It’s very likely you’ve received mailers promoting tests that screen for vascular disease.
The testing is usually performed at a convenient location that has been rented for a testing day. The organizations sponsoring the tests are reputable, the tests are easy and safe, and the price is reasonable.
But should you participate?
What are the tests?
The vascular screenings currently being packaged and promoted to middle-aged and older adults typically include three tests that use ultrasound diagnostic techniques:
• a test that looks for obstructions in the large blood vessels in the neck (carotid arteries);
• a test that looks for obstructions in blood vessels going to the legs;
• and a test looking for abdominal aortic aneurysm (weakness and bulging of the wall of the big blood vessel leading from the heart to the legs).
To determine whether it’s wise to spend the money on these tests, it’s best to turn to the advice of experts. The U.S. Preventative Services Task Force is arguably the most authoritative of the agencies and medical societies that study the available scientific evidence regarding screening tests.
This agency recommends you save your money — and not take the time for most vascular screening tests. The one exception made by this agency is screening for abdominal aortic aneurysm: It recommends screening for men (not women) between the ages of 65 and 75 who have ever smoked tobacco.
Medicare will not pay for vascular screening tests with the exception of tests for abdominal aneurysm. And such tests are covered only for men between ages 65 and 75 who have smoked, and even then only if the tests are ordered as part of a “Welcome to Medicare” initial physical examination.
It’s not that the vascular screening tests are unable to find troubles that lurk silently in some people. The problem is that the tests too often suggest a problem that proves not to be a problem when more sophisticated testing is performed, and the tests too often fail to detect problems when they actually exist.
These types of test failures are called false positives and false negatives. Because a significant number of false-positive results occur with vascular screening tests, additional tests are needed to confirm the presence of disease. And these additional tests aren’t harmless.
Screening those without symptoms yields false positive results for too many people without significant disease who are then subjected to additional tests that could do harm. And if the tests miss a problem that actually exists, false reassurance is provided to the person being tested.
Steps you can take
Another major problem with the tests is the difficulty in treating disease if its existence is finally proven. Definitive treatment involves invasive surgical procedures with associated risks that too often are unacceptably high for people with no symptoms.
Here’s my advice:
• If you have worrisome symptoms, see your physician.
• If you have no symptoms, don’t get the screening tests.
• Don’t smoke.
• Avoid dietary cholesterol, and be sure your physician monitors your blood cholesterol.
• Make sure your blood pressure is checked at least once every six months, and follow your physician’s advice if you’re told your blood pressure is too high.
• Get plenty of exercise. The more the better.
• If you’re overweight, get on a diet.
• Pray a lot.
Dr. Michael Spilane, now retired, spent more than four decades practicing and teaching geriatric medicine in St. Paul. Send comments or questions to firstname.lastname@example.org.