Dangerous Medical Tests and Procedures You May Want to Avoid

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Medical Tests to Avoid That May Endanger Your Health

By Elizabeth Agnvall, AARP Bulletin.

You may not need these common health exams as often as you think.

Doctors are warning that some of the common medical tests routinely taken by Americans do more harm than good, waste billions of health care dollars annually and could endanger your health or even your life.

Among the tests targeted by prestigious panels of doctors as overused were annual Pap smears, regular PSA tests, regular EKGs and even routine yearly physicals. Overuse of such tests leads to dangerous side effects, pain, radiation exposure, unnecessary surgery — even death, the doctors said.

The American Board of Internal Medicine Foundation asked more than 50 medical societies — of family doctors, oncologists, cardiologists and other specialties — to identify tests and treatments that are often unnecessary. AARP is a consumer partner with this campaign, called Choosing Wisely.

John Santa, medical director at Consumer Reports, another Choosing Wisely partner, says these screening tests often yield false-positive results that lead to a spiral of unneeded invasive procedures, medications and even surgeries. If you have symptoms or certain risk factors, these tests can be valuable — even lifesaving — but they’re performed on far too many people.

1. Nuclear stress tests, and other imaging tests, after heart procedures

Many people who have had a heart bypass, stent or other heart procedure feel they’ve had a brush with death. So patients — and doctors — understandably want to be reassured through a nuclear stress test or other tests that their hearts are beating strong. But performing these tests every year or even every two years in patients without symptoms rarely results in any change in treatment, says William Zoghbi, immediate past president of the American College of Cardiology. “More testing is not necessarily better,” he says. In fact, it can lead to unnecessary invasive procedures and excess radiation exposure without helping the patient improve. Instead, patients and doctors should focus on what does make a difference in keeping the heart healthy: managing weight, quitting smoking, controlling blood pressure and increasing exercise.

2. Yearly electrocardiogram or exercise stress test

A survey of nearly 1,200 people ages 40 to 60 who have never had heart disease or any symptoms found that 39 percent had an EKG over the previous five years, and 12 percent said they had an exercise stress test. The problem: Someone at low risk for heart disease could be 10 times more likely to get a false-positive result than to find a true problem, says John Santa of Consumer Reports, which conducted the 2010 survey. This could lead to unnecessary heart catheterization and stents. Instead, have your blood pressure and cholesterol checked. And if you’re at risk for diabetes, have your blood glucose level checked as well.

3. PSA to screen for prostate cancer

Cancer is always scary, but the PSA test often finds slow-growing cancers that won’t kill men. “The evidence is extremely convincing that in a man with usual risk and no symptoms, the PSA test causes more harm than benefit,” says Reid Blackwelder, president of the American Academy of Family Physicians (AAFP). As a result of the test, he says, men often have ultrasounds, repeat lab tests and even biopsies for a problem that isn’t there — an estimated 75 percent of tests that show high PSA levels turn out to be false alarms. When men do have treatments such as surgery or radiation, 20 to 40 percent end up with impotence, incontinence or both.

Not all doctors agree with AAFP’s recommendation against routine PSA screening, but many agree that the test is overused. Even the American Urological Association, which supports the use of PSA testing, says that it should be considered mainly for men ages 55 to 69. The American Society of Clinical Oncology recommends against PSA testing for prostate cancer screening in men with no symptoms when they are expected to live less than 10 years. A recent study published in the journal Cancer found that Medicare spent almost $450 million a year on PSA screenings, one-third of which was for men over age 75.

4. PET scan to diagnose Alzheimer’s disease

Until recently, the only way to accurately diagnose Alzheimer’s was during an autopsy. In the last few years, doctors have begun using PET scans with a radioactive dye to look for beta-amyloid protein that is found in the brains of people with the disease. Although this test has promising use for research, there are serious questions about whether it should be used on those who complain of a fuzzy memory. PET scans in older people consistently find the protein in 30 to 40 percent of people whose memories are just fine.

