Medical Tests

Pop quiz: What kind of test can you still fail, no matter how hard you study?

Sure, calculus and organic chemistry cause brain cell blowout. But medical tests are worse. With those, late-night cramming won''''t do you a bit of good.

There are literally hundreds of tests that doctors can perform to help diagnose illnesses. If you''''ve read the chapters on gynecological exams (see page 159) or pregnancy (see page 309), you''''ve been introduced to a few of them. But these are only the tip of the medical-test iceberg.

The main function of medical tests is to save lives. So you''''re doing yourself a favor when you get the tests you need--on schedule. If every woman followed established guidelines for breast cancer screening, for instance, doctors estimate that some 15,000 lives would be spared each year. Similarly, screening for colon cancer could prevent many thousands of deaths annually. Even simple things such as having your blood pressure checked and your blood cholesterol levels measured and controlled regularly could help prevent up to half of the 250,000 heart attack deaths and the 100,000 stroke deaths among women each year.

Getting the Whole Story

Each woman''''s needs are different, based on age, genetics, medical history and lifestyle. But some basic information can help you--along with the advice of your doctor--to determine a screening schedule that''''s best for you.

The following general guidelines for women are approved by physicians representing the American Medical Women''''s Association.

Note: In addition to these, you may want testing for AIDS and other sexually transmitted diseases--recommended by many doctors. (See "Sexually Transmitted Diseases" on page 341.)

Blood Tests

Heart disease is the leading cause of death in American women, striking down half a million each year. You can detect heart disease early and take steps to reverse it if you follow the guidelines below.

Blood Pressure Test

Which is: A measurement of blood pressure done with an inflatable cuff (sphygmomanometer).

How often: Once every year if all of the following apply to you:

* You are age 19 to 40

* You have no heart disease factors

* You are not taking oral contraceptives

Twice or more every year if any of the following apply to you:

* You are over age 40

* You take oral contraceptives

* You have borderline high blood pressure (140/90 or greater)

* You have a personal or family history of high blood pressure or heart disease

* You are on blood pressure control medication

* You smoke

* You are overweight

* You regularly take over-the-counter nonsteroidal anti-inflammatory medications (analgesics) such as aspirin or ibuprofen

* You have a physician''''s recommendation to take the test more than once a year

Comments: If you have healthy blood pressure, the reading should be less than 140 systolic over less than 90 diastolic. (The first number is a measure of pressure when your heart contracts; the second, when it expands.)

Blood Cholesterol Test

Which is: A small blood sample that''''s analyzed at the doctor''''s office or in a laboratory. The results tell you your total cholesterol plus HDL and LDL ratios in addition to your triglyceride level.

How often: At least once every year if:

* You are any age

Twice or more every year if any of the following apply to you:

* You have recently gained a lot of weight

* You have become sedentary

* You have become ill

* You have borderline high cholesterol (about 200 to 240 mg/dl)

* You have high cholesterol (above 240 mg/dl)

* You are on cholesterol-lowering medication

* You have diabetes or kidney disease

* You have HDL (good cholesterol) levels below 35 mg/dl

* You have had your ovaries removed

* You have recently gone through menopause

* You have heart disease or symptoms of heart disease

* You have a physician''''s recommendation to have it done more often than once a year

Comments: The test should be taken after a 12-hour fast, because triglycerides are very sensitive to diet. Even children should take the test. For women, healthy readings should be in the range of 160 mg/dl for total cholesterol, with an HDL of 50 mg/dl or higher, LDL below 120 mg/dl and triglycerides below 110 mg/dl.

Exercise Stress Tests

These tests are valuable because they show how your heart performs when you''''re actually exercising. About 40 percent of the tests come back with a false-positive--that is, the test indicates problems when there are none. But your doctor has an arsenal of more sensitive tests that can be given for follow-up. When the finding is abnormal, your doctor might give you a stress echocardiogram--measuring with ultrasound while you exercise--or a nuclear medicine test, which involves injection of a radioactive tracing material. In fact, if you''''re at high risk for heart disease because of family history or a prior record of heart problems, a physician might skip the exercise stress test and go directly to the more sensitive test.

