By Barbara Stepko, AARP, May 28, 2021
It's time to book the doctor's appointments and health screenings you skipped during the pandemic.
It’s official: Half of Americans are fully vaccinated against COVID-19, according to the Centers for Disease Control and Prevention (CDC). Now a new health care hurdle: Reassuring people that it’s safe to return for recommended screenings, checkups and exams. Concerned about contracting COVID-19, people have been delaying necessary doctor visits.
According to an analysis by the Epic Health Research Network (EHRN), an electronic medical records system, screening appointments for cancers of the cervix, colon and breast were down between 86 and 94 percent in March, compared with average volumes in the three years before the first COVID-19 case was confirmed in the U.S.
Another study, led by researchers at Johns Hopkins Bloomberg School of Public Health, found that the number of primary care consultations — where cholesterol and blood pressure assessments usually take place — plummeted by more than 21 percent during the second quarter of 2020, compared with the same time period in 2018 and 2019.
Equally concerning: A Cleveland Clinic survey found that 65 percent of heart disease patients have put off health screenings or checkups, with many turning “to the internet or friends and family instead of a health care provider for informal medical guidance, even though 53 percent of heart disease patients reported feeling a troubling symptom, such as shortness of breath.”
Doctors worry that delays in screening could result in patients being diagnosed with more advanced, harder-to-treat health problems down the road. The National Cancer Institute predicts 10,000 excess deaths from breast and colorectal cancers alone over the next decade in the U.S. And underserved communities, already disproportionately affected by COVID-19, will be hit particularly hard.
Now that we’re seeing light at the end of the tunnel, let us help you get back on track.
When you need it: The U.S. Preventive Services Task Force this month issued new recommendations that average-risk colorectal cancer screening should begin at age 45, not 50.
Part of the reason for the change is that while death rates have been decreasing year by year, numbers have been increasing among people younger than 50. Health care experts don’t know the exact reason, though some suspect poor eating habits — including diets high in red meat and processed foods — may be a cause. “Now the universal message is, start [having the conversation about] screenings at age 45 and continue every 10 years thereafter if the results are normal,” says Aasma Shaukat, M.D., a colorectal cancer prevention expert and spokesperson for the American Gastroenterological Association. Those at higher-than-normal risk — say, because first-degree relatives have had colon cancer or you’re a smoker — should have the procedure every three to five years. People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through the age of 75. For people age 76 through 85, the decision to be screened should be based on a person’s preferences, life expectancy, overall health and prior screening history. Screening is not recommended for people over 85.
Why you need it: Though colon cancer is the most preventable cancer (caught early, the five-year survival rate is about 90 percent), it is the third most commonly diagnosed cancer and the third leading cause of cancer death in the U.S. Why? Only about 66 percent of all adults over the age of 50 are up to date on colorectal screening, according to the American Cancer Society. In 2020, there were an estimated 104,610 new cases of colon cancer and 43,340 cases of rectal cancer diagnosed in the U.S., and almost 90 percent of those cases were found in adults age 50 and older.
At-home stool sample tests, such as fecal immunochemical test (FIT) or the DNA test (Cologuard), are very effective if done regularly (either once a year, or, in the case of Cologuard, every three years). But the gold standard is still a colonoscopy. As experts point out, it’s a one-stop test: It not only discovers precancerous polyps — it removes them before they can cause trouble down the road. (It takes about 10 years for polyps to turn into cancer.) Also, if anything suspicious is found with a stool test, a follow-up colonoscopy will be needed.
Need a nudge? For many patients, the bowel prep before the procedure — which required downing jugs of an awful liquid laxative — is the hardest part of a colonoscopy. But, notes Shaukat, there are now preparations that are half the volume of the regular prep (about a gallon of liquid, or about two liters). “You can also do things to make the prep more palatable,” she says. “Since a lot of these preps have a salty aftertaste, add flavored Crystal Light to the mixture and sip it on ice, with a straw.”
