By Dr. Greene, Medi-Share Medical Director
The rising health risks associated with our over-planned, busy lifestyles have become common knowledge in the popular press over the last 10 years. It is well advertised that Americans are more overweight than other developed countries with 39.8% of adults categorized as “obese” (Centers for Disease Control). We are also less physically active, as only 20% of us complete the recommended 2.5 hours of weekly moderate exercise than at any other time in our history.
This trend has led to a greater incidence of chronic diseases. For example, 9.4% of the adult population has diabetes and, more shockingly, more than one third of these people (American Diabetes Association) do not even know that they have diabetes. That is more than 7 million Americans.
All of these factors contribute to heart disease, which remains the #1 cause of death with cancer related deaths close behind, despite advances in cancer screening and detection.
One factor of concern is the confusion about what types of preventive care and screenings are recommended. There are a number of expert specialty groups which have suggested varying strategies and all of these conflicting guides can be overwhelming.
As a starting point, it is always best to be engaged with your primary care provider who can review your unique health factors and provide you with personalized guidance. Screening is especially important after the ages of 35-40 as your risk for chronic diseases and cancer rise as you get older.
While you may need to consult with your individual provider for some of your unique requirements, there are some overall preventive screening guidelines that are recommended for almost everyone. Here are a few that have high agreement among the experts:
- Blood Pressure – Unfortunately elevated blood pressure, or Hypertension, usually does not cause symptoms. The risks of untreated high blood pressure include increased heart attack, stroke and kidney damage. Screening is recommended at least every 3 to 5 years for all, but annually for adults older than 40 or at increased risk. While checking your blood pressure at drug stores is a reasonable initial step, it is important to get a formal blood pressure screening at a doctor’s office. To get accurate blood pressure readings the machine must be calibrated frequently and, most importantly, be the right size for your arm. Cuffs that are too small or too large can give you an erroneous reading. The goal for a normal blood pressure is less than 140/90. If either the top or the bottom number are too high, this could signal Hypertension.
- Cholesterol (Lipids) – High cholesterol seldom presents symptoms, although some people can develop cholesterol deposits in the skin, especially around the eyes, if they have extremely high cholesterol levels. Fasting lipid panels are recommend for all adults aged 40 and older with use of a risk calculator to help determine who should be treated if high cholesterol is detected. Those with a 10-year risk of heart disease or stroke greater than 10% should discuss treatment with a cholesterol-lowering medication. It is important to note this calculator is only intended for adults without a known history of cardiovascular disease.
- Diabetes – Remember, one third of Americans with diabetes do not know they have the disease. Early in the course of the illness, high blood sugar may not have a lot of symptoms except frequent urination or increased appetite and thirst. Screening should be started early for those at risk, but annual screening for adults older than 45 is recommended with a fasting blood sugar or Hemoglobin A1C. A normal fasting blood sugar should be less than 100. People with diabetes are defined as fasting blood sugars greater than 126 or a Hemoglobin A1C greater than 6.5%. Less commonly, a random non-fasting blood sugar over 200 can also indicate diabetes. What does that mean for people with numbers between 100 and 126? They are considered pre-diabetic or sometimes also called metabolic syndrome/insulin resistant. These people can usually improve their blood sugar by weight loss and exercise changes, ultimately avoiding or delaying the development of full blown diabetes.
Various other labs are sometimes included as a part of “routine” screening to include complete blood count (CBC), chemistry panel which measures blood electrolytes, and urinalysis which provides information about kidney function. However, evidence does not support the use of these tests in asymptomatic adults.
When it comes to cancer screening it is always important to review your family history. If your parents, siblings, or children have a history of cancer, you should be screened earlier than a person at average risk – usually about 10 years prior to the age of cancer onset of your family member. The most common cancers are lung, colon, breast, prostate, and female genital cancers.
Again, just like lab test screenings, there are competing recommendations regarding cancer screenings. The United States Preventive Services Task Force is an independent volunteer panel of experts which provides general guidance for people at average risk, and there recommendations have been proven to reduce death due to cancers.
Recommended screening for everyone includes:
- Colon cancer – Screening should begin at age 50 for average risk people though most recent surveys show that only 62% of adults participate in screening. There are multiple options available for screening including traditional colonoscopy every 10 years, flexible sigmoidoscopy every 5 years with three fecal cards that test for blood in the stool annually, or fecal DNA tests (like Cologuard) every three years. Positive results found on flexible sigmoidoscopy, stool cards, or stool DNA tests require a full colonoscopy to allow for biopsy, which guides management. One note about Cologuard is that its success in picking up cancer is 92% compared to 95% on colonoscopy; but, unfortunately, it only detects 42% of pre-cancerous colon polyps making it less effective than colonoscopy.
- Breast cancer – It is estimated that 1 in 8 women will have breast cancer in her lifetime, but recommendations for screening are somewhat controversial. The best evidence supports biannual screening beginning at age 50. Many patients choose to start screening at age 40; however, this increases the risk for false positive results. It is an individual decision that women should discuss with their doctors.
- Cervical cancer – Screening is recommended to begin at age 21. While most women are familiar with annual “pap smears,” guidelines for cervical cancer screening have been revolutionized as understanding that the disease is caused by infection with the Human Papilloma Virus (HPV, most commonly types 16 and 18) has been understood and technology has advanced to allow for direct testing for the virus infection. For women ages 21-29, use of the standard pap smear every 3 years is still the standard. This is due to the fact that many young women who get infected with HPV are able to clear the infection on their own without intervention. Beginning at age 30, women can add HPV viral testing (test taken at the time of pap smear), extending the screening interval to 5 years or, alternately, choose HPV testing alone every 5 years.
Unfortunately, both prostate and lung cancer screening have been problematic. Screening for these cancers do identify more patients with early cancer, but also results in many false positives, leaving patients with the need for biopsies and surveillance. Blood test screening with Prostate Specific Antigen (PSA) for prostate cancer should be an individual decision after discussion with your physician starting at age 55.
Likewise, lung cancer screening with a low-dose CT scan (CAT) can be considered in heavy smokers or former smokers who have quit tobacco within the last 15 years beginning at age 55. Careful discussion with your physician is also important in this case.
All of these recommendations can seem daunting, which is why you should schedule annual check-ups with your primary care physician.
To ease this stress of paying for primary care visits, Medi-Share is launching new program levels in the fall that will allow for the choice of Direct Primary Care and/or Annual Physicals with Limited Labs. Any member on the $12,000 AHP level who chooses a DPC Provider arrangement can have their DPC membership fees applied to their AHP (up to $1,800). This will be available in December 2020.
Annual Physicals with Limited Labs will be available on all Medi-Share 3.0 program levels, which goes live on September 1, 2020. Any NEW member as of 9/1 and any current member who switches on or after 9/1, will qualify. As always, Medi-Share members also have access to free or reduced cost mammograms, as well as discounts on lab work.
At the end of the day, you are your number one advocate when it comes to your health. In order to be good stewards of our health, we ought to take care to eat the right things, exercise regularly, and make routine care a priority.