Your guide to preventive health care

You are responsible, in large part, for managing your own preventive health care. It is the most important investment of your time and money. Yet, most Filipinos do not receive all the important preventive services they need — that is, screening tests for early detection of disease, immunizations, and education about healthy habits. Why not?

• Many Filipinos are not aware of these various preventive care services, and even if they do, they may not be able to afford them.

• A great number of Filipinos have no health insurance to pay for tests, vaccines, and other medical care.

• Many people do not get continuity of care. They may have to switch doctors as they switch from one insurer, company, or HMO, making it hard to keep track of what services they’ve had.

• Many miss out on preventive services because they do not go to their doctors for years, do not go for the tests their doctors recommend, or are confused about which tests to ask for. They may not know that prevention is the most economical form of medicine — well worth budgeting for, even if insurance doesn’t cover it.

• With tests for some cancers, there’s the embarrassment factor. Some people may dread being tested for colon, prostate, cervical or breast cancer and they are relieved if the doctors fail to mention it. Some people would simply rather not know.

• Both patients and doctors may be confused by contradictory recommendations. What should a medical checkup consist of? How often should a woman have a Pap smear?

• Doctors may fail to ask patients about smoking and drinking, not to mention exercise habits, diet, sleep, and emotional problems.

How About Annual Physicals?

In the old days, people were advised to undergo a “complete physical exam” periodically. That standardized one-size-fits-all exam for seemingly healthy people has now largely been discarded, since it doesn’t pay off in terms of better health and longer life.

Starting in the 1980s, an independent committee of US experts, known as the Preventive Services Task Force, evaluated the benefits and drawbacks of common screening tests and came up with evidence-based recommendations. The Task Force continues to update and re-evaluate its advice. Thanks largely to this work, some tests that used to be done routinely, such as chest x-rays, electrocardiogram (EKGs), urine tests, and complete blood counts, are now reserved for people with symptoms or risk factors. In other words, they are not routine screening tests for healthy people (and as such are not covered in this article). A 2007 article found that “periodic health evaluations” could be beneficial because they allow doctors and patients to evaluate risk factors, and undertake the preventive services now proven to be beneficial and tailored to the specific patient. For this reason, it’s a good idea to see your doctor every year or two.

Vaccinations: A Checklist For Adults

• Influenza: Those age 50 and over; younger people with certain chronic disorders, such as asthma, lung or heart disease, diabetes, cancer, or HIV infection; women in second or third trimester of pregnancy; and health-care workers. Young, healthy adults can also benefit from the shot.

• Pneumococcal (pneumonia): Those 65 and over; younger people with certain chronic disorders (same as for influenza).

• Tetanus: Everyone, every 10 years for life.

• Chickenpox: Anyone who has never had chickenpox.

• Shingles: People 60 and over.

• Rubella (German measles): Women of child-bearing age, but not during pregnancy.

• HPV (human papilloma virus), to prevent cervical cancer: women 26 and younger.

• Hepatitis A: Travelers to most parts of Latin America, Africa, Asia, or other areas where hepatitis A is common; those with chronic liver disease; anyone who wants to be protected.

• Hepatitis B: Sexually active gay men; heterosexuals with multiple partners; health-care workers; frequent travelers to high-risk areas; partners of infected people; drug users who share needles; certain other groups. There’s a combined vaccine for hepatitis A and B.

Preventive Services For Healthy Adults

These are the major screening tests (that is, routine tests for people without symptoms). Our advice is based largely on the recommendations of the US Preventive Services Task Force. Infants, children, and pregnant women need other kinds of preventive care not described here.

The discussion on this list follows the following sequence: The service, who needs it, how often, and other comments.

• Blood pressure measurement (to detect hypertension): All adults. Once every two years for those with normal blood pressure. More frequently for those over 60 and anyone with readings over 120/80.

• Cholesterol measurement (including HDL, LDL, and triglycerides): All adults. Once every five years. More often if any results are abnormal or there are other risk factors. Those at high risk for heart disease need medical advice about lifestyle changes and possibly drug therapy.

• Pap test (for early detection of cervical cancer): All women, starting within three years of becoming sexually active, no later than age 21. Annually until age 30. After 30, if three consecutive years are normal, once every two to three years, unless a woman smokes or has multiple sex partners or other risk factors. Women 70 and over who have had normal recent results can stop being screened, unless they are at high risk. Women who have had their cervix removed do not need to be tested.

• Breast cancer screening (mammography): All women 50 and over; those at higher risk need to start earlier. Annually. Certain women at high risks should also have an annual MRI scan starting at age 30. Clinical breast exams are important, too — consult your doctor.

• Colorectal cancer screening (fecal occult blood test, sigmoidoscopy, colonoscopy): Everyone over 50 and over; earlier for those at high risk. Occult blood test annually plus sigmoidoscopy every five years. Or preferably, colonoscopy every 10 years. X-ray with barium enema or CT (“virtual”) colonoscopy may also be done. Those with abnormal results need more frequent testing.

• Prostate cancer screening (prostate specific antigen or PSA test; digital rectal exam or DRE: Men with family history of prostate cancer, start testing at age 40. For others, DRE and possibly PSA, starting at age 50. DRE to be done annually; PSA on professional advice. Routine PSA screening for all men remains controversial. Discuss with your doctor.

• Diabetes screening (fasting blood glucose test): Everyone 45 and older; earlier for those at high risk. Every two to three years. Blacks, Hispanics, Asians, obese people, and those with strong family history need more frequent screening, starting at age 30.

• Thyroid disease screening: Women 50 and over; those with high cholesterol, family history, or other risk factors. Frequency depends on professional advice. Routine screening remains controversial. Talk with your doctor about risk factors.

• Bone density testing: Women 65 and over; younger women at high risk for bone loss; men at high risk. Frequency depends on professional advice. Risk factors include being small-boned, sedentary, a heavy drinker, or a smoker, or having a personal or family history of osteoporosis.

• Chlamydia screening: Sexually active women 24 and younger; older women at increased risk (such as multiple partners). Annually, or more often. Men who have unprotected sex should also be tested.

• Glaucoma screening: people at high risk; those over 65, very nearsighted, or diabetic; those with family history of glaucoma. Frequency depends on professional advice of eye specialist. Benefits of routine screening remain unproven. Still, most eye specialists advise testing all adults 40 and over every three to five years.

• Abdominal aortic aneurysm (ultrasound): men 65 to 75 who ever smoked (at least 100 cigarettes in his lifetime). Once only. Some experts think women 65 to 75 who smoked, and anyone over 75 who smoked, should also be tested.

• Dental checkup: All adults. Every six months, or on professional advice. Should include cleaning and exam for oral cancer.

Bottom line: Medical experts may disagree about a lot of things, but they all agree that good health depends on improved access to and increased use of preventive services. –Tyrone M. Reyes, M.D. (The Philippine Star)