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Checkup, Please

Making tests and screenings a priority

By MELISSA MARES

When Helen Hackett was told she had to have a biopsy after her doctors at Evanston Northwestern Healthcare (ENH) saw a worrisome spot on her annual mammogram slides, she was not troubled.

"I wasn't the slightest bit concerned," Hackett says.

She maintained a healthy diet, worked as a personal trainer and spinning instructor and had regular mammograms. She had been diagnosed with benign breast cysts in the past, and she assumed that this incident would turn out the same way.

But this time was different. Hackett was diagnosed with stage 1 breast cancer in March of this year. After her diagnosis, she underwent a lumpectomy to remove the tumor and then had chemotherapy and radiation. She will also take a drug called Tamoxifen for the next five years, which can help prevent a recurrence of breast cancer. Hackett has finished active treatment with a good prognosis, but has been profoundly affected by the experience.

"You never know why it happens to you," Hackett says. "You realize your life is never going to be the same."

Generally healthy people can easily forget about having regular preventative screenings or to rank them low on their list of priorities, but Hackett's story confirms that these tests can be the early warning for a serious condition.

With so much literature on testing and so many tests that doctors deem important, it can be difficult to determine which to have. The U.S. Preventive Services Task Force compiled a list of 27 recommended preventative services for adults (http://www.ahrq.gov/clinic/uspstfix.htm). The first step to developing a preventative health plan is to visit a general internist who can help lay out health priorities, work out cost-related issues if necessary and take a family history, says Dr. Russell G. Robertson, chairman of the family medicine department at ENH. In fact, Robertson says that the family history is one of the best ways for patients to determine which screenings to concentrate on.

"I usually tell patients that during the holidays, when you're with your family, ask them what runs in the family," Robertson says. "That's invaluable, inexpensive and is so important."

As with any health program, it is essential to talk to a doctor about each individual's personal needs. The following tests are among those that doctors cite as most important. They can be useful in maintaining good health or, as in Hackett's case, can save a life.

Blood pressure

Measuring blood pressure is one of the easiest and least expensive tests doctors can do to make a significant impact on a patient's health, according to Robertson.

"You can even do it yourself," Robertson says. Anyone can buy a blood pressure cuff at the drugstore and monitor his or her own blood pressure to make sure it falls within the normal range, he says.

The blood pressure measurement is represented as two numbers: the systolic (top) number is the pressure when the heart contracts and the diastolic (bottom) number is the force of blood against the arterial walls when the heart muscle relaxes between beats. Blood pressure is measured with a sphygmomanometer, which works when a cuff around the upper arm is inflated to constrict the blood vessels, while a stethoscope is used to listen to the pulse rate.

The Centers for Disease Control and Prevention (CDC) classifies high blood pressure for adults as a systolic blood pressure of 140 mmHg or higher or a diastolic blood pressure of 90 mmHg or higher. Normal blood pressure is a systolic blood pressure of less than 120 mmHg and a diastolic blood pressure of less than 80 mmHg.

"[High blood pressure] is the 'silent killer'," says Dr. Georges C. Benjamin, executive director of the American Public Health Association. High blood pressure often has no symptoms, and signs of it typically do not appear until major organ damage has occurred, he says.

Heart disease is the leading cause of death in the United States and kills more people than all types of cancer combined, according to the CDC. High blood pressure is a risk factor for heart failure, stroke, kidney damage and even blindness, brought on by burst blood vessels in the eyes. Early detection and control with medication, diet and exercise can prevent organ damage before it occurs.

Cholesterol

Cholesterol is a waxy substance found in the bloodstream and cells of all people. The human body produces some cholesterol for normal body functions, but levels can become too high from eating a lot of animal products. A diet high in saturated and trans fats can also trigger the body to produce even higher levels of cholesterol. Some aspects of cholesterol levels are also dependent upon genetics and family history.

A blood test can easily determine cholesterol levels, which are broken into two sub-categories. Low-density lipoprotein (LDL) is also known as "bad" cholesterol. This is the type that can clog arteries and lead to heart attack or stroke. High-density lipoprotein (HDL) is sometimes called "good" cholesterol because it prevents LDL from clogging the arteries. According to the American Heart Association (AHA), studies suggest that high levels of HDL can reduce one's risk of heart attack.

A total cholesterol level of less than 200 mg/dL is considered normal, and 240 mg/dL is considered high. The AHA estimates that close to 20 percent of the U.S. population has cholesterol at the high level. Similar to high blood pressure, elevated cholesterol levels can often be controlled with a combination of diet, exercise and newer, effective medications.

Body Mass Index (BMI)

It has been well reported that the United States is facing a major obesity epidemic, which will continue to impact public health significantly in the coming years. Both Drs. Benjamin and Robertson cite measurement of the body mass index (BMI) as a simple and reliable test to evaluate a patient's weight and the obesity-related risks faced.

