Your 50’s are a new stage in your life. Even though you’ve always done things the same way for decades and everything has worked out fine, entering a new life phase means new preventative measures to take to stay healthy for decades more.
In this segment, Dr. Jennifer Allen discusses the important screenings people over 50 years old should have performed and how to interpret the results.
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Recommended Health Screenings for People Over 50
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Learn more about Jennifer Allen, MD
Jennifer Allen, MD
Jennifer Allen, MD is an Internal Medicine specialist with Hendricks Regional Health Medical Group.Learn more about Jennifer Allen, MD
Transcription:
Recommended Health Screenings for People Over 50
Melanie Cole (Host): Your 50s are a new stage in your life and even though you’ve always done things a certain way for decades and everything has worked out fine, entering this new phase means new preventive measures to take to stay healthy for decades more. My guest today is Dr. Jennifer Allen. She’s an internal medicine physician at Hendricks Regional Health. Welcome to the show, Dr. Allen. Let’s talk about screening recommendations for the over-50 crowd. I’d like to start with blood pressure because it seems to be a baseline for so many other comorbidities. Speak about blood pressure. How often should you have it checked, and what kind of numbers would you like to tell the listeners you’d like to see?
Dr. Jennifer Allen (Guest): Blood pressure screening is very common. You get it done at your dentist’s office, so most people, by the time they’re 50, they will have had their blood pressure checked several times. For the 50 and over crowd – really for the 40 and over the crowd, we say you should have your blood pressure checked at least annually. Our goal blood pressure would be -- for people who are 60 and under, a goal blood pressure would be less than 140 on the top and less than 90 on the bottom, although we would like it a little bit lower than that if possible. For patients over 60, they’ve actually relaxed the blood pressure guidelines a little bit to a blood pressure less than 150 on the top number and still less than 90 on the bottom number.
Melanie: And now on to cholesterol. When we get our annual physicals every year, and they check your cholesterol – people see these numbers, they see words like LDL, and HDL, and triglycerides, and they don’t know what all these numbers mean and what would you like to tell them they do mean?
Dr. Allen: We follow several of those numbers. We tend to think that for healthy people without heart disease, without a history of stroke, we would like to see their total cholesterol less than 200. LDL, we think of as bad cholesterol – it’s not quite that simple – and we’d like to see that less than 130 for most people. And then your HDL, which is your good cholesterol, we’d like to see over 40 to 50 if possible. Your good cholesterol is actually very important, and that’s something you can modify with lifestyle. Exercise will bring that up. Maintaining a healthy weight can bring that up, and that’s actually a protective form of cholesterol.
Melanie: And now on to diabetes screening because it’s such a prevalent problem – actually an epidemic in this country as is obesity. People hear their fasting blood glucose, and then do they have the A1c? What about diabetes screening? Should we be screened for it?
Dr. Allen: Absolutely. For any adult with high blood pressure, or high cholesterol they should definitely start to be screened for diabetes at age 40 and then for anyone in that age or higher – especially who’s overweight – we should be having annual screenings for diabetes. We tend to test the fasting blood sugar or a hemoglobin A1c. A fasting blood sugar is just your morning blood sugar before you’ve had anything to eat. The goal would be less than 100, which is the completely normal range. One hundred to 126 is going to be a prediabetes range, and higher than that on more than one occasion is sufficient for a diagnosis of diabetes.
A hemoglobin a1c is a three-month average test that can tell us what your blood sugars have been running, so it’s very good for telling us if – even when we’re not testing, your blood sugar may be creeping up higher than we thought. An A1c is just an alternative screening test that we use to see if someone is a diabetic.
Melanie: While we’re talking about these blood tests and cholesterol and the A1c or the fasting blood glucose. Other things that show up in our blood tests, Dr. Allen, might be CRP -- people hear about that, and they’re not sure if this is a measure of inflammation for heart disease -- whether we should be getting that. And what about getting tested for vitamin D as we get older?