Exercise Stress Test

Which is: A test of coronary fitness. You will perform some exercise, such as walking on a treadmill or pedaling a stationary bike, while being monitored with an electrocardiogram. This test can help reveal coronary artery disease.

How often: Once for screening if:

* You have no risk factors and the test comes back negative

Repeated tests every two to five years if any of the following apply to you:

* You are over age 40

* You are over age 30 and have strong risk factors for heart disease such as high blood pressure, diabetes, obesity, smoking or family history of heart disease

* You have had your ovaries removed

* You have high cholesterol

* You have symptoms of heart disease

* You have a physician''''s recommendation

Comments: To prevent the onset of heart disease--particularly if you are at high risk because of your lifestyle or family history, see the exercise recommendations beginning on page 443 and nutritional guidelines beginning on page 266.

Gynecological Tests

We''''re all susceptible to a wide range of gynecological problems, from vaginal infections and uterine fibroids to cervical abnormalities and ovarian growths. Along with the annual pelvic exam, you should be aware of some of the other screening tests that are available to women. Here''''s a summary.

Pelvic Exam

Which is: Manual examination of your vaginal area to check for abnormalities of the uterus and ovaries.

How often: Once every year if:

* You are over the age of 18

Pap Test

Which is: An examination for signs of cervical cancer. The doctor takes a scraping of cells from the cervix and the cervical canal and smears it on a slide. The sample is then sent to a laboratory for analysis.

How often: Once every year if:

* You are over age 18

Comments: For greatest reliability, you need a skilled medical professional and analysis from a well-qualified laboratory. Seek a board-certified health practitioner for your test.

Transvaginal Ultrasound

Which is: A screening tool to detect changes in the lining of the uterus and ovaries that might suggest cancer. An ultrasound probe is inserted into the vagina, and the probe transmits images of the uterus and ovaries to a monitoring screen.

How often: One screening test--possibly followed by others if your physician recommends it or if any of the following apply to you:

* You are at or past menopause

* You have risk factors for endometrial cancer

* You have a strong family history or other significant risk factors for ovarian cancer

Endometrial Tissue Sample

Which is: Removal of a tiny piece of tissue from the lining of the uterus (endometrium) to check for development of cancer. To perform this test, a thin instrument is inserted through the vagina and cervical opening to remove the tissue sample from the uterus.

How often: One screening test, possibly followed by others as recommended by a doctor, if any of the following apply to you:

* You are past menopause and are considering getting--or are currently receiving--hormone replacement therapy

* You are taking tamoxifen

* You eat a very high fat diet

* You have a history of infertility

* You have a history of not ovulating

* You are very overweight

* You have a family history of endometrial cancer

* You exhibit abnormal uterine bleeding

Comments: This procedure--also called an endometrial biopsy or aspiration--can cause cramping. To avoid damage to the uterus, endometrial sampling should only be performed by an experienced physician.

Breast Examinations

More than 180,000 women are diagnosed with breast cancer every year, and as many as 46,000 die prematurely as a result of this disease. But experts from the American Medical Women''''s Association say that if all women followed the guidelines below, one-third of those deaths could probably be avoided.

Breast Self-Examination

Which is: Careful self-palpation (examination by touch) of each breast to check for any unusual lumps or masses.

How often: Every month, preferably the week after your period if:

* You are over age 16

Comments: Many doctors say that breast self-exam (BSE) should be a lifelong habit. To learn the skill of BSE, ask your physician for guidance or take classes at your community hospital or at a woman''''s health clinic. Your local American Cancer Society office should have information. (To find out how a BSE is done, see page 58.)

Breast Examination by a Health Professional

Which is: Visual examination and careful palpation of the breasts and underarms by a qualified doctor or health professional. You should be examined both sitting up and lying down.