When you need it: Breast cancer screening guidelines vary among medical boards. To keep it simple, many doctors recommend that women who are not at higher-than-average risk have annual screening mammograms beginning at age 40. The American Cancer Society (ACS) recommends annual mammograms for women age 45 to 54, with women age 55 and older continuing annual mammograms or switching to a mammogram every two years. (Breast cancer diagnosed in women over 55, especially those who have transitioned through menopause, is more likely to be slower-growing and less aggressive.) Women at high risk because of a family history of the disease or other factors, such as dense breasts or the presence of a BRCA gene mutation, likely need more frequent screenings. Mark Pearlman, M.D., who is one of the coauthors of the American College of Obstetricians and Gynecologists Practice Bulletin on Breast Cancer Risk Assessment and Screening in Average-Risk Women, says “women who have very dense breasts have about a four-fold risk of developing breast cancer in their lifetime, compared to women who have very fatty breasts.”
The ACS also suggests that women continue to undergo screening mammograms as long as they are in good health and are expected to live at least 10 more years.
Be sure to let your mammography technologist know if you’ve gotten the COVID-19 vaccine — along with how many doses you’ve gotten and which arm it was administered in. Why: In some women, breast cancer appears as swollen lymph nodes under one arm. Some patients have reported developing swollen lymph nodes after a COVID-19 vaccination. This finding could be mistaken for a potential breast cancer diagnosis.
Why you need it: Eighty percent of all breast cancers occurs in women 45 and older. (In women age 40 to 50, there is a 1 in 68 risk of developing breast cancer. From age 50 to 60, that risk increases to 1 in 42. In the age group 60 to 70, the risk is 1 in 28.) However, since 1990, breast cancer death rates have fallen between 1.8 percent and 3.4 percent per year — in large part because mammograms are good at finding breast cancer, especially in women age 50 and older, correctly identifying cancer 87 percent of the time.
Most medical organizations don’t recommend routine breast self-exams as a part of breast cancer screening. According to the Mayo Clinic, “that’s because breast self-exams haven’t been shown to be effective in detecting cancer or improving survival for women who have breast cancer.” Getting an annual mammogram is the best way to catch the disease at an early stage, when it’s less likely to have spread.
Need a nudge? It’s estimated that up to 50 percent of women skip mammograms because the procedure can be painful. Popping a Tylenol or Advil about an hour before your mammogram can help, says Pearlman. You can also try this breathing trick: Before the technician compresses your breast between the imaging plates, take a deep breath, then slowly exhale as the compression begins. (Breathing out helps your muscles relax.) Just be sure to hold your breath while the X-ray is being taken to avoid (yikes) retakes.
3. Dental Exam
When you need it: The American Dental Association (ADA) recommends getting a professional cleaning every six months to do away with cavity-causing plaque and tartar buildup that you won’t be able to get rid of with brushing alone. The ADA also suggests getting a set of X-rays taken every six to 12 months for adults with an increased risk of cavities; those with no decay or increased risk may be able to extend it to every two to three years.
Why you need it: Tooth decay can be stopped in its tracks (or even reversed) if detected early enough. Some cavities stay small for years, while others get large within months, requiring treatment. If not caught in time, a cavity will eventually work its way through the dentin layer of your tooth, just below the enamel. If your tooth remains untreated, decay may reach the nerve, and a cavity that could have been treated with a filling will require a more involved (and painful) procedure, such as root canal and crown — or possibly an extraction and dental implant.
Older adults are particularly vulnerable. “Our saliva helps neutralize the acid in our mouths,” says John Cross, a dentist at Aesthetic Dental Group in Martinsville, New Jersey. “But as we age, our salivary glands become less active, which can lead to dry mouth, and make patients more susceptible to decay. Certain medications that older adults may be taking can also cause lead to dry mouth.” And those fillings a lot of us have accumulated over the years may weaken and fracture along the edges, allowing bacteria to seep into the tiny crevices, further leading to decay.
Making matters worse, dentists have seen a rise in stress-related oral health conditions in patients since the COVID-19 pandemic began, according to data from the ADA Health Policy Institute. Fifty nine percent of dentists who were polled reported increases in bruxism (more commonly known as tooth grinding) and 53 percent in chipped and cracked teeth.
Need a nudge? Not only will your teeth suffer — so will your bank account. Check it out: a single filling, on average, will set you back between $50 and $500 (depending on what the filling is composed of), compared to a root canal and crown (about $2,500 to $3,000) or a dental implant (average price: $3,000 to $5,000).