Dr. Allen: There are no guidelines that say that everyone should be tested for vitamin D as we get older. Certainly, adults over 50 want to make sure that they’re getting a sufficient amount of vitamin D. Probably 1000 international units of vitamin D3 is a good supplement for most people to take, but there’s no guidelines to test everyone over a certain age for vitamin D deficiency. It’s certainly very common for us in the Midwest where it’s cold a lot of the year, and we don’t get a lot of sun exposure to be low in vitamin D. Certainly, if you’re having any muscle pain, tell your doctor – any muscle weakness – tell your doctor and that might be a test they would want to go ahead and order.
C-reactive protein, when it’s elevated has been associated with a higher risk of cardiovascular disease, and we use it as a – just something to put you in a risk category. It might be that if your CRP is elevated, we’re not going to make any radical changes, but if we were on the fence about putting you on a cholesterol medicine, or doing something to reduce your cardiovascular risk factors, we might treat it more aggressively. With people with high CRP, it would be much more important, let’s say, for instance, quit smoking, or exercise regularly – basically do the things that are going to make them healthier overall in order to reduce their risk of heart disease or stroke.
Melanie: Dr. Allen, 50 seems to be a milestone for certain things and one of the big ones is colon cancer screening. They say to have that first colonoscopy at 50-years-old, and then depending on polyps – so speak about colon cancer screening and who do you think should have it at 50-years-old?
Dr. Allen: Everyone should have it at 50-years-old unless you are someone who is high risk and you have had it earlier. At 50, everyone should have it. This is something where a lot of people say, “Well, doc, I am not having any problems. I am not getting this done.” Well, that’s exactly when you need to have a colon cancer screening, and it’s so important because by the time people do have symptoms – if they’re going to develop a colon cancer – it’s usually fairly advanced requiring very significant treatment. With colonoscopies, we screen for it, and we aim to find colon cancer essentially before it’s cancer, when it can just be snipped out and taken care of. If everything’s fine, depending on – if everything is perfect you don’t have to have it done again for another ten years. It’s a very important test and one that everyone should have done by the time they’re 50 – at 50.
Melanie: And what about mammography? Does that change as we get a little bit older? Because we hear about pap smears and the little controversy about that – whether or not you should be getting a pap smear now every year if you don’t have HPV -- but what about mammograms, because women are a little confused now whether they should be getting their mammogram every year?
Dr. Allen: Mammogram screening has become a little bit more of a personal preference than it used to be. It used to be everyone would get it starting at age 40 every year. Well now, there are several different guidelines, and they range from starting at 40 to starting at 50 -- or maybe a little bit older -- and they range from one to two years. The risk of having mammograms every year starting at 40 is that we find more what we call false positives, meaning we find something that looks like it could be cancer, but isn’t. We put women through biopsies, lots of stress for it for a very benign finding. Now, it’s a conversation between you and your doctor. I think that conversation should probably start in women’s 40s and it should be a discussion for whether you want to go ahead and get a mammogram every one or every two years, and if you want to start screening at 40 or 50. A lot of that is going to depend on personal preference and how much risk you’ve got. Do you have breast cancer in your family, or ovarian cancer, or colon cancer in your family? Things that might affect whether you get breast cancer screenings earlier and more frequently, or not.
Melanie: I’d like to try and cover three more things. Let’s start with a skin exam, how often should we see a dermatologist and have them give us a big once over?
Dr. Allen: It depends on person to person. You can certainly – if you’re fairly low-risk for skin cancer – you can certainly have your primary care physician do a once-over once a year and that would be reasonable. For people who’ve had a skin cancer, if it was something like melanoma they would definitely be seeing a dermatologist. This is a very high-risk, dangerous skin cancer. They would definitely be seeing a dermatologist more frequently especially at first, but for lots of people who have had less scary, more slow-growing skin cancers, such a basal cell skin cancer or squamous cell skin cancer. These are still concerning, and those folks would probably want to go ahead and see a dermatologist every six months to a year.