How often: Every two to three years if:

* You are under age 39 and have no risk factors for or symptoms of breast cancer

Once a year or more frequently at a doctor''''s recommendation if any of the following apply to you:

* You are over age 40

* You have lumpy breasts that are difficult to self-examine

* You do not perform monthly breast self-exams

* You have risk factors for breast cancer: a family history of the disease, no children before age 30, breast biopsies that show atypical growths or a personal history of breast cancer

Mammography

Which is: A low-dose breast x-ray. The breast is pressed firmly between two plates (uncomfortable--but necessary) for each x-ray view. Usually two or three views per breast are required for a complete screening.

How often: One baseline test, followed by additional tests every one to two years if:

* You are age 40 to 49 and don''''t have risk factors for or symptoms of breast cancer

Once every year or at a doctor''''s recommendation if either of the following applies to you:

* You are age 50 or older

* You have risk factors for breast cancer (no matter what your age)

Comments: Most doctors recommend that you schedule your mammogram the week after your menstrual period to minimize discomfort. If the doctor does find a suspicious lump, it should be biopsied for a definite diagnosis. There is a 15 percent false-negative rate for mammography: That means there''''s better than a one in ten chance you have no problem, even if the mammography shows a mass or lump. The biopsy is an important and necessary backup to verify the mammography.

Bone Tests

If you''''re an American woman, you have a one in two chance of developing fractures from osteoporosis sometime during your lifetime--most likely after menopause. Complications resulting from hip fractures account for 50,000 deaths every year. Many of these deaths may be preventable.

"There''''s no reason we can''''t prevent most hip fractures and deaths from osteoporosis if we combine early detection and treatment," says Sydney Lou Bonnick, M.D., director of osteoporosis services at the Texas Woman''''s University in Denton and author of The Osteoporosis Handbook. Many tests are available, and all the techniques are capable of detecting low bone mass and diagnosing osteoporosis, according to Sandra C. Raymond, executive director of the National Osteoporosis Foundation. But some experts believe "that for predicting fracture risk, the specific bone at risk for fracturing should be measured," says Raymond. That means the doctor may choose to focus on a particular area of bone, such as the hip, where fractures are likely to happen.

Many doctors recommend a bone scan before menopause. This first test provides a baseline measurement that your doctor can interpret to find out whether you should take estrogen or another medication (such as salmon calcitonin or etidronate) to prevent further bone weakening. By repeating the scan 12 to 18 months past menopause, the doctor can later determine whether you have lost too much bone. Based on the results, she may recommend that you need to begin medication or adjust your current dosage.

Not all tests are accurately interpreted, however. "It''''s a problem all of us recognize and are trying to improve," says Dr. Bonnick. He recommends that before having the test, you ask the technician whether she''''s had several years of experience with bone scans. Make sure that the physician will be reviewing the test and providing a written interpretation. Don''''t settle for a computer printout­based diagnosis, Dr. Bonnick cautions.

Bone Scan

Which is: Performed by machines that use low-dose radiation to measure bone mass. You sit or lie on a table with the machine positioned above or below you. The procedure is painless and, depending on the technology used, may take from 5 to 30 minutes.

How often: One baseline test just before menopause or very early in menopause with a second test 12 to 18 months after menopause.

You may need more follow-up tests, at the recommendation of your doctor, if any of the following apply to you:

* You have risk factors for osteoporosis based on your family history

* You use steroids

* You have a low-calcium diet

* You lead a sedentary lifestyle

Comments: Many different technologies are available for measuring bone density, but it''''s not always easy to find a facility where you can take the test. The National Osteoporosis Foundation suggests checking with a local academic health center, a major hospital or a local branch of the American Medical Association.

Tests for Colon Cancer

Colon cancer is the third leading cancer among women, after breast cancer and lung cancer--and more women than men get it every year. If you follow the screening recommendations below, you might be able to detect precancerous changes and early cancer. When it''''s caught early, colon cancer can usually be treated very effectively.

Digital Rectal Exam

Which is: Examination of the rectum with a gloved finger to detect abnormalities.

How often: Once every year if:

* You are age 40 or over

Fecal Occult Blood Test

Which is: A stool sample obtained at home or at the physician''''s office. In the lab the stool is analyzed for the presence of blood, which is a possible symptom of colorectal cancer.

