Get Your Health Screenings During COVID-19
With the coronavirus still in our lives, you may wonder whether it’s wise to get health screenings now or postpone them until you’re vaccinated against COVID-19. Screenings, after all, are preventive—to detect potential early warning signs of diseases, not to treat a current health problem.
While you want to stay up to date with screenings, “they tend to be less urgent than a test or study that your doctor orders to evaluate a symptom,” says Michael Hochman, MD, an internal medicine physician at Keck Medicine of USC in Los Angeles and host of the “Healthy Skeptic, MD” podcast.
You may also be unclear on which screenings you need. Some, like prostate cancer screenings, are not routinely advised for people over a certain age; others, such as lung cancer screenings, are advised only if you have risk factors. Guidelines may also vary from medical association to medical association.
It’s best to talk with your doctor about the optimal screening schedule for you. To help, we’ve asked experts which screenings most older adults should stay on schedule with and which they can consider putting off or skipping.
Mammogram
What it is: This breast X-ray helps detect lumps that may signal cancer.
Who should have it: The American College of Physicians, which synthesized the advice from several medical organizations, advises a mammogram every other year for women between 50 and 74 at average risk. (Ask your doctor about your risk level.) “While an annual mammogram slightly decreases breast cancer deaths in this age group, it also leads to many more false positive results, breast biopsies, and overtreatment,” says Jacqueline Fincher, MD, president of the ACP.
Can you postpone it? Pushing it off a month or two is fine, but more than six months could do more harm than good, Fincher says.
Can you skip it altogether? In general, women 75 and older, or those with a life expectancy of 10 years or less, can stop having these screenings, the ACP says.
Colonoscopy
What it is: A doctor checks your rectum and colon for polyps (tissue masses). Polyps are usually harmless, but some can become cancerous. Polyps can be removed during colonoscopy.
Who should have it: In general, those ages 45 through 75 at average risk, the American Cancer Society says. (Ask your doctor about your risk level.)
Can you postpone it? It’s important to have it on time, Hochman says. If you’d prefer, ask your doctor whether you can do a home stool test instead.
Can you skip it altogether? At age 76, talk with your doctor. The ACS advises that people between 76 and 85 decide based on personal preferences, life expectancy, health, and screening history. The ACP says people older than 75 at average risk or those with a life expectancy of less than 10 years can stop.
Bone Density Scan
What it is: This X-ray, aka a DEXA scan, determines the strength of your bones.
Who should have it: The U.S. Preventive Services Task Force (USPSTF) recommends the screening for women 65 and older and postmenopausal women younger than 65 at higher risk for osteoporosis (brittle bones). Men 70 and older may want to talk to their doctors. For normal results, you can wait at least a decade for another screening. For low bone mass (osteopenia), you’ll be rescreened every three to five years; for osteoporosis, every two years.
Can you postpone it? It’s best to have it. “You don’t want to find out (about a higher fracture risk) by slipping in your driveway and breaking your hip and ending up in the emergency room during the pandemic,” says Sharon Brangman, MD, chair of geriatrics at Upstate University Hospital in Syracuse, N.Y.
Can you skip it altogether? Yes, if you’re younger than 65 with no risk factors.
Pap Smear
What it is: This exam checks cervical cells for abnormalities that may lead to cancer.
Who should have it: Generally, women younger than 65 and older women with a history of cervical cancer. The ACS and American College of Obstetricians and Gynecologists advise a Pap test every three years, or a Pap test along with a human papillomavirus test every five years.
Can you postpone it? It’s wisest to have it if you’re due or overdue, Fincher says.
Can you skip it altogether? Women without a cervix and those 65 and older who’ve had three normal Pap tests in a row in the prior 10 years can stop.
Blood Sugar Test
What it is: A fasting glucose test measures your blood sugar (glucose) levels after you’ve gone without calories for at least 8 hours, and an HbA1c test determines your average blood sugar levels over the prior two or three months.
Who should have it: Adults between ages 40 and 70 who are overweight or obese, the USPSTF says. If results are normal, the task force says rescreening every three years may be a “reasonable approach.” Those with prediabetes or type 2 diabetes will have a different schedule.
Can you postpone it? With prediabetes or type 2 diabetes, it’s key to keep up. Poorly controlled diabetes can make you more vulnerable to COVID-19 complications. Otherwise, it can probably wait.
Can you skip it altogether? If you’re older than 75, talk with your doctor. “There’s no set age to discontinue screening,” Brangman says. “It really depends on a person’s overall health and life expectancy.”
Cholesterol Check
What it is: This blood test measures levels of LDL (bad) and HDL (good) cholesterol, and triglycerides (fatty acids).
Who should have it: Healthy adults should be screened every four to six years, the American Heart Association says. If you take a cholesterol-lowering statin drug, the AHA and the American College of Cardiology advise screening every three to 12 months.
Can you postpone it? For a couple of months, but not much more, says Mary Tinetti, MD, a geriatrician at Yale School of Medicine in New Haven, Conn.
Can you skip it altogether? If you’re older than 75, ask your doctor, Tinetti says. There’s less evidence that high cholesterol leads to heart disease at this age.
What About an Annual Physical?
Though some research suggests that a once-a-year exam offers few benefits for healthy adults younger than 65, it’s a must for older adults, says Jacqueline Fincher, MD, president of the American College of Physicians. She says that most seniors have at least one chronic condition that requires monitoring and that doctors can assess for issues such as fall risk and depression during the appointment. “It also allows older adults to maintain a rapport and a close connection with their doctor,” Fincher says.
If you’re due for a physical but trying to minimize doctor’s appointments, you can schedule it for after you get the COVID-19 vaccine. In the meantime, you can probably do much of your physical via telehealth, says NYU Langone’s Joshua Chodosh, MD. (Share information on home screenings, such as those for blood pressure, with your doctor, too.) But there are limits. “It’s hard to check someone’s gait and balance over the internet,” Chodosh says. If you’re not due but haven’t seen a doctor since the pandemic hit, it’s wise to have a virtual check-in, says USC’s Michael Hochman, MD.
Prepare for a Doctor's Office Visit
Do your homework. Before your appointment, call to ask about safety steps, says Yale School of Medicine’s Mary Tinetti, MD. Universal mask use, sanitizing exam rooms between patients, and social distancing practices at check-in and in waiting areas are a must.
Don’t touch. Stay at least 6 feet from others in the office, and avoid contact with surfaces such as doorknobs, elevator buttons, and touchpads. If you must touch something, do so with a tissue and wash your hands or use a hand sanitizer afterward.
Skip small talk. It’s not the time to be chatty. Come prepared to describe your concerns clearly. If you have multiple concerns or questions you’d like to ask, make a list. This will ensure that the appointment is efficient and thorough.
Editor’s Note: A version of this article also appeared in the March 2021 issue of Consumer Reports On Health.
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