Although beta-amyloid plaques are present in all of those who have Alzheimer’s, it is not known if or when everyone with the plaques will develop the disease, says Peter Herscovitch, president-elect of the Society of Nuclear Medicine and Molecular Imaging. What’s more, even if a PET scan could accurately diagnose the disease, it’s untreatable. If you’re concerned about your memory, the better course is to have a complete medical evaluation by a doctor who specializes in diagnosing and treating dementia. Many other medical conditions, such as strokes, thyroid deficiencies and vitamin deficiencies, can cause the same symptoms, and these are treatable.

5. X-ray, CT scan or MRI for lower back pain

Unfortunately, back pain is incredibly common — 80 percent of people will suffer from back pain some time in their lives. It can be both excruciating and debilitating. Naturally, people want to know what’s wrong. Here’s the catch: The best imaging machines in the world often can’t tell them. Many older people with no back pain can have terrible-looking scans.

Most back pain goes away in about a month and imaging tests tend to lead to expensive procedures that often don’t help recovery. One study found that people who got an MRI during the first month of their back pain were eight times more likely to have surgery than those who didn’t have an MRI — but they didn’t get relief any faster. If you don’t feel better in a month, talk to your doctor about other options such as physical therapy, yoga or massage. But if your legs feel weak or numb, you have a history of cancer or you have had a recent infection, see your doctor as soon as possible.

6. Yearly Pap tests

The yearly Pap smear is a common part of women’s health checklists, but it doesn’t need to be. Women at average risk only need them every three years, since cervical cancer generally takes 10 to 20 years to develop. If women have also had negative tests for the human papillomavirus (HPV), which is now known to cause the cancer, they only need a Pap test along with the HPV test every five years. And women older than 65 who have had several normal Pap tests in a row can stop having them altogether. Do note, however, that a yearly visit to an ob-gyn stays on the to-do list.

7. Bone density scan for women before age 65 and men before age 70

For the estimated 10 million people — mainly women —in the United States who have osteoporosis, bone-strengthening medications can lower the chances of breaking a bone. But many experts argue that for those ages 50 to 65 who have osteopenia — mild bone loss — testing and subsequent drug prescriptions may be a waste of time and money. Not only is the risk of fracture often quite low, medications such as Fosamax (alendronate) and Boniva (ibandronate) have been linked to throat or chest pain, difficulty swallowing, heartburn, muscle pain, bone loss in the jaw and thigh-bone fractures. And there’s scant evidence that people with osteopenia get much benefit from the drugs.

To help keep your bones strong, try walking and weight-bearing exercises, says Blackwelder. Get enough calcium and vitamin D in your diet. If you smoke, quit.

8. Follow-up ultrasounds for small ovarian cysts

Many women receive repeated ultrasounds to verify that ovarian cysts have not become cancerous, but current research says that these tests aren’t necessary. For one thing, premenopausal women have harmless ovarian cysts regularly. For another, about 20 percent of postmenopausal women also develop harmless cysts.

“The likelihood of these small simple cysts ever becoming cancer is exceedingly low,” says Deborah Levine, chair of the American College of Radiology Commission on Ultrasound and a professor of radiology at Harvard Medical School.

In postmenopausal women, only cysts larger than 1 centimeter in diameter need a follow-up ultrasound. For premenopausal women, who typically have benign cysts every month when they ovulate, cysts smaller than 3 centimeters aren’t even worth mentioning in the radiologist’s report, says Levine.

9. Colonoscopy after age 75

Most people should have screening for colon cancer at 50 and then every five to 10 years after that, if the first test is normal. By age 75 — if you’ve always had normal colonoscopies — you can stop taking this test altogether. That should be good news, because a colonoscopy can cause serious complications in older people.

“Just the preparation for colonoscopy can be exceptionally harsh,” says James Goodwin, director of the Sealy Center on Aging at University of Texas Medical Branch, who studies overuse of colonoscopies. Some patients become incontinent or experience weeks of pain, diarrhea and constipation. In worst cases, the procedure can perforate the colon. Despite such risks, recent studies have found that substantial numbers of people over 75, even over 85, are still getting screening colonoscopies.