4. Pap Smear
When you need it: The ACS recommends women age 20 to 65 get a Pap test every three years — or a human papillomavirus (HPV) test (or combination of a Pap and HPV test) every five years, if both tests come back negative the first time you take them. Those with a higher risk of cancer may need to be tested more often. Ultimately, your doctor can recommend what’s best for you. Women over age 65 can stop getting screened if they’ve had at least three consecutive negative Pap tests or two negative HPV tests within the previous 10 years. Women who’ve had a hysterectomy and no history of cervical cancer do not need to be screened.
Why you need it: Although your risk of cervical cancer decreases with age, your need for routine Pap tests doesn’t necessarily stop with menopause. One in 125 women will get cervical cancer — and more than 20 percent of cases are found in women over 65. However, these cancers rarely occur in women who are vigilant about getting tested. That’s because the procedure, which involves collecting a sampling of cervical cells from the cervix, can discover precancerous changes to prevent cancer from developing. The HPV test, another screening tool, detects the presence of HPV, the virus that causes cervical cancer.
Need a nudge? Beyond the Pap test, a pelvic exam can assess other parts of your gynecological health. Your ob-gyn will look for signs of ovarian cysts or early-stage endometrial cancer — and can also address menopause-related issues such as hot flashes or vagial dryness, as well as issues like low libido, or UTIs.
5. Skin Cancer Screening
When you need it: The Skin Cancer Foundation recommends yearly professional skin exams, along with monthly skin self-examinations. The greater your risk of skin cancer, the more important regular skin checks are. Older adults are particularly vulnerable since a lifetime of sun exposure can significantly up your odds. Armed with a dermatoscope, a combination magnifying glass-and-flashlight, a dermatologist will do a head-to-toe exam, taking an extra-close look at any suspicious spots that are hard to see with the naked eye, and, if necessary, removing a piece of tissue to be biopsied.
Why you need it: Skin cancer is the most common cancer in the U.S., affecting 1 in 5 Americans by age 70. Experts estimate that 450,000 new cases are diagnosed each year — 10,000 of which are melanomas, the most aggressive form of skin cancer. (Basal and squamous cell cancers, more common forms of skin cancer, are less deadly.) Melanoma can appear suddenly and spread quickly, so early detection is critical. In fact, it can become life-threatening in as little as six weeks. The estimated five-year survival rate for patients whose melanoma is detected early is about 99 percent; the survival rate drops to 66 percent when the disease reaches the lymph nodes. For that reason, it is crucial that you stay vigilant and contact your doctor if you see any unusual changes in your skin. (Look for lesions that are asymmetrical, have irregular or ragged borders, are multicolored, are larger than a pencil eraser in diameter, or that change over time.)
Need a nudge? Yes, at-home skin exams are important: About 44 percent of melanomas are discovered by doing self-exams. But a professional once-over can add an extra layer of protection. While skin cancer usually appears on parts of the body exposed to UV light, melanoma can appear in places that haven’t been exposed to the sun. A doctor will be able to suss out hard-to-see spots, like your back, scalp, buttocks, and behind your ears.
6. Cholesterol test
When you need it: The American Heart Association (AHA) recommends that adults 20 or older have their cholesterol checked every four to six years, provided their risk remains low. People with cardiovascular disease, for instance, may need their cholesterol assessed more often. Those taking cholesterol-lowering statins also need follow-up testing of their lipid levels to monitor their response to the medication, typically a month or two after starting the drug.
Usually ordered by a primary care doctor during routine physical exams, the cholesterol test is a blood test that measures several different types of lipids, or fats, in your blood — among them, total cholesterol (the total amount of cholesterol in your blood), low-density lipoprotein (LDL) or “bad” cholesterol, and high-density lipoprotein (HDL) or “good” cholesterol, which helps remove LDL cholesterol from your blood.
Why you need it: At least 48 percent of U.S. adults have some form of cardiovascular disease, according to the AHA, and heart disease is the leading cause of death in both men and women. For men, the risk starts to climb at about age 45, when 1 out of every 100 men develop signs of heart disease; by age 55, the risk has doubled, and continues to increase. For women, the risk also goes up with age, particularly after menopause.
Advances in home-monitoring systems, such as watches that measure heart rate and cholesterol testing at pharmacies, make it easier to track the health of your ticker. But although these assessments are important tools for detecting elevated digits — and potential heart problems down the road — in-person testing is still important. For one thing, your numbers don’t tell the whole story: Your doctor will also want to take your age, gender, family history, and risk factors (such as smoking and diabetes) into consideration when determining possible treatments.
