Landmark medical tests loom large as we age

Published on Thursday, February 1, 2024

By: Gary Petus, gpettus@umc.edu

Taking tests may not be your favorite thing to do – but what if someone gave you the answers?

That’s the beauty of medical tests and screenings; even more beautiful: They may save your health, or life, especially as you grow older.

Although standards can vary, certain checks, exams screenings and even vaccines are advised for people in their prime, often by age 40-45, and beyond.

“One of the biggest is colon cancer screenings,” said Dr. Jarrett Morgan, assistant professor of medicine at the University of Mississippi Medical Center.

“The minimum age was recently dropped to 45. But if you have a first-degree relative with colon cancer, the testing age should be 10 years earlier than the age of the family member when they were first diagnosed. Or age 45, whichever comes first.”

Morgan, who is an internal medicine/pediatrics specialist, suggests one of two types of colon cancer screenings: either a colonoscopy or the at-home Cologuard test, which involves stool testing.

“Even after the stool testing, depending on the results, you may need a colonoscopy as well,” Morgan said. “By age 75, it’s no longer done, because colon cancer is so slow-growing and, if you haven’t had it by then, you probably won’t.”

It’s also important for women to be screened for colon cancer, said Dr. Elizabeth Lutz, associate professor of obstetrics and gynecology at UMMC.

“Ob-gyns are primary care doctors. We make referrals for colonoscopies. We also do blood work to screen for cholesterol and diabetes when it’s age-appropriate and when obesity is present and family history is relevant.

“Ob-gyns screen for depression during annual visits, as well as for domestic violence, along with doing blood pressure checks and pelvic and breast exams at recommended ages.”

When it comes to potentially life-saving mammograms, Lutz follows the lead of the American College of Obstetricians and Gynecologists: “Routine mammograms every year starting at age 40,” she said.

“That’s for a screening mammogram, meaning nothing is going on as far as it’s known. But, if something concerning is found, or if more information is needed, the radiologist performing the test will bring you back for a diagnostic mammogram, which includes additional X-ray images.

“I do think it’s important to note that, if your internal medicine physician or another non-ob-gyn physician has different recommendations, that’s OK. They’re going by their own professional organization’s guidelines.”

Other tests, screenings and more for women:

• Pap test: “We refer to it now as cervical cancer screening,” Lutz said, “and it should be done every three years from ages 21 to 29; then, at ages 30 to 65, every three to five years. There are two tests: the traditional PAP smear and a screening for HPV [Human papillomavirus]. Which of those tests you get depends on your age, and your doctor will help you with that.”
• Screenings for sexually transmitted diseases during pregnancy: “We are now focusing in particular on syphilis screenings because of the high rates of the disease in Mississippi,” Lutz said. “STD’s are screened multiple times during pregnancy.”
• Hepatitis B testing for pregnant women: “That has been a routine screening for a long time,” Lutz said.
• Vaccines: “There are vaccines for women during pregnancy,” Lutz said, “such as the flu and COVID vaccines which are very safe in pregnancy and can be administered if you’re getting ready for pregnancy. If you’re thinking about getting pregnant, the varicella , or chicken pox, vaccine is recommended beforehand. And we encourage everyone to get the HPV vaccine, including men and women up to age 45. It can prevent certain cancers, including cervical cancer. It’s offered mostly for teens, beginning around age 11 or 12, up to age 45.”

Physicians encourage everyone to get certain other vaccines as they age.

“If you’re age 50 or above, there’s the shingles vaccine,” Morgan said.  

“The pneumonia vaccine is for people age 65 and above. But, if you have certain conditions or a cochlear implant, it’s also for people between 19 and 64.

“And there’s the flu shot: an annual vaccine after the age of six months.”

Of course, men do have a concern particular to them. “You should start getting tested for prostate cancer by age 50,” Morgan said, “but that is not a hard-and-fast rule.

“Guidelines are based on concerns you express in conversations with your doctor – for instance, if there is a family history of the disease, or unexplained symptoms such as low back pain or trouble with urination.

“You can get either get a blood test or a prostate exam. Most patients lean toward blood testing.”

Even if you’re only in your twenties, or younger, routine medical tests are a good idea, Morgan said. “That’s true for diabetes and for cholesterol issues – they can set people up for heart disease down the line.

“And if you have certain other conditions such as high blood pressure, you will need routine screenings to monitor kidney function.”

Blood pressure-wise, be ever-vigilant, Morgan said. “If you have certain symptoms such as frequent lightheadedness, severe headaches or dizziness, for instance, you need to check your blood pressure frequently.

“Outside of those symptoms, it can be done monthly at home. Or go to the store to get it checked, or use a family member’s cuff.

“If you don’t have high blood pressure, ideally you should at least get an annual screening with your regular doctor. If you’ve had a diagnosis of high blood pressure, check it at least once a week.

“The maximum reading should be 130 over 80. Technically, the goal is 120 over 80 or below. Above that is considered elevated blood pressure, but not hypertension. In which case, you should still keep a close watch on it.”

Let’s not forget the kids, Morgan said. “This question comes up quite a bit: Do children need routine blood tests? Usually, the answer is no. But we suggest blood lead exposure testing and hemoglobin screenings starting by age 1. 

“For teens, we don’t usually do blood tests, but if they are obese or have high blood pressure or diabetes, usually we do a lipid [cholesterol} screening around early adolescence.

“Getting a cholesterol profile, for most people, should be done annually – at the latest by age 21 for those who haven’t had a test before.

“It’s common during a doctor’s visit to get several tests and checks: blood pressure, cholesterol, A1C [blood sugar], kidney function and so forth – all that can be done at the same time.”

The list goes on. When it comes to regular checkups or checks, don’t forget your eyes, skin, teeth — and, significantly, your weight.

To ease the journey toward a healthy Body Mass Index (BMI), getting 30 to 45 minutes of physical activity about four times per week is the standard for all adults, Morgan said.

“Also, add higher amounts of fresh fruits and vegetables to your diet. Avoid fried, fatty foods, and limit intake of red meat and sugary, processed foods.” That may be the hardest test of all.

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