Preventive screenings help us stay one step ahead of some of the deadliest diseases, because when it comes to your health, the best defense is a good offense
WRITTEN BY Kinsey Gidick
PHOTOGRAPH BY Scott Henderson
When performed in patients who don’t exhibit symptoms but do have certain risk factors (including age), preventive screenings allow doctors to identify diseases when they are still potentially curable. So why do many people ignore early screening options? According to the Centers for Disease Control, if everyone in the United States received the recommended clinical preventive care, more than 100,000 lives could be saved each year. And yet, “only eight percent of U.S. adults ages 35 and older had received all of the high-priority, appropriate clinical preventive services recommended for them,” reported the journal Health Affairs in 2018.
This disconnect, Dr. Forren says, boils down to a variety of factors. “By definition, a patient doesn’t have symptoms at the time of a preventive screening.” Because a patient isn’t exhibiting any pain or abnormal issues, they may ignore screening recommendations or fail to see a doctor at all. Typically, age-appropriate preventive screenings get discussed at a patient’s annual physical, but if that person doesn’t see their doctor regularly (and only one in five American adults do), easy-to-detect diseases can get overlooked.
The COVID-19 pandemic has also caused many who would have been screened for diseases this past year to miss their routine wellness checks. Cervical cancer screenings, for example, declined significantly in the face of lockdowns, quarantines and physical distancing, according to the journal Cancer. The Epic Health Research Network released findings in May 2020 that indicated an abrupt drop—between 86 and 94 percent—in preventive cancer screenings performed nationwide compared with equivalent weeks from 2017 to 2019. A February 2021 survey from TIME-Harris Poll showed that more than a quarter of respondents had put off their annual physicals by at least three months, a dangerous downward trend.
Dr. Forren points out that routine visits with a primary care doctor should be considered an essential part of wellness. As a doctor of osteopathic medicine, she strongly advocates annual physicals that include preventive screenings. Depending on the disease, most of these tests are relatively straightforward, covered by insurance and highly effective. You’re likely already familiar with many of these simple screenings, which include mammograms, colonoscopies and blood tests for cholesterol and diabetes. Even weight checks are considered a preventive service. “The most common tests check for the issues that kill most Americans. Number one is atherosclerotic vascular disease—the good, old-fashioned heart attack.” As it turns out, doctors can detect increased risk for heart disease with a simple blood pressure test that reveals hypertension.
When to be screened is generally determined by age, although a doctor may adjust that time line based on a patient’s health and recent medical reports. For instance, the U.S. Preventive Services Task Force recently shifted its age recommendation for colorectal cancer from 50 to 45 due to a rise in cases of colon cancer in younger adults. “On the spectrum of cancers, breast, colon, prostate and lung cancer are some of the deadliest,” says Dr. Forren. “Luckily, we have pretty good screening tests for most of them.” Mammograms are used to detect breast cancer in women beginning at age 40. A prostate-specific antigen (PSA) test, performed via a blood draw, targets prostate cancer in men aged 50 (or younger for those with elevated risk factors).
As for that life-saving lung cancer screening? It’s a low-dose CT scan of the chest. “This is for patients between ages 57 and 77 who have smoked at least 30 pack years in their lifetime—in other words, a pack a day for 30 years or two packs a day for 15 years,” says the doctor. The screening, she notes, can be performed on a patient who hasn’t smoked in 15 years and still accurately detect possible lung cancer.
The luxury of modern medicine is deceptive. Preventive screenings are a fairly recent development, having existed only for about 80 years. The 19th century saw the rise of disease prevention with advancements like the X-ray and Louis Pasteur’s discovery of microbes, but the chance to identify and heal diseases in their preclinical (read: curable) stages didn’t come about until the 20th century. “The convergence of cheap and non-invasive tests, handy galenic forms of treatment, a theory of screening, to which we add the access to care, made the development of mass screening campaigns possible,” says a 2004 article in the Postgraduate Medical Journal. After World War II, the U.S. Army bolstered efforts to control syphilis infections among troops thanks to the discovery of quick and inexpensive tests and the introduction of penicillin. Around the same time, the United States Public Health Service began rolling out large-scale community diabetes screenings using urine and blood glucose tests, and Dr. Georgios Papanicolaou successfully developed the first cervical cancer cytological test, known today simply as the “Pap.”
As science unravels even more secrets to better health, screenings will also continue to improve. Take, for example, the dual-energy X-ray absorptiometry (DEXA) scan, which was introduced on a wide scale in 1987 as a way to measure bone mineral density and spot early osteoporosis in seniors.
Of course, whether we get to enjoy the advantages of preventive medicine is really up to every individual patient. While COVID-19 may have delayed a significant number of Americans from getting their recommended preventive screenings, many physicians and patients are playing catch up now that vaccines have made people more comfortable with in-person visits. And Dr. Forren insists that it’s not too late to get tested for any number of diseases.
Finding a general practice doctor whom you trust is the best place to start. “Lean on people you respect and find out who their doctor is. Ask those that you know in the medical field who they would go to for a regular check-up. Also, make sure that the doctor is accredited,” says Dr. Forren. Once you have a doctor in mind, make an appointment.
At your visit, consider discussing more than just what’s ailing you at present. “Mention if you’re interested in specific screenings, particularly if you have a family history of something like breast or colon or ovarian cancer,” continues the doctor. Bottom line: Don’t be afraid to get tested. As Dr. Forren has seen time and again, the patients who seek out preventive testing are often the ones who are able to get treatment and, in the best scenarios, get better faster.