Need a nudge? A Cleveland Clinic survey from earlier this year found that 42 percent of Americans put on weight during the pandemic (25 percent gained more than 20 pounds) and three-quarters reported feeling more stressed because of COVID-19. What that means, notes doctors: At a time when fewer of us are being checked out for heart disease or stroke, many of us may be at greater risk for those very conditions.
7. Eye exam
When you need it: The American Academy of Ophthalmology (AAO) recommends that adults get a complete eye exam at age 40, when changes in vision usually start to appear. Those who have an eye disorder or risk factor should consult with their eye doctor about how often to get checked. Those who’ve undergone cataract surgery, for example, need regular checkups to monitor the health of your eyes. The American Diabetes Association recommends that adults with diabetes have a dilated eye exam every year, unless instructed otherwise. Also, if you wear eyeglasses or contact lenses, you should visit your eye doctor for a checkup every one to two years to make sure your vision hasn’t changed before purchasing a new pair. Those 65 and older should schedule an exam every year or two.
During a routine exam, your eye doctor will usually check your eyesight and peripheral vision, then whip out a lighted handheld microscope (or slit lamp) to inspect the outer eye and structures at the front of the eye (such as the cornea and lens) for signs of a cataract. For a look further inside, eye drops will be used to dilate your pupils, making it easier to examine the back of the retina and optic nerve.
Why you need it: According to the CDC, the leading causes of blindness and low vision in the U.S. are age-related eye diseases, such as cataracts, diabetic retinopathy, glaucoma and macular degeneration. It is important to diagnose them early when they are treatable or, in some cases, curable.
It’s estimated that by age 65 over 90 percent of people have a cataract, and half of those between the ages of 75 and 85 have lost some vision due to a cataract, according to UCLA Health. The prevalence of diabetic retinopathy has increased significantly over the past two decades, due to an increase in the disease. Glaucoma, which occurs when fluid pressure builds inside the eye, potentially damaging the optic nerve, is particularly concerning. There are often no early symptoms, which is why 50 percent of people with glaucoma don’t know they have the disease. By age 40 about 1 in 200 have glaucoma, increasing to 1 in 8 at age 80.
Need a nudge? Annual appointments with your ophthalmologist or optometrist are critical for maintaining your vision, sure, but their benefits go well beyond keep your eyes in working order: A close inspection of the inner workings of your orbs can reveal a host of systemic disorders — sometimes before there are symptoms anywhere else. One example: heart disease. Eye exams can detect a number of cardiovascular conditions, such as clogged arteries, says Brian Stagg, M.D., an ophthalmologist and retina specialist at the University of Utah’s John A. Moran Eye Center. “Sometimes we can see little plaques deposits inside the eye that have broken away from buildup on the carotid artery, which supplies most of the blood supply to the brain.”
8. Hearing Test
When you need it: Adults over the age of 50 should get their hearing checked every three years, according to the American Speech-Language-Hearing Association (ASHA). Those who wear hearing aids may want to be tested more often since adjustments to the device may be necessary over time. Tests commonly performed by an audiologist: pure tone audiometry (a series of sounds, at various pitches and volumes, sent through headphones, to determine hearing loss) and speech testing (which gauges your ability to understand speech in noisy settings).
Why you need it: According to the National Institute on Aging (NIA), approximately 1 in 3 people age 65 to 74 have hearing loss. But presbycusis (age-related hearing loss) sneaks up gradually, which means many may not realize there’s a problem. Indeed, in a 2017 study published in the journal JAMA, which included 2,613 people age 60 or older, researchers found that 42 percent of those who reported no hearing trouble actually had mild hearing loss when tested.
Why you need it Research from the Johns Hopkins School of Medicine and the NIA found that even mild hearing loss can increase your risk of taking a tumble by three times, with the risk increasing by 140 percent for every additional 10 decibels of hearing loss. Why? Balance requires brain power, and those with hearing loss use more of that gray matter to hear, which means there are fewer mental resources left to help you stay upright. What’s more, hearing issues can wreak havoc on spatial awareness (translation: where our bodies are positioned in relation to the people and objects around them).