch of reasons, including one that may not have occurred to you: An oral cancer screening is supposed to be part of every routine checkup, according to the American Dental Association. Problem is, not all dentists are quite so routine about it, so if yours isn’t doing this relatively simple exam—it’s basically a look-and-feel around your mouth, throat and neck—be sure to ask. More than 34,000 cases of oral or pharyngeal cancer are found in the U.S. every year, and it’s not just with tobacco users: New data suggests the fastest growing segment of the population to be diagnosed with the disease are nonsmokers younger than 50. So make sure you get screened at every dental visit—it’s covered by insurance, by the way—and if you notice any funny-looking lesions or patches in and around your mouth (lips, gums, tongue, tonsils, cheeks) between appointments, call your dentist.