To protect your colon, eat plenty of fruits, vegetables and whole grains for fiber. Cut down on fatty foods, red meat and processed meats. Lose weight if you’re overweight and exercise. Sound familiar? It should, because that’s the best advice for protecting the rest of your body — and mind — as well.

10. Yearly physical

There’s little evidence that having an annual checkup can keep you healthy. Many tests that doctors regularly perform — to diagnose anemia, liver disease or urinary tract infections, for example — don’t make sense unless there’s a reason to suspect a problem. “A healthy 52-year-old does not need to see the doctor once a year,” says Jeremy Sussman, an internist for the VA system and assistant professor at the University of Michigan who was on the Society of General Internal Medicine task force for making the Choosing Wisely recommendation.

“We certainly don’t think people should never see doctors — quite the opposite. We question the value of seeing someone for the sake of seeing someone.” Your specific needs should determine how often you see your doctor, he adds. If you have an illness that needs treatment, you should see your physician. And do talk to your doctor about how often you need to have your blood pressure and cholesterol tested. “Our real point is, don’t do these things for the sake of a calendar,” he says. “Do them for the sake of your health.”

March 2014

Elizabeth Agnvall is a writer and features editor for AARP Media.

Editor: Although the publication date of an article may not be current the information is still valid.

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Doctor Groups Issue List of Overused Medical Tests – by LAURIE TARKAN The New York Times.

In an effort to change entrenched medical practices, 17 major medical specialty groups recommended on Thursday that doctors greatly reduce their use of 90 widely used but largely unnecessary tests and treatments.

This list of “don’ts” builds on 45 recommendations made last April, under a broad initiative by the American Board of Internal Medicine Foundation, in partnership with the magazine Consumer Reports.

“As you look through the lists, a lot of these were mea culpas,” said Dr. Eric Topol, chief academic officer of Scripps Health, a health care provider in San Diego. Dr. Topol was not involved in creating the new recommendations. “The literature had supported these recommendations, but until now they were not sanctioned as no-no’s by the professional groups,” he said.

Some of the recommendations reinforce existing guidelines, but others aggressively go after procedures that have little evidence of benefit and may cause harm, yet are still practiced on a daily basis.

For example, the American Society of Echocardiography recommended against using echocardiograms before or during surgery for patients with no history or symptoms of heart disease; doctors routinely perform this test. The Society of Nuclear Medicine and Molecular Imaging urged physicians not to perform routine annual stress testing using a nuclear heart scan after coronary artery surgery. This is also a routine test, and it exposes the patient to radiation equivalent to 2,000 chest X-rays.

“Many of these tests are wasteful, and they could put patients in danger of harm without any benefits,” said Daniel Wolfson, executive vice president of the American Board of Internal Medicine Foundation. “The goal is to begin to change attitudes both from the public side and the physician side that sometimes less is better.”

Each medical specialty society participating in the foundation’s initiative has offered up five procedures that patients should question. “That’s a key point. I don’t think they’ll have any impact unless patients get activated,” Dr. Topol said.

The new list includes recommendations against inducing labor or performing a Caesarean section before a woman’s 39th week of pregnancy, unless it is medically necessary. Scheduled Caesareans and inductions are commonly performed for convenience, but delivery before 39 weeks is associated with increased risk of learning disabilities, respiratory problems and other risks to the baby.

The American Academy of Pediatrics urged doctors not to automatically use computed tomography, or CT scans to evaluate children’s minor head injuries. According to the report, approximately 50 percent of children who visit hospital emergency departments with head injuries undergo a CT scan, exposing them to radiation. Other groups also called for reductions in the use of CT, PET and M.R.I. scans for a variety of ailments.

Several physician groups recommended against prescribing antibiotics for common respiratory illnesses, including sinusitis, sore throat and bronchitis. The vast majority of these illnesses are caused by viruses, not bacteria, making antibiotics pointless. The pediatrics group also said not to treat children under 4 years of age with cough and cold medicines. Studies have shown that these products have little benefit and may cause serious side effects in children.

