By the time a person begins to feel ill from high blood pressure, blood sugar or cholesterol, often, the damage has already been done. Even if we feel great, to ensure good health, it is essential that we receive preventive screening.
To maintain board certification in preventive medicine, I have to pass a comprehensive exam every 10 years. A portion of the test is always dedicated to asking which screening tests are recommended for specific populations based on factors such as age and gender. Over the years, I have watched with curiosity the shrinking number and frequency of recommended tests for some of the most common illnesses.
The US Preventive Services Task Force (USPSTF), a federal advisory group, deals with much more than exam questions. Its recommendations now drive policy at multiple levels as our country implements the Affordable Care Act and rolls out health care reform.
Two years ago, the USPSTF recommended that with, few exceptions, women age 40 to 50 should no longer receive an annual mammogram and that women aged 50-64 should still have them, but only every two years. At present, the task force is accepting public comment on new draft recommendations that only woman age 21 to 65 should receive Pap smears to screen for cervical cancer and now only every three years. Perhaps most striking is the USPSTF’s recent draft recommendation to end all routine screening for prostate cancer.
In principle, the USPSTF, comprised of preventive medicine experts and researchers, reviews the scientific literature and considers factors such as harm versus benefit of screening tests, the number of tests performed to find a positive case, and whether finding a positive case through preventive screening results in a better treatment outcome. The task force also weighs costs. It considers, for example, the price tag to find a single case of breast, cervical or prostate cancer.
The USPSTF analyzes the number of Years of Productive Life Lost from a given illness. The point is that a relatively modest investment of health care dollars used to educate a child with high cholesterol about dietary choices may yield a higher return on investment than dollars spent on intensive care for an 87-year-old who just had a third stroke.
Sunday, at the American Heart Association Conference, a panel from the National Heart, Lung and Blood Institute is expected to recommend cholesterol screening for all children by age 11. Considering that one third of American children are obese, regrettably, this is probably a good idea.
Remember that public health recommendations are designed to look after the "herd" and do not consider the unique needs of each member of society. We should each work with our primary care doctor to make shared decisions for health screening and treatment.
Even if our children look and feel great, we need to screen them for illnesses that, at least early on, remain silent. Take advantage of an early opportunity to offer them the best life possible.
Welcome and kudos to Michelle Obama who is actively dedicated to health lifestyles for our children.
Today, she is scheduled to visit MA’O Organic Farms and Sunday she is hosting a luncheon for the spouses of APEC leaders at Kualoa Ranch that features grass-fed cattle. The Let’s Move Campaign has children through out the islands burning calories in fun-loving ways. That’s what it takes. As ohana and community get behind healthy eating habits and consistent, enjoyable physical activity for our children, those screening tests should come out just fine.
Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
