Children need healthy parents, yet many parents put off those regular, and potentially life-saving health checks for themselves. Prioritizing your health not only sets an example for your children, but also ensures you’re able to be there for your kids for longer. The sad truth is that, as our age increases, so does our risk of disease. We spoke to Dr. Nizar Al-Salahat, M.D. Ph.D, medical director and orthopedic and team leader at Puhua International Hospitals – Shuangjing, and Dr. Wang Shoudong, general practitioner and director of the Immigration Check-Up Department at Vista Medical Center, to help grown-ups navigate the quagmire of adult health tests.
21 Years Old: Pap Smear
Dr. Nizar, the American Cancer Society, and a number of other medical organizations recommend that women get their first pap smear at 21, and continue getting tested annually until the age of 65. Dr. Wang suggests women start even early as 18. After three consecutive years of normal results, the pap smear should be repeated every two years.
This very important test screens for cervical cancer and pre-cancerous abnormalities like human papilloma virus (HPV). HPV is a sexually-transmitted virus that has many types; some have no symptoms, others cause warts. While a minority of overall HPV cases progress into cancer, almost all cases of cervical cancer are caused by HPV, so early detection is crucial.
A woman’s chance of getting cervical cancer under the age of 20 is slim to none, but it jumps to 14 percent between the age of 20 and 34, and spikes to 25.9 percent for women from 35 to 44. The incidence stays at 23.9 percent for women between 45 and 55, but Dr. Nizar points out: “If a woman gets to age 44 with all normal pap smears, her chance of getting cervical cancer is very low.”
It’s necessary for women to begin regular pap smears in their early 20s. “Women have a higher incidence of being infected by HPV at that age,” says Dr. Nizar. It progresses into cervical cancer by the time a woman hits the 35-44 age range. Aside from HPV, risk factors for cervical cancer include smoking, family history, a previous chlamydia infection, more than three full-term pregnancies, a first pregnancy at younger than age 17, oral contraceptive pills, a low-fiber diet, or an intra-uterine device (IUD).
When scheduling a pap smear (also called Thinprep Cytology Test, or TCT), make sure it is not when you are menstruating, and refrain from intercourse 48 hours before the test. If the test comes back abnormal, it may indicate abnormal cell growth, called dysplasia. The dysplasia may be mild or moderate, which warrants observation, but if the dysplasia is severe, a colposcopy and biopsy will be indicated for further investigation.
30 Years Old: Cholesterol
Once you’re out of your “roaring 20s,” it’s time to start getting annual lipid profiles. A full lipid profile checks for total cholesterol, HDL (“good” cholesterol), LDL (“bad” cholesterol), and triglycerides. Dr. Wang recommends ringing in your 30th year with one such profile. Why 30? He explains: “[At this age,] we start to have more pressure from work, we lack exercise, and we eat too much. [Though high cholesterol itself has] no symptoms, it can develop into heart and brain diseases.”
Risk factors for high cholesterol include smoking, obesity, a diet high in fat and cholesterol, lack of exercise, high blood pressure, diabetes, and a family history of heart disease. If there is a family history of chronic heart disease and high cholesterol, Dr. Nizar says, “We need to start testing children at two years of age.”
The lipid profile is a blood test, and you must refrain from eating, eight to twelve hours before. By Western measurements, the normal total cholesterol is under 200mg/dL (Chinese hospitals use the standard of 5mmol/L). Total cholesterol levels between 200 and 240 (or 5.2 and 6.2) are a bit high, and those levels require exercise and a low-fat diet, with a follow-up blood test within six months. Levels over 240 (or 6.2) are very high, and in addition to the lifestyle changes, both doctors would prescribe medication with a follow-up test a month later. Even those who get consistently normal results should get lipid profiles annually; those with high cholesterol may need to follow up as regularly as every month.
40 Years Old: Bone Marrow Densitometry
Our bones, says Dr. Nizar, are in a constant state of balance between construction and destruction. The body naturally creates new bone and destroys old bone, but as we age, the destructive process outpaces that of construction. “[Thus], osteoporosis,” says Dr. Wang, “is common in the elderly, as well as in pregnant and post-menopausal women.” Osteoporosis develops when bone density is low and bones become weak, brittle, and prone to fractures.
Women don’t need to be elderly to be at risk for osteoporosis; loss in bone density generally begins during or after menopause, when the amount of estrogen in a woman’s body decreases. Men are also at risk as they age, as are Caucasian and Asian women, and anyone who has undergone radiotherapy, used steroids, or has a family history of osteoporosis. Lack of exercise can also contribute to its development, and those who are thin are more at risk.
