Pittsburgh Post-Gazette: Your guide to getting caught up on preventive care
The pandemic has put a lot of things on hold, including preventive health care. Many people have postponed doctor visits they felt weren’t necessary, whether because of concerns about COVID-19 risk, changes in insurance or financial reasons.
One study from January 2021 estimated that 29% of patients missed a primary care appointment from March to June 2020. Two years into the pandemic, plenty of people still haven’t gotten caught up.
But it’s not all patients’ fault. In the early months of the pandemic, some doctor’s offices and clinics closed their doors temporarily, while hospitals were too backed up with COVID-19 patients to see people for routine screenings and preventive care.
Doctors worry that the lingering effects of pandemic-related disruptions to preventive care could have lasting implications for our health. For example, if some cancers are not caught at an early stage, they can spread and become much more difficult to treat. Experts say now is the time to get caught up on the preventive care you might have missed.
The physical exam
Recommendations vary, but most younger adults should plan to get a physical every two to three years. Older adults and those with underlying health conditions should plan to get a physical around once a year. This exam is a chance for your doctor to check on your overall health.
Dr. Galli said physicals are important for adults of all ages, not just older individuals with known health problems.
“When you sit down with a doctor and they meet you for the first time, we ask your medical history and that also includes family history,” she said. “When we do that, sometimes we realize that certain patients actually need to have screening tests a lot earlier than what is typical in average risk adults.”
Dr. Holly Thomas, an assistant professor of medicine at the University of Pittsburgh and an internist at UPMC, said physicals are a time for patients to talk to their doctors about new or lingering health issues or their health goals.
“For an annual exam, we have more time with the patient than a typical appointment which allows us to do some important things that we otherwise might not be able to do,” said Dr. Thomas. That can include screenings for depression, diabetes and high blood pressure, for instance.
Physicals are usually when your doctor will perform health screenings and recommend additional tests based on your age and risk. The following sections cover many of the common recommended screenings and preventive care for different age groups, but this isn’t meant to be an exhaustive list.
Kids have also missed out on important preventive care throughout the pandemic. Childhood immunization rates fell nationally during 2020 compared to the previous year, and while vaccination rates did rebound some by year’s end, fewer children were up to date on their routine vaccines in fall 2020 compared with the previous year.
A JAMA Pediatrics study published in October 2021 found that 74% of infants turning 7 months in September 2020 were up to date, compared with 81% of infants turning 7 months in September 2019.
“For most of the vaccines, you can get caught up, but there is a time period when these children will be under vaccinated and at risk for vaccine preventable diseases until they do,” said Dr. Malini DeSilva, a pediatrician at the HealthPartneRs Institute in Minnesota and an author on the study.
“For some vaccines, such as the rotavirus vaccine, there are more strict age requirements of when you start this series and when it needs to be completed by, and if you don’t get the vaccines in that time period, you can’t get caught up on them because of those age limits,” she said. “So there is concern about the level of immunity within the younger population.”
The Centers for Disease Control and Prevention’s child and adolescent vaccine schedule can help parents stay on track with their kids’ immunizations. In addition to the usual childhood vaccines, children 5 and older are eligible for the COVID-19 vaccine. Adolescents should get two doses of the HPV vaccine, while teens 15 and older will need three doses of the shot.
During well-child visits, pediatricians will perform developmental screenings and also test your child’s hearing and vision. Your doctor may also screen for obesity, blood pressure, depression and dental health. The American Academy of Pediatrics has a “Periodicity Schedule” for screenings and assessments recommended for each age group.
Adults starting at age 18
The U.S. Preventive Services Task Force (USPSTF) recommends screening for high blood pressure in adults age 18 or older. High blood pressure, or hypertension, affects approximately 45% of the adult U.S. population and is a major contributing risk factor for heart failure, heart attack, stroke and chronic kidney disease. Adults age 18 to 39 years with normal blood pressure who do not have other risk factors should be rescreened every three to five years.
At your regular checkup or wellness visit, your doctor will also screen for depression by talking to you about your mood, sleep, eating habits and other activities.
And if you haven’t received it already, you can get the HPV vaccine through age 26.
Women in their 20s
Starting at age 21, most women should see their gynecologist for a pelvic exam and a Pap smear once every three years. During a pelvic exam, your doctor examines your vulva and internal reproductive organs for redness, soreness and other issues. A Pap smear is a test for cervical cancer screening and involves collecting cells from the cervix. Some people need more frequent screenings based on the findings.
During a Pap smear, your doctor may also screen for sexually transmitted infections, such as chlamydia and gonorrhea, depending on whether you are sexually active.
Men in their 20s
The CDC recommends that men who have sex with men should be tested once a year for HIV, syphilis, chlamydia and gonorrhea. Men who are living with HIV should be tested once a year for hepatitis C. Those with multiple partners may need to be tested more frequently.