How often: Once every year if:

* You are age 50 or over

Comments: This test has been criticized because of the high rate of false-positives (wrongly indicating a possibility of cancer) and false-negatives (missing cancer that''''s really there). A positive result might indicate ulcers, hemorrhoids or other problems--and a number of follow-up tests such as the ones below can be used to confirm the results of this test.

Sigmoidoscopy

Which is: Examination with a thin, hollow, lighted tube to look for precancerous polyps and remove them before a cancer develops. The tube is inserted into the rectum and lower part of the colon. Flexible sigmoidoscopes are preferred, because they cause less discomfort than rigid scopes.

How often: Once every three to five years if:

* You are age 50 or over and have no colorectal cancer risk factors or symptoms

More than once every three years, at the discretion of your physician, if any of the following apply to you:

* You have a personal history of colon polyps, chronic inflammatory bowel disease or colorectal cancer

* You have a family history of these diseases--especially if your parents, siblings or children developed colon cancer before age 50

* You have symptoms of colorectal cancer, such as diarrhea, constipation or both, blood in your stools, very narrow stools, unexplained weight loss, frequent gas pains and general stomach discomfort

* You have a feeling that the bowel does not empty completely

* You have a history of breast, endometrial or ovarian cancer

Tests on the Horizon

Doctors, researchers and technicians are coming up with new medical tests so fast that it''''s hard to keep track of all the advances. But the general direction of the improved medical tests is toward less pain, more gain.

Among the new generation of medical tests the "ouchless" variety. Some of these are noninvasive--that is, they involve no knives, needles or tubes. Others are far less invasive or inconvenient than conventional procedures used previously. In many cases, the new procedures are faster and more accurate.

Though some of these ouchless tests are still under development, it never hurts to ask your doctor if they''''re available. Here''''s a rundown of what these procedures have to offer.

A Rodeo for Breast Checks

A technique that has been tested at Baylor University Medical Center in Dallas may help many women with suspicious breast lumps avoid the wait, worry and discomfort of breast biopsies. It involves simply placing a cone-shaped antenna over the breast for a few moments.

Rotating delivery of excitation off-resonance (RODEO) is an improved form of magnetic resonance imaging (MRI). While MRI combines magnetic fields and radio waves to produce an image of the inside of a breast, RODEO goes beyond that. It shows the contrast between normal breast tissue and cancerous tissue.

"Conventional MRI uses a contrasting agent that makes tumors appear as white," says Steven Harms, M.D., director of magnetic resonance at Baylor and co-developer of RODEO. "But since fatty tissue in the breast also shows up as white, finding a breast tumor on a standard MRI image can be like locating a snowman in a snowstorm. With RODEO a special radio field blocks out the fat, so cancerous tumors really stand out."

Speeding Up Bone Scans

Doctors can now spot bone loss indicating osteoporosis in women years earlier than they could before. The secret: dual energy x-ray absorptiometry (DEXA), the fastest and most precise radiological test developed.

DEXA uses much the same technology as its predecessor in bone density testing, dual photon absorptiometry, or DPA. You lie on a padded table while a device resembling an x-ray machine takes a picture of your bones.

Although DEXA has been around for several years, you might have to ask your doctor to refer you to a major medical facility that provides the test.

Scoping Out Balky Bowels

Doctors at the Mayo Clinic in Rochester, Minnesota, have developed a test that can complement routine blood tests and may even eliminate the need for complex endoscopic (internal) exams in the diagnosis of irritable bowel syndrome (IBS). It''''s called bowel scintiscan, and it''''s as easy as taking an aspirin.

In IBS, problems in the stomach or small intestine can keep food from passing through the digestive system smoothly. As if that''''s not uncomfortable enough, the syndrome is usually diagnosed after a series of tests are negative. These include endoscopy, which involves passing a tube with a light at the end through the mouth and into the stomach and small intestine.

A separate exam with a similar tube evaluates the colon. A tiny camera passed down the tube takes pictures of what''''s going on inside.

