To Test or Not to Test: Guidelines for testing health conditions

Screening tests that can detect disease in its early stages can save millions in medical costs and priceless amounts of pain and heartache. But who needs what? And when?
Here are some guidelines for testing for various health conditions:

Men

Abdominal aortic aneurysm: A man between the ages of 65 and 75 who has smoked at least 100 cigarettes should have a single ultrasound screening of the abdominal aorta.

Colorectal cancer: The typical age to begin screening is 50. Doctors recommend annual testing for fecal occult blood, a test which is done with stool cards at home, and colonoscopies every 10 years if tests results are normal. Doctors don't usually order colonoscopies for people over age 85 because the stress of the test could offset its benefits.

Diabetes: Men who develop high blood pressure or high cholesterol should then be tested for diabetes.

Depression: Men who feel sad or hopeless over a period of several weeks or receive little pleasure from things they once enjoyed should ask to be screened for depression.

High cholesterol: Testing should begin for most men at age 35. Younger men who smoke, have a history of heart disease in their families, have diabetes or high blood pressure should talk to their doctors about administering a cholesterol test before they reach 35.

High blood pressure: Anyone 18 or older should be screened for high blood pressure at least once a year.

HIV: Men should discuss the need for HIV testing if they have done any of the following: Had sex with men since 1975; had unprotected sex with multiple partners; injected drugs; exchanged sex for money or drugs; or had sex with anyone who is bisexual, has HIV, or has injected drugs; or had a blood transfusion between 1978 and 1985.

Prostate cancer: Digital rectal exams or a PSA (prostate-specific antigen) blood test should be administered yearly starting at age 50. Men who are at high risk for prostate cancer -- those who have had a father or brother develop prostate cancer before the age of 65, and black men, whose rates of prostate cancer are high -- should begin testing at age 40. Because prostate cancer grows so slowly in older men, doctors recommend that annual testing stop after age 75.

Sexually transmitted infections: Men should discuss the need to be tested for gonorrhea, syphilis, chlamydia or other sexually transmitted diseases with their doctors.

Women

Breast cancer: Have a mammogram every one to two years between the ages of 40 and 50 and an annual mammogram after 50. Women with a history of breast cancer in their families should have a baseline mammogram at age 35 and begin annual screening at 40 or 50. A woman who has a relative who developed breast cancer before menopause should have a baseline mammogram 10 years younger than the age of that relative.

Cervical cancer: Women should have a Pap smear every one to three years, beginning at age 18 or within three years of starting sexual activity. Most women have an annual pap smear and should continue to do so until they have had three normal pap smears in a row and are in a stable sexual relationship. Women who have a lifetime history of normal pap smears may want to talk with their doctors about discontinuing them after age 65. Most experts recommend discontinuing pap smears after removal of the uterus and cervix for reasons other than cancer, if previous pap smears have been normal.

Chlamydia and other sexually transmitted diseases: Women should be tested for chlamydia if they are 25 or younger and are sexually active. Older women should discuss being tested for chlamydia and other sexually transmitted diseases with their doctors.

Colorectal cancer: Same as men.

Diabetes: Same as men.

Depression: Same as men.

High cholesterol: Women should start having regular cholesterol checks at 45. Those who are younger than 45 should talk to their doctors about cholesterol checks if they smoke, have diabetes, have high blood pressure or have heart disease in their families.

High blood pressure: Women should have their blood pressure checked at least every two years.

HIV: Women should be tested for these reasons: if they are pregnant; had sex for money or had sex partners who did; have used needles to inject drugs; have had unprotected sex with multiple partners; have had sex with partners who are bisexual, used needles to inject drugs or who have HIV; if they are undergoing treatment for sexually transmitted diseases; or had a blood transfusion between 1978 and 1985.

Osteoporosis: Women should have a bone-density test at age 65. Women who weigh 154 pounds or less should talk to their doctors about being tested between the ages of 60 and 64.

Sources: The Agency for Healthcare Research and Quality of the U.S. Department of Health & Human Services, and Dr. Randall Clinch, a doctor of osteopathic medicine and an associate professor in the Department of Family & Community Medicine at Wake Forest University Baptist Medical Center.