When it comes to your health, your stance may be that “more” is better—more tests, more doctor visits, more vigilance. But in certain cases, less is the way to go. Not only can excessive or unwarranted testing lead to a chain reaction of follow-up tests, unnecessary medications, or avoidable surgeries, it can also cause anxiety and be harmful to your overall health since all tests and procedures have risks, says Kristine Arthur, MD, an internist at Orange Coast Memorial Medical Center in Fountain Valley, CA.
That’s not to say you should be in the dark about your health status—quite the opposite, in fact. This is about being informed and making the right choices. It’s important to have the appropriate screenings at the appropriate times, just as it’s important to avoid the ones that you can. Here are eight that you might want to reconsider.
Pap smear
For the longest time the recommendation was that women get an annual Pap test, so you probably still schedule a yearly well-woman visit like clockwork. Definitely keep the appointment to discuss any concerns and problems, and determine whether you should have a pelvic exam, but skip the Pap. “Cervical cancer doesn’t just develop overnight,” says Angela Jones, MD, an ob-gyn in Freehold, NJ. In general, it takes 10 to 20 years to do so, so you don’t need a Pap test every year. The American Congress of Obstetricians and Gynecologists and the US Preventive Services Task Force recommends women ages 30 to 65 get Pap screening every 3 years. Those who get the Pap and HPV combination testing can be screened every 5 years. If you are over 65 and have had three consecutive normal Pap results within the past 10 years (or two normal co-tests), with the most recent being within the past 5 years, or if you’ve had a total hysterectomy, you no longer need Pap testing at all.
Imaging test for back pain
When you have back pain that’s bad enough to see a doctor, you likely go right along with her recommendation for an MRI or X-ray to try to determine the cause. However, according to the American Academy of Family Physicians (AAFP), this is another procedure you can probably take a pass on. First of all, most back pain gets better in about a month. Second, studies have shown that imaging scans of the back often reveal anatomic abnormalities in people with no back pain. So, not only could imaging point out something that’s not the cause of the problem (or any problem, for that matter), it also could lead to treatments that aren’t very helpful. One review of six clinical trials out of the Oregon Health and Science University found that people who had an MRI for back pain didn’t get better any faster than those who didn’t have a scan, and they experienced the same amount of pain, depression or anxiety.
Another reason to skip the imaging: X-rays and CT scans expose you to radiation, which increases the risk of developing cancer. Granted, low doses of radiation likely raise cancer risks by a very small amount; however, the effects of radiation are cumulative, so the more CT scans and X-rays (and other exposures to radiation), the greater your risk.
But—and this is important—if your back pain is accompanied by unexplained weight loss, a fever over 102°F, weakness or numbness in your legs, loss of control of your bladder or bowels, pain for longer than 6 weeks, or you have a history of cancer, your doctor should recommend that you get an imaging test right away.
Teeth polishing
Itching to get out of the dentist’s chair ASAP? You’re in luck. When the hygienist whips out that small motorized rubber cup to polish your teeth at the end of your dental exam, you can decline. This procedure may make your teeth feel smooth for a short while, but it’s totally optional. “The main purpose of teeth polishing is to remove stains, so it’s more for a cosmetic effect rather than a health benefit,” says Julie Frantsve-Hawley, RDH, PhD, editor-in-chief of the International Journal of Evidence-based Practice for the Dental Hygienist. And if you’re a heavy smoker or drink beverages that cause staining, more pressure may be required during polishing, which could possibly cause more harm to the enamel, since polishing involves using an abrasive. Your best bet to avoid stains: Brush and floss or use interdental brushes to clean between your teeth daily.
Dental visits
Speaking of teeth, you know that “see your dentist every 6 months” advice we always hear? That may not be the case for you. You might not need to go as often, or you may need to go more frequently. “Everyone has different risk factors and different rates of tartar and plaque buildup,” Hawley says. Some people should go in every 3 or 4 months; others can go a little longer—6 months, a year or more, Hawley says. It all depends on your individual circumstances. (Check out these 12 things dentists know about you just by looking at your mouth.) Talk to your oral health professional to determine how often you should schedule exams and cleanings.
Annual cardiac stress test
According to the American College of Cardiology (ACC), a cardiac stress test may be one more thing you can cross off your to-do list. “If you have no symptoms and are low risk for heart disease—and that includes no high blood pressure, diabetes, smoking, family history, or high cholesterol—there’s really no benefit to a stress test,” says William Zoghbi, MD, director of cardiovascular imaging at Houston Methodist and past president of the ACC. That also goes for regular electrocardiograms (EKGs) and exercise stress tests. Doing the test every year on a “just in case” basis can lead to unnecessary invasive procedures and excess radiation. So, if you’re at low risk and have no symptoms of heart disease, such as chest pain, shortness of breath, heart palpitations, or irregular heartbeats, you can probably skip it.
Bone density tests
If you haven’t yet reached your 65th birthday, and you don’t have risk factors for serious bone loss (such as smoking, drinking heavily, having a low body weight, very low vitamin D levels, rheumatoid arthritis, or long-term use of corticosteroids), you can likely postpone this test. A bone density test, also known as a DEXA scan, is a type of X-ray that measures the amount of calcium and other minerals in your bones. Most people don’t need the test because they don’t have bone loss (or have very mild bone loss) and are at low risk for breaking a bone. Moreover, if you do have a scan and it detects mild bone loss, the medications used to treat it may help for only a few years (or not help at all), and they can have some side effects.
Instead, work on protecting your bones: Do aerobic and strength exercises, get enough calcium and vitamin D, limit alcohol intake, don’t smoke, and avoid taking (or at least limit) medications that could harm the bones, such as corticosteroids. (Here’s how to tell if you have a vitamin D deficiency.)
PET or CT scans
Knowing how serious some diseases are, it may seem wise to get a CT scan to screen for lung cancer, or a whole-body PET-CT scan, which can look for cancers in nearly any area of the body. But these procedures are not suited for routine use. Based on studies using PET/CT for screening, the likelihood of finding cancer in adults who have no signs or symptoms of the disease is extremely low (around 1%), according to the Society of Nuclear Medicine and Molecular Imaging. And then there’s the radiation issue again. “Radiation accumulates over your lifetime,” Arthur says. “So when people come in and say, ‘I’m worried about cancer. I want to have imaging every year,’ they’re actually increasing their overall risk of cancer by constantly exposing themselves to radiation,” she says. The only people who may need CT scans to screen for lung cancer are those who are age 55 to 74 and have been smoking heavily for a long time (a pack of cigarettes a day for 30 years, or two packs a day for 15 years) and either still smoke or quit within the past 15 years. (It’s never too late to quit smoking.) PET scanning is used most often in people who have already been diagnosed with cancer.
Urinary catheter
If you’ve ever had a urinary catheter inserted, you know it’s not fun. The good news is you may be able to decline it next time. Oftentimes, catheters aren’t used for necessity, but for the convenience of the hospital staff (and possibly you). And, unfortunately, they increase your risk of developing a urinary tract infection (UTI). A catheter may be required if you’ve had surgery on your urinary system, you’re critically ill and the medical staff needs to monitor your urine output, you have a urinary obstruction and need relief, or there’s pain with urination during end-of-life care. Otherwise, you can probably tell the nurse, “No, thanks.” Go to choosingwisely.org for more tests and procedures you should think twice about.