The American Geriatrics Society recommended against using feeding tubes in patients with advanced dementia. These patients should be fed orally. Tube feeding is associated with agitation, increased use of physical and chemical restraints and pressure ulcers.

Other notable recommendations include:

· Don’t use opioid or butalbital treatment for migraine except as a last resort. Frequent use of these drugs can worsen headaches.

· Don’t routinely treat acid reflux in infants with anti-reflux therapy. There is emerging evidence that it may be harmful to infants in certain situations.

· Avoid routine preoperative testing for low-risk surgeries without a clinical indication. Most pre-op tests turn up nothing unusual and don’t lead to better outcomes.

· Avoid using medications to achieve tight control of glucose levels in most adults aged 65 and older with Type 2 diabetes. Moderate control is generally better.

· Don’t use benzodiazepines or other sedative hypnotics in older adults as a first choice for insomnia, agitation or delirium. Studies consistently show a doubling of risk of car accidents, falls and hip fractures in older adults taking these medications.

· Don’t perform annual Pap tests in women 30 to 65 years of age who are not at high risk for cervical cancer. The Pap test should be performed every three years in women aged 21 to 30, and every three to five years for women aged 30 to 65.

February 21, 2013

Editor: Although the publication date of an article may not be current the information is still valid.

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Overused Tests and Procedures that Harm Patients – By Patrick J. Skerrett, Executive Editor, Harvard Health.

Top Two “Don’ts” From 9 Medical Specialty Organizations

American Academy of Allergy, Asthma & Immunology

• Don’t perform unproven diagnostic tests, such as immunoglobulin G (IgG) testing or an indiscriminate battery of immunoglobulin E (IgE) tests, when evaluating a possible allergy.
• For uncomplicated acute sinusitis, don’t order sinus computed tomography (CT) or indiscriminately prescribe antibiotics.

American Academy of Family Physicians

• Don’t do imaging for low back pain within the first six weeks, unless red flags are present.
• Don’t routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement.

American College of Cardiology

• When initially evaluating patients who are not having cardiac symptoms, don’t perform stress cardiac imaging or advanced non-invasive imaging unless there are markers the patient is at high risk.
• Don’t perform stress cardiac imaging or advanced non-invasive imaging as part of routine follow-ups in patients without symptoms of cardiovascular disease.

American College of Physicians

• Don’t perform exercise electrocardiogram testing (exercise stress test) in patients who do not have any symptoms of heart disease and who are at low risk for coronary heart disease.
• Don’t obtain imaging studies in patients with non-specific low back pain.

American College of Radiology

• Don’t do imaging for uncomplicated headache.
• Don’t image for suspected pulmonary embolism (PE) without moderate or high pre-test probability.

American Gastroenterological Association

• When prescribing long-term acid suppression therapy for gastroesophageal reflux disease (GERD), choose the lowest dose of a proton pump inhibitor or histamine2 receptor antagonist to achieve therapeutic goals.
• Do not repeat colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals.

American Society of Clinical Oncology

• Don’t use cancer-directed therapy for patients with a solid tumor who have the following characteristics: low performance status, no benefit from prior evidence-based interventions, not eligible for a clinical trial, and no strong evidence supporting the clinical value of further anticancer treatment.
• Don’t perform PET, CT, and radionuclide bone scans in the staging of early prostate cancer at low risk for metastasis.

American Society of Nephrology

• For patients on dialysis who have limited life expectancies, don’t perform routine cancer screening unless the patient has signs or symptoms of cancer.
• Don’t administer drugs that stimulate red blood cell production in patients with chronic kidney disease who do not have symptoms of anemia if their hemoglobin levels are greater than or equal to 10 g/dL.

American Society of Nuclear Cardiology

• Don’t perform stress cardiac imaging or coronary angiography in patients without signs or symptoms or cardiac disease unless they have other markers indicating they are at high risk for cardiac disease.
• Don’t perform cardiac imaging for patients who are at low risk.

April 05, 2012

Editor: Although the publication date of an article may not be current the information is still valid.