June 15, 2011 -- There are health tests we need, and those we don't. Pelvic ultrasound? Sounds ultrasuspicious. Occult blood test? Only if it comes with an exorcism. Urinalysis? Great, now I'll be kicked off the tour...
It's tough to know which of these are truly essential, especially when they're packaged with dozens of other tests and called an "executive health exam." And yet thousands of men sign up for these screenings -- at an out-of-pocket cost of up to $10,000 apiece -- based on the sales pitch that a test may uncover a hidden health condition.
Of course, 10 grand might be worth it if all that random screening actually did any good. But a seminal study by the Rand Corporation found that patients who had the most screenings over five years were no healthier than those given less medical attention. This isn't to say executive health exams are scams. They can be quite valuable -- if you know which of the procedures are worthwhile. So we asked our experts to create an a la carte menu to bring to your GP. Think of these as the best tests for a recession.
Cardiac CT Angiography
These colorful 3-D images allow radiologists to calculate one of your most important heart numbers: your coronary artery calcium score, a measure of how much plaque is piling up in your arteries. A 2007 study of over 10,000 people published in the journal Atherosclerosis reported that calcium scores alone can predict heart attacks, while a 2003 study found that a high calcium score is associated with a tenfold increase in heart-disease risk. This is compared with a less-than-twofold increase in risk from traditional risk factors such as diabetes and smoking. The test has one significant downside: The radiation exposure from your average cardiac CT is equal to 600 chest X-rays, according to a study in the Journal of the American Medical Association. This produces a 1-in-5,000 risk of cancer, another study reveals.
Who needs it: Men with some of the risk factors for heart disease whose physicians may be on the fence about starting treatment. "In these medium-risk cases, cardiac CT scans and calcium scoring can provide the extra level of information that we feel we need," says Gerald Fletcher, M.D., a professor of cardiology at the Mayo Clinic. The lower the calcium score, the lower the risk. If you reach 112, your physician might recommend aspirin or statins.
Cost: $350 to $900. Most insurance companies will reimburse you if you've previously had an abnormal stress test or chest pain.
Bone Density Scan
Think osteoporosis affects only old ladies? Fact is, men begin losing bone mass at age 30. That's why it's important to assess the state of your skeleton now with a dual energy X-ray absorptiometry (DEXA) scan, which uses low-radiation X-rays to gauge bone mineral density (it can also measure body fat percentage). "DEXA scans allow us to identify people at high risk for fracture so they can start treatment to strengthen their bones before a fracture occurs," says Murray J. Favus, M.D., director of the bone program at the University of Chicago medical center. Your doctor might suggest adding strengthening workouts to your exercise program and supplementing your daily diet with up to 1,000 milligrams of calcium and up to 400 IU of vitamin D.
Who needs it: Anyone with any osteoporosis risk factors: inactivity, smoking, a family history of the disease.
Cost: $250 to $300. To increase the odds of your insurance covering the scan, make sure your doctor notes any risk factors.
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VO2 Max Test
With the VO 2 max test, you hop on a treadmill or stationary bike and give your maximum effort while wearing a mask that captures your every breath. By analyzing the amount of oxygen you consume, the test determines how efficiently your body extracts and uses oxygen from the air. This makes it the gold standard of fitness markers, as well as a strong indicator of your overall health. "Blood pressure, cholesterol -- those are what we call 'remote markers.' The best predictor of your longevity is going to be your fitness," says Walter Bortz, M.D., a longevity researcher at Stanford University.
Who needs it: Anyone who wants their blood to pump. If your score is under 18 ml/kg/min, talk to your doctor about increasing the intensity of your workouts.
Cost: $110 to $160. The test is available at physical therapy, rehab, or cardiopulmonary centers. Insurance providers won't cover it.
By definition, something "virtual" usually can't compare to the real thing. But with a virtual colonoscopy, you avoid the two downsides of a traditional colonoscopy -- sedation and the risk of a perforated colon -- while still benefiting from the one big upside: test results you can stake your life on. "Virtual colonoscopies have the same sensitivity for detecting large polyps, which are the precursor lesions of colon cancer," says Judy Yee, M.D., a professor of radiology at the University of California at San Francisco. Though the CT scanning technology of a virtual colonoscopy can miss some smaller polyps, a University of Wisconsin study found that these are usually benign anyway. And don't sweat the radiation; you'll receive about 5 to 8 millisieverts, an amount that isn't considered dangerous, says Dr. Yee.
Who needs it: People ages 50 and older, especially those on blood thinners, because an "oops" with a regular scope could cause dangerous internal bleeding. The exception: If your family has a history of colon cancer, you should be screened at least 10 years before the age your relative was when he or she was first diagnosed, Dr. Yee says. People who are overweight or inactive, drink or smoke heavily, or have an inflammatory bowel disease should also consider early screening.
Cost: $500 to $1,000. Many health-care plans now recognize the effectiveness of virtual colonoscopies and increasingly cover them.
Tip: Cut back on calories and chemicals by avoiding the 20 unhealthiest drinks in America.
While it's not a test per se, putting your diet under the microscope could result in a leaner body and a longer life. "The benefits of meeting with a dietitian are accountability, moral support, and troubleshooting if your progress stalls," says Alan Aragon, M. S., the Men's Health Weight-Loss Coach. In a 2008 Kaiser Permanente study, diabetic patients who received nutritional counseling were nearly twice as likely to lose weight as those who had no guidance. To find a registered dietitian who can see beyond the food pyramid, Aragon recommends going to the American Dietetic Association's Web site (eatright.org)and clicking on "Find a Nutrition Professional." Then call the R.D. and ask how he or she stays up on the latest research, which should include reading journals such as the American Journal of Clinical Nutrition or the Journal of Applied Physiology.
Who needs it: Anyone who should lose weight or simply wants to know how they can eat to beat disease.
Cost: $40 to $75 a session. Your insurance company may reimburse you if you have a condition that can be improved with diet changes. Ask your doctor for a referral.
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