Melanie: Lung cancer screening? We’re hearing more about that in the media. Who should be screened for lung cancer?
Dr. Allen: Sure, this is a relatively new development. There’s a recommendation now that starting at age 55 smokers and former smokers consider being screened for lung cancer. The screening only applies to people who have smoked within the last 15 years and who have smoked a total of 30 pack-years. We calculate a pack-year by how many packs a day you’ve smoked times how many years. For people who have been fairly heavy smokers – so 30 pack-years – starting at 55, we recommend a yearly low-dose CT scan to look for a lung cancer. Now again, this is a discussion between a doctor and a patient for if a patient would like to have that done. It’s a relatively new recommendation, and we do think that a CT scan is much, much more effective than a Xray. We don’t actually recommend yearly Xray screenings for lung cancer.
Melanie: And the last one that I would like to ask you about is osteoporosis screening. Who should have this DEXA scan, and where should they get it? Because now you can see them offering these at health clubs. Should they get them from their internal medicine physician?
Dr. Allen: Screening for osteoporosis is really important. We recommend that all women be screened for osteoporosis at age 65, younger if they have any risk factors. For instance, if they have been on prednisone that’s a risk factor. If they’re a life-long smoker, that’s another risk factor, or if they have a strong family history of osteoporosis. One thing that we miss is that men should also be screened for osteoporosis, starting a little bit older, but starting at 70 men should actually be getting a bone density test as well.
I don’t actually know a lot about DEXA scans in health clubs. I know that a lot of times they’re aimed at judging body fat and lean body mass and those kinds of things. I would recommend getting a bone density done at the Women’s Center, which is in Building 3.
Melanie: Wrap it up for us, with your best advice, about these screenings – it’s really been great information, Dr. Allen. Give everybody your best advice about prevention of some of these diseases and living a healthy lifestyle.
Dr. Allen: I think the most important thing is that starting at 50, you should be having regularly doctor’s appointments to discuss with your physician which screening tests are going to be appropriate for you. Prevention is just so important. Any of these things that we can take care of early are going to have so much less of an impact on long-term on people’s lives. I think having a yearly doctor’s appointment, especially starting at 50 if you haven’t already been doing so, to talk with your doctor specifically about prevention is very important and what I’d recommend.
Melanie: Thank you, so much, for being with us today. You’re listening to Health Talks with HRH, Hendricks Regional Health. For more information, you can go to Hendricks.org, that’s Hendricks.org. This is Melanie Cole. Thanks, so much for listening.
Recommended Health Screenings for People Over 50
Melanie Cole (Host): Your 50s are a new stage in your life and even though you’ve always done things a certain way for decades and everything has worked out fine, entering this new phase means new preventive measures to take to stay healthy for decades more. My guest today is Dr. Jennifer Allen. She’s an internal medicine physician at Hendricks Regional Health. Welcome to the show, Dr. Allen. Let’s talk about screening recommendations for the over-50 crowd. I’d like to start with blood pressure because it seems to be a baseline for so many other comorbidities. Speak about blood pressure. How often should you have it checked, and what kind of numbers would you like to tell the listeners you’d like to see?
Dr. Jennifer Allen (Guest): Blood pressure screening is very common. You get it done at your dentist’s office, so most people, by the time they’re 50, they will have had their blood pressure checked several times. For the 50 and over crowd – really for the 40 and over the crowd, we say you should have your blood pressure checked at least annually. Our goal blood pressure would be -- for people who are 60 and under, a goal blood pressure would be less than 140 on the top and less than 90 on the bottom, although we would like it a little bit lower than that if possible. For patients over 60, they’ve actually relaxed the blood pressure guidelines a little bit to a blood pressure less than 150 on the top number and still less than 90 on the bottom number.