There are several BMI calculators available on the internet or by use of the following formula: weight (lb) / height (in) / height (in) x 703 = BMI

Once BMI is calculated, it can be interpreted by applying the number to the following ranges:

Below 18.5 = Underweight

18.5-24.9 = Normal

25.0-29.9 = Overweight

30+ = Obese.

"I know that most people who are overweight know they're overweight," says Robertson. "But the BMI can be compelling." The BMI is a helpful indicator, especially if it motivates an individual to take steps to ensure that they are at a healthy weight, he says.

Benjamin agrees. He cites diabetes, back pain, heart disease and other serious problems that occur in people with a high BMI.

Though some people who struggle with these problems are clearly obese, others have weight issues that might not be as obvious, Benjamin says. He cites a high percentage of body fat as one such signal and says that BMI seems to be a better indicator of these issues than a scale alone.

Colorectal cancer

Colonoscopy gained national attention in March of 2000 when Katie Couric had her colonoscopy broadcast on live television to raise awareness of colorectal cancer.

Colorectal cancer (often referred to as colon cancer) is the second leading cause of cancer deaths in the United States, but it is more than 90 percent preventable with screening, says Benjamin.

According to the CDC, if all people aged 50 or older had colonoscopy every 10 years, as many as 60 percent of colorectal cancer deaths could be prevented.

Before the procedure, patients must restrict their diet and take a regimen of laxatives so that the colon is empty for the test. The doctor administers a sedative and pain medication, which relaxes the patient and keeps him or her comfortable during the procedure.

A thin, flexible instrument called a colonoscope allows the doctor to examine the lining of the colon and rectum to look for abnormal, precancerous lesions called polyps. In many cases, the doctor can remove the polyps during the colonoscopy, preventing colorectal cancer before it even takes hold.

Many people unfamiliar with the colonoscopy feel nervous about having the procedure. However, Benjamin says that the test's most common side effect is minor abdominal cramping, and most patients do not remember anything about the test as a result of the sedative. He adds that the life-saving potential of colonoscopy make it a cost-effective and extremely worthwhile test.

Robertson agrees. "People tolerate [colonoscopy] very well," he says. "The anxiety is often out of proportion."

Breast cancer

Breast cancer screening is a three-pronged effort, and each part is an important component of detection. The three parts are breast self-exam, physical breast exam (by a doctor) and mammogram.

Most breast lumps are found by the women themselves, either during regular daily activity or during self-exams. Doctors recommend that women examine their own breasts once a month to feel for lumps and changes in breast tissue. Self-exams paired with an annual

physical exam by a physician can detect breast cancer at an early stage, when it is most treatable.

As important as physical exams are, doctors consider mammograms one of the most important tools available for early detection of breast cancer. The American Cancer Society recommends that women over the age of 40 have annual mammograms. Doctors may recommend starting yearly mammograms earlier for women who are at a high risk for breast cancer or have a strong family history of the disease.

During the mammogram, a technician compresses each breast between two plates and takes films of each, which are then read by a radiologist for abnormalities. Many women experience some level of discomfort as a result of the compression of the breasts, but doctors remind patients that the compression is essential to getting a clear view of the tissue.

This is not an exhaustive list of necessary tests, but it can be a good starting place for a conversation about establishing a preventative health plan under a doctor's supervision.

Ideally, all healthy people would have these tests as often as recommended and have active relationships with their doctors to stay current about their changing health needs. In reality, doctors recognize that a host of obstacles can arise, which cause patients to delay or avoid having the necessary tests. One of these problems is lack of insurance and the cost of some of these screenings.

Robertson encourages patients without insurance to tell their physicians about their situation and says that many physicians' offices will apply a sliding scale or negotiate payment options when necessary. Many doctors urge generally healthy people to look at costs from a different perspective.

"It is much cheaper to do a colonoscopy than to pay for care for colon cancer, not including the morbidity and mortality," says Benjamin.

Robertson also advises that individuals concerned about costs associated with health care carefully evaluate the benefits of the tests. "There are a lot of people who will spend fairly large amounts of money on a television, but neglect their health care," he says. "I think it's a somewhat unjustified attitude that [health care] is too expensive....Don't assume that screening is prohibitively expensive."

Helen Hackett is one patient who believes in the power of regular health screenings. In September of this year, she completed her last treatment for breast cancer. Though she will not be considered "cured" until she is cancer-free for five years, her prognosis is very good. Hackett believes that if she had not had regular mammograms, she might not have been so lucky. She spreads the word about her experience when she can.

After her diagnosis, she urged her female spinning students to make sure they had regular mammograms because she says, "They work!"

Some of her students had mammograms after Hackett's reminder. One of those students was also diagnosed with breast cancer and is currently undergoing treatment. Hackett feels, and doctors agree, that these tests are immensely important in maintaining health.

"The value of knowing is so much more important than the anxiety of not knowing," says Robertson.

Published: December 01, 2006
Issue: Holiday 2006