PRESERVING INDEPENDENCE: Health Screening Recommendations For Adults

by Darline Turner Lee, Physician Assistant, ACSM Exercise Specialist

Article Last Reviewed: Sept. 9, 2006

When I visited my family this summer, I was surprised to hear my parents discussing plans for retirement. It’s eerie to acknowledge my parents are “senior citizens”.

I am comforted by the fact that my parents are both in good health. My dad has hypertension controlled with a single medication, diet and exercise. My mother has a hiatal hernia with acid reflux also controlled with medication and lifestyle awareness.
Neither of them smoke, drink or are overweight. These “seniors” plan to spend their golden years cruising with friends, visiting their children and grand children and “doing a little something on the side for some spare change and mental amusement”.

Thinking of them challenges me to follow their example. To meet the challenge, I posed the following question to my family physician, Dr. Terry S. Wiggins:

“I’m nearly forty and in generally good health. What examinations or tests should I undergo for preventive care?”

According to Dr. Wiggins (and the American Academy of Family Physicians) I should have a thorough physical examination and complete panel of blood work at age 40. In the 40’s physicians begin looking for early signs of hypertension, high cholesterol and diabetes. Early management of these conditions may prevent future negative events like heart attack and stroke.

A thorough skin check is essential. A 40-ish individual may develop pre-cancerous skin changes. Doctors examine the skin closely, especially on the back where individuals have difficulty checking, looking for precancerous changes.

For women, the exam should include a Pap smear, Pelvic exam and breast examination which can be done by her family physician/internist or her OB/GYN. She should also have a screening mammogram at age 40. Men should have a digital rectal exam to evaluate the prostate.

If the examination and lab tests come back within normal ranges, exams should be repeated in 3-5 years. If there are abnormalities, individuals should return for further evaluation and treatment at intervals determined by their physicians.

I asked Dr. Paula Starche, an internist and women’s health specialist to discuss her recommendations on screening mammography, bone densitometry and colonoscopy for women in their 50’s and 60’s.

Dr. Starche confirmed what I found in the medical literature: “The only agreed upon screening interval for mammography is that women should have annual mammograms after age 50, due to the increased risk of breast cancer. Screening mammography in the 40’s is still controversial.” She added, “In my practice, I screen women at the age of 40, then every one to two years thereafter. If a woman has risk factors for breast cancer, or is difficult to examine, she may need more frequent mammography. The clinical picture and patient history dictate the screening interval.”

A certified densitometrist, Dr. Starche states, “All women, by the age of 65, should have a bone mass density screening.” Clinical recommendations indicate women should have screening bone mass densities done at the onset of menopause, typically age 50. Bone mass density reports include a graphic showing a woman’s bone mass density and its relationship to the norm. The exam and report dictate when the exam should be repeated. If a woman has risk factors for osteoporosis, she may be screened sooner than age 50 and more frequently as her clinical history indicates.

Dr. Starche screens for colorectal cancer with a digital rectal exam and Fecal Occult Blood Testing annually after age 50. She recommends a baseline flexible sigmoidoscopy or full colonoscopy at age 50 and, if normal, every 5-10 years thereafter.

Covering men’s health and adult immunizations is internist and public health researcher Dr. Ghassan Salman. He reiterated Dr. Starche’s recommendations for colorectal screenings but recommends colonoscopies every 6-7 years after age 50.

I asked him to comment on the PSA test for prostate cancer. “The PSA test is controversial. Some believe it over detects cancers leading to over treatment. We know there is some benefit to screening men between the ages of 50 and 65. After 65, the benefit decreases. After age 65, men need to consult their physicians to determine their specific prostate screening needs.”

Dr. Salman made these lifestyle recommendations: “If you smoke you must quit. If you are overweight, lose weight to avoid developing hypertension, diabetes, heart disease and stroke. Smoking and obesity are the two most modifiable risk factors contributing to disease in adults.” All adults, especially older adults, should make walking a daily habit. Walking not only improves circulation and helps strengthens the heart, it also preserves mobility and agility. Adults should avoid high fat diets and increase their calcium intake.

He added, “All adults should receive the pneumonia vaccine at or about age 65. This vaccine lasts approximately 10 years. Adults should also have tetanus boosters every 10 years. If an individual frequently travels out of the country, he/she should consult with a physician who specializes in travel medicine to determine what other immunizations are needed.”

Terry S. Wiggins, M.D. is a family physician in private practice in Westlake.
Paula Starche, M.D. is an internist and women’s health specialist at The Menopause Center of the Austin Diagnostic Clinic.
Ghassan Salman, M.D., M.P.H. is an internist and public health researcher at the Austin Diagnostic Clinic.