Melanie: And now on to cholesterol. When we get our annual physicals every year, and they check your cholesterol – people see these numbers, they see words like LDL, and HDL, and triglycerides, and they don’t know what all these numbers mean and what would you like to tell them they do mean?
Dr. Allen: We follow several of those numbers. We tend to think that for healthy people without heart disease, without a history of stroke, we would like to see their total cholesterol less than 200. LDL, we think of as bad cholesterol – it’s not quite that simple – and we’d like to see that less than 130 for most people. And then your HDL, which is your good cholesterol, we’d like to see over 40 to 50 if possible. Your good cholesterol is actually very important, and that’s something you can modify with lifestyle. Exercise will bring that up. Maintaining a healthy weight can bring that up, and that’s actually a protective form of cholesterol.
Melanie: And now on to diabetes screening because it’s such a prevalent problem – actually an epidemic in this country as is obesity. People hear their fasting blood glucose, and then do they have the A1c? What about diabetes screening? Should we be screened for it?
Dr. Allen: Absolutely. For any adult with high blood pressure, or high cholesterol they should definitely start to be screened for diabetes at age 40 and then for anyone in that age or higher – especially who’s overweight – we should be having annual screenings for diabetes. We tend to test the fasting blood sugar or a hemoglobin A1c. A fasting blood sugar is just your morning blood sugar before you’ve had anything to eat. The goal would be less than 100, which is the completely normal range. One hundred to 126 is going to be a prediabetes range, and higher than that on more than one occasion is sufficient for a diagnosis of diabetes.
A hemoglobin a1c is a three-month average test that can tell us what your blood sugars have been running, so it’s very good for telling us if – even when we’re not testing, your blood sugar may be creeping up higher than we thought. An A1c is just an alternative screening test that we use to see if someone is a diabetic.
Melanie: While we’re talking about these blood tests and cholesterol and the A1c or the fasting blood glucose. Other things that show up in our blood tests, Dr. Allen, might be CRP -- people hear about that, and they’re not sure if this is a measure of inflammation for heart disease -- whether we should be getting that. And what about getting tested for vitamin D as we get older?
Dr. Allen: There are no guidelines that say that everyone should be tested for vitamin D as we get older. Certainly, adults over 50 want to make sure that they’re getting a sufficient amount of vitamin D. Probably 1000 international units of vitamin D3 is a good supplement for most people to take, but there’s no guidelines to test everyone over a certain age for vitamin D deficiency. It’s certainly very common for us in the Midwest where it’s cold a lot of the year, and we don’t get a lot of sun exposure to be low in vitamin D. Certainly, if you’re having any muscle pain, tell your doctor – any muscle weakness – tell your doctor and that might be a test they would want to go ahead and order.
C-reactive protein, when it’s elevated has been associated with a higher risk of cardiovascular disease, and we use it as a – just something to put you in a risk category. It might be that if your CRP is elevated, we’re not going to make any radical changes, but if we were on the fence about putting you on a cholesterol medicine, or doing something to reduce your cardiovascular risk factors, we might treat it more aggressively. With people with high CRP, it would be much more important, let’s say, for instance, quit smoking, or exercise regularly – basically do the things that are going to make them healthier overall in order to reduce their risk of heart disease or stroke.
Melanie: Dr. Allen, 50 seems to be a milestone for certain things and one of the big ones is colon cancer screening. They say to have that first colonoscopy at 50-years-old, and then depending on polyps – so speak about colon cancer screening and who do you think should have it at 50-years-old?
Dr. Allen: Everyone should have it at 50-years-old unless you are someone who is high risk and you have had it earlier. At 50, everyone should have it. This is something where a lot of people say, “Well, doc, I am not having any problems. I am not getting this done.” Well, that’s exactly when you need to have a colon cancer screening, and it’s so important because by the time people do have symptoms – if they’re going to develop a colon cancer – it’s usually fairly advanced requiring very significant treatment. With colonoscopies, we screen for it, and we aim to find colon cancer essentially before it’s cancer, when it can just be snipped out and taken care of. If everything’s fine, depending on – if everything is perfect you don’t have to have it done again for another ten years. It’s a very important test and one that everyone should have done by the time they’re 50 – at 50.
