Annual Physicals Popular Despite Benefit Doubts
Health planning experts can't find any evidence that annual physical exams benefit healthy adults. But a new survey shows that 65 percent of doctors still perform the regular checkups. They say the benefits may be difficult to quantify, but they are real.
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Physicians who believe annual physicals are beneficial often note that the visits allow them to perform certain medical screenings -- for blood pressure or cholesterol, for example. But with so many types of screening tests available and promoted by various organizations, how is a patient to know which tests to ask for?
The U.S. Preventive Services Task Force (USPSTF) is a panel of experts that tries to address this question with rigorous science. Looking at evidence from clinical trials, they evaluate the health costs and benefits of screenings. The USPSTF then assigns a recommendation for or against each particular screening. Or, they will declare that "the evidence is insufficient to recommend for or against" a screening.
The standards of the task force are high, and some organizations, like the American Heart Association, recommend screenings that the USPSTF says are not sufficiently supported by evidence. This doesn't mean the screenings aren't worth it for some individuals; it just means that the Task Force didn't find evidence that the benefits clearly outweighed the risks.
As with almost everything in medical care, the screenings physicians perform should be tailored to the age, sex, symptoms and medical history of the individual patient.
Below is an outline of which screenings the USPSTF recommends for adults without disease symptoms. There are several screenings the USPSTF recommends that are not included, because they don't involve lab tests. These include screenings for depression, alcohol misuse, obesity, hearing loss and visual impairment.
Abdominal aortic aneurysm: Men only, ages 65-75: one-time screening by ultrasound for people who have smoked at some point in their lives
Blood pressure: Ages 18 and over: screen for high blood pressure
Breast cancer: Women only, ages 40 and over: mammography every one to two years, with or without clinical breast exam
Cervical cancer: Screen women who have been sexually active and who have a cervix; may choose to decline screening after age 65 if not otherwise at risk
Chlamydial infection: Women only, ages 25 and younger; screen sexually active individuals
Colorectal cancer: Adults ages 50 and over; screen using one of several tests
Osteoperosis: Women only, ages 65 and older; screen for bone density
USPSTF Recommendations for Pregnant Women
Anemia: Using hemoglobin or hematocrit
Down syndrome: By serum multiple-marker testing
Hepatitis B: At first prenatal visit
HIV: During prenatal care
Neural tube defects: During prenatal care
Preeclampsia: At first prenatal visit and periodically through rest of pregnancy
Rh incompatibility: For blood type and antibody testing at first prenatal visit
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