Another diagnostic procedure is a bowel scintiscan--an outpatient procedure that involves swallowing a harmless radioactive capsule on an empty stomach and eating a small meal. Pictures, similar to x-rays, of the abdomen are taken immediately after the capsule and meal are swallowed and at intervals later. The pictures help a physician determine whether you have IBS or another disturbance of the contractions of the intestines.

Bowel scintiscan has several advantages over older tests, according to Michael Camilleri, M.D., professor of medicine in the Mayo Clinic''''s Gastroenterology Research Unit. "For a patient it''''s painless, and it allows us to test without inserting any tubes into the body. For the physician it provides an extended exam that effectively assesses the entire digestive tract," he says.

First offered at the Mayo Clinic, the bowel scintiscan is expected to become increasingly available at other major research and treatment centers around the country.

A Breathalyzer for Ulcers

Conventional methods for detecting duodenal ulcers may involve blood tests and endoscopic exams, which must often be conducted several weeks after treatment has started. But the latest innovation in ulcer testing not only eliminates the invasive procedures but also takes the guesswork out of diagnosis and can chart the healing process without lengthy and costly laboratory work.

The innovation is a breath test developed at Baylor College of Medicine to detect Helicobacter pylori, a type of bacteria that lives in the digestive tracts of duodenal ulcer patients.

To take the test, you swallow a special form of urea, a natural compound, that has been tagged with heavy, nonradioactive carbon. If H. pylori is present, it will feed on the urea and release the carbon. When you breathe into a test bag, the amount of heavy carbon in your breath then tells your doctor the amount of H. pylori you have in your digestive system.

A positive test for H. pylori can confirm a diagnosis of duodenal ulcer.

Bloodless Glucose Tests

Many diabetes patients must prick their fingers several times a day to get blood samples for glucose monitoring. But soon there may be a painless alternative to this sticky problem.

One kind of monitor that''''s being tested uses infrared light to check glucose levels in the blood. When a finger is passed through an infrared beam, circulating blood acts like a prism, dispersing the light into a spectrum. The monitor, which could be available for home use, would simply read the spectrum to determine how much glucose is present.

Spying on Heart Attack

Ultrafast computed tomography (CT) is a testing technique that targets the coronary arteries and the heart. Doctors anticipate that it may replace the conventional CT scan in heart disease screening and diagnosis.

Both ultrafast CT and conventional CT methods involve x-raying the heart and surrounding blood vessels. A CT scan takes pictures over several seconds, while ultrafast CT shoots its images within one-tenth of a second. Like a camera with a fast shutter speed, ultrafast CT freezes the motion of the beating heart and captures it in great detail.

In fact, ultrafast images are so detailed that they can allow doctors to spot minute calcium deposits in the coronary arteries--and they can intervene long before these deposits progress to full-blown heart disease. Ultrafast CT is already in use at hospitals around the country.

Testless Testing

In some cases the best replacement for tests that predict heart attack risk may be no new tests at all.

One study suggests that sometimes a program of regular physical exams, exercise stress tests and careful history taking may prove just as valuable in saving lives. The study, conducted at the Lown Cardiovascular Medical Center in Brookline, California, targeted 171 heart disease patients who had been referred for second opinions on their need for angiograms. (Angiography is a procedure used to detect blockages that involves injecting a trace substance in the arteries and then tracking its path through the blood vessels.)

Using medical histories and results of exercise tests and physical exams, the second-opinion doctors decided that 80 percent of the patients didn''''t need angiograms. (Only six patients were encouraged to have the procedure.)

After four years the second opinions had predicted actual outcomes very well: A majority of the patients had experienced no major problems.

No one would suggest that noninvasive, ouchless tests are the answer for every patient; many of them have yet to be perfected, and depending on your situation, more complicated conventional testing may be just what the doctor ordered. But if you think that one of these noninvasive tests may be for you, ask your doctor. Don''''t be surprised if the next time she tells you, "This test won''''t hurt a bit," it''''s true.

See also Blood, Breasts, Gynecological Exam, Heart, Rectum, Reproductive System, Sexually Transmitted Diseases