Dr. Nizar recommends that women get their first bone densitometry test after the age of 40 and before menopause to establish a baseline bone density, but emphasizes that, “after menopause, a bone densitometry test is a must.” He recommends men to get their first bone densitometry test around age 50. The bone densitometry scan is a mild x-ray exposure, generally of the vertebrae and the femur (thigh bones), though Dr. Wang says pregnant women can undergo a bone densitometry test via ultrasound if pregnancy-related osteoporosis is suspected. The test should be repeated every two years.
To determine bone mass, doctors use T-score results. “The maximum bone mass reached by a woman is at age 33,” says Dr. Nizar, so the T-score standard of zero uses a 33-year-old woman as the standard. Anything above -1 is normal, -1 to -2.5 indicates osteopenia, which generally indicates pre-osteoporosis. Anything under -2.5 is osteoporosis.
Those with normal bone density should have a follow-up test every two years. Those with osteopenia should begin a high calcium diet and take calcium supplements, but “to be absorbed into the body, calcium needs the help of Vitamin D, so Vitamin D supplements should be taken with calcium supplements,” says Dr. Wang. Depending on the woman, some doctors will recommend she begin estrogen supplements to help combat osteoporosis.
Regardless of bone density, it’s still a good idea to make sure your diet has enough calcium. A man or woman needs around 1,000 mg of calcium per day, though those with osteopenia or osteoporosis may need more. Milk has about 750 mg of calcium per glass, though if you don’t like milk, broccoli and oranges are high in calcium, and Dr. Wang also recommends more beans or Chinese bone soup.
50 Years Old: Prostate Check
As men approach 50, they must seriously consider their prostate health. Dr. Nizar provides the alarming statistic that after 50 years of age, when the incidence of prostate cancer is 1 in 476, the chances of prostate cancer jump to 1 in 43 by age 60. Men have a one in eight chance of developing prostate cancer after the age of 75, and about half of men over the age of 50 have prostate problems or infections.
Risk factors for prostate cancer include family history, a high-fat diet, and obesity. African-American men also have a higher rate of prostate cancer. Having a prostate exam at 50 may not only be a lifesaver in detecting the early stages of prostate cancer, but it can also help diagnose or treat benign prostatic hyperplasia (BPH). This painful condition, explains Dr. Wang, can cause urination problems and, if left untreated, requires surgery. Twenty-four hours before a prostate exame, men should avoid ejaculation.
There are three forms of prostate checks: the first is the digital rectal exam (DRE), in which a doctor checks the rectum and prostate for lumps, hardness, or enlargement. The next is a blood test for prostate specific antigen (PSA). Dr. Nizar cautions that it’s not a diagnostic test, but rather an indicator of potential prostate cancer that helps determine if abnormalities felt during the DRE will require a biopsy. The third test is an ultrasound, which can help evaluate the size and shape of the prostate, as well as detect calcifications and abnormalities.
50 Years Old: Mammogram
One of the leading causes of death among women is breast cancer. According to Dr. Nizar, 1 out of 8 women will get breast cancer; the risk gets significant at age 50, and continues to increase every decade thereafter. Hence, the importance of mammograms, which can detect breast cancer in its early stages.
A mammogram should become a regular check-up after age 50, and Dr. Wang recommends that women get their first mammogram at age 35. For Dr. Nizar, there is “a lack of clear-cut evidence of the effectiveness of mammograms [in women under 40].” However, he urges “high-risk women with a family history of breast cancer” to start at age 40.
A family history means two or more first-degree relatives (sister, mother, grandmother, aunt), one or more relatives with two or more cancers (for example, a relative with breast and ovarian cancer), or a male relative with breast cancer. Further risk factors for breast cancer include smoking, obesity, family history, hormone therapy, and oral contraceptive pills. Additionally, women who began menstruating under the age of 12, or women with menopause above the age of 55, have increased risk. Two things that help decrease the risk of breast cancer? Breastfeeding and physical activity.
Once the mammogram is complete, the findings can range from calcium deposits to distorted tissues or masses and lumps. If a mass or lump is present, often a biopsy is required to rule out cancer. Dr. Wang emphasizes that every woman should get mammograms every one to three years, depending on the recommendations of her doctor.
The key to all these tests is to start doing them before problems arise. Regular tests and early detection will keep you at your peak for years to come. On the other hand, it’s important to keep in mind the recent controversy surrounding prostate screenings and mammograms; some doctors warn against unnecessary testing and treatment because of potential side effects. When considering any tests or treatment, an assessment of risk, history, and quality of life should factor into any health decisions.
photo by Mitchell Pe Masilun.