Men should start getting screened for high cholesterol in their 20s because they tend to have higher cholesterol levels than women.
Adults in their 30s
Last year, the USPSTF lowered the recommended age for diabetes screening for those who are at higher risk. Adults who are overweight or obese should now start screening for prediabetes and Type 2 diabetes at age 35 instead of the previous recommendation of starting at age 40. The federal health advisory group said the updated recommendation was due to rising rates of obesity and Type 2 diabetes.
Prediabetes means your blood sugar levels are higher than normal but not high enough to be considered Type 2 diabetes yet.
“Oftentimes, people have no signs and symptoms of prediabetes. So the vast majority of people who are in this condition don’t realize that they are. That’s why we screen for it with a blood test,” said Dr. Thomas.
Prediabetes screening is important because people in that range can make changes in their diet and exercise routine to prevent it from turning into full-blown diabetes.
Women in their 30s
Generally, women don’t need to begin screening for high cholesterol until their 30s, unless they have certain risk factors, such as having diabetes, being overweight, previously having high cholesterol or having a family history of heart disease or high cholesterol.
Adults in their 40s
A recent change in screening recommendations means that adults should start getting regular colon cancer screenings at age 45. Previously, the age to begin screening was 50. But medical experts recommended the change last year in response to an alarming rise in colon cancer among younger adults. From 2008 to 2017, deaths of people under age 55 from colon cancer increased 1% every year, even as overall rates of the disease declined.
“Colon cancer screening is probably the most underutilized type of screening but one of the most helpful and important because it can catch precancerous lesions in the colon before they go on to turn into cancer,” said Dr. Thomas. “They’re easy to remove when they’re small and precancerous, but are life-threatening when they spread.”
A colonoscopy isn’t the only option for screening. At-home blood and protein tests can also catch colon cancer. Those with an existing gastrointestinal disease or a family history of colon cancer may need to begin screening earlier than age 45.
Dr. Sterling Ransone, president of the American Academy of Family Physicians, said it’s especially important for men to get screened because incidence rates of colon cancer are about 30% higher in men.
“In my experience, women tend to be far better at coming in and getting routine screenings. From a social standpoint, a lot of women will talk to their friends about things while guys don’t,” he said. “A lot of men really haven’t been socialized like that.”
Women in their 40s
Women in their 40s need to start thinking about beginning breast cancer screening, which involves an X-ray picture of the breast called a mammogram. Different medical groups have slightly different opinions on when you should start getting regular mammograms. The American College of Obstetricians and Gynecologists recommends it every one to two years for women ages 40 and older, but the Preventive Services Task Force says it’s OK to get one every two years beginning at age 50.
“We used to have a model in medicine where the doctor decided everything that happened to patients, and patients didn’t really like that. They liked being more involved in their care,” said Dr. Galli. “Now we engage in this shared decision-making model.”
She said the best thing to do is to have a discussion with your doctor about when you would like to start screening. Women who might be at higher risk of breast cancer, such as those with a family history or individuals with Ashkenazi Jewish heritage, may need to start screening earlier.
While mammograms can save lives, they may also lead to unnecessary treatment if they find a suspicious-looking area that would have never developed into cancer. Your doctor can walk you through the pros and cons of breast cancer screening.
Adults 50 and older
Our immune systems tend to get weaker as we get older, and as a result, our bodies aren’t as good at fighting off diseases. That’s why it’s recommended for older adults to receive the flu vaccine every year. In addition, adults 50 and older should get two doses of the shingles vaccine, and adults 65 and older should get one dose of a pneumococcal vaccine. Adults 50 and older are also eligible for a second COVID-19 booster shot.
Men in their 50s
For men aged 55 to 69 years, the decision to undergo periodic prostate cancer screenings is an individual one.
Screening involves a blood test called a prostate specific antigen (PSA) test, which measures the level of PSA in the blood. Levels of this protein can be elevated in men with prostate cancer.
Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men can receive false-positive results that lead to additional testing, possible biopsy and unnecessary treatment that can cause complications, such as incontinence and erectile dysfunction.
“There is some debate about how helpful the prostate cancer screening test is,” said Dr. Thomas. “The challenge with the PSA test is it’s not as accurate as we would like it to be.”
The USPSTF recommends against PSA screening for prostate cancer in men 70 years and older because prostate cancers detected in that age group are typically slow-growing and unlikely to cause harm.
Women over 65
The American College of Obstetricians and Gynecologists recommends that women aged 65 years or older get a bone mineral density test annually to check for the risk of osteoporosis, a condition in which the bones become thin, weak and brittle. Osteoporosis is five times more common in women than in men.
Emily Mullin: [email protected]
First Published April 30, 2022, 6:00am