Melanie: And what about mammography? Does that change as we get a little bit older? Because we hear about pap smears and the little controversy about that – whether or not you should be getting a pap smear now every year if you don’t have HPV -- but what about mammograms, because women are a little confused now whether they should be getting their mammogram every year?
Dr. Allen: Mammogram screening has become a little bit more of a personal preference than it used to be. It used to be everyone would get it starting at age 40 every year. Well now, there are several different guidelines, and they range from starting at 40 to starting at 50 -- or maybe a little bit older -- and they range from one to two years. The risk of having mammograms every year starting at 40 is that we find more what we call false positives, meaning we find something that looks like it could be cancer, but isn’t. We put women through biopsies, lots of stress for it for a very benign finding. Now, it’s a conversation between you and your doctor. I think that conversation should probably start in women’s 40s and it should be a discussion for whether you want to go ahead and get a mammogram every one or every two years, and if you want to start screening at 40 or 50. A lot of that is going to depend on personal preference and how much risk you’ve got. Do you have breast cancer in your family, or ovarian cancer, or colon cancer in your family? Things that might affect whether you get breast cancer screenings earlier and more frequently, or not.
Melanie: I’d like to try and cover three more things. Let’s start with a skin exam, how often should we see a dermatologist and have them give us a big once over?
Dr. Allen: It depends on person to person. You can certainly – if you’re fairly low-risk for skin cancer – you can certainly have your primary care physician do a once-over once a year and that would be reasonable. For people who’ve had a skin cancer, if it was something like melanoma they would definitely be seeing a dermatologist. This is a very high-risk, dangerous skin cancer. They would definitely be seeing a dermatologist more frequently especially at first, but for lots of people who have had less scary, more slow-growing skin cancers, such a basal cell skin cancer or squamous cell skin cancer. These are still concerning, and those folks would probably want to go ahead and see a dermatologist every six months to a year.
Melanie: Lung cancer screening? We’re hearing more about that in the media. Who should be screened for lung cancer?
Dr. Allen: Sure, this is a relatively new development. There’s a recommendation now that starting at age 55 smokers and former smokers consider being screened for lung cancer. The screening only applies to people who have smoked within the last 15 years and who have smoked a total of 30 pack-years. We calculate a pack-year by how many packs a day you’ve smoked times how many years. For people who have been fairly heavy smokers – so 30 pack-years – starting at 55, we recommend a yearly low-dose CT scan to look for a lung cancer. Now again, this is a discussion between a doctor and a patient for if a patient would like to have that done. It’s a relatively new recommendation, and we do think that a CT scan is much, much more effective than a Xray. We don’t actually recommend yearly Xray screenings for lung cancer.
Melanie: And the last one that I would like to ask you about is osteoporosis screening. Who should have this DEXA scan, and where should they get it? Because now you can see them offering these at health clubs. Should they get them from their internal medicine physician?
Dr. Allen: Screening for osteoporosis is really important. We recommend that all women be screened for osteoporosis at age 65, younger if they have any risk factors. For instance, if they have been on prednisone that’s a risk factor. If they’re a life-long smoker, that’s another risk factor, or if they have a strong family history of osteoporosis. One thing that we miss is that men should also be screened for osteoporosis, starting a little bit older, but starting at 70 men should actually be getting a bone density test as well.
I don’t actually know a lot about DEXA scans in health clubs. I know that a lot of times they’re aimed at judging body fat and lean body mass and those kinds of things. I would recommend getting a bone density done at the Women’s Center, which is in Building 3.
Melanie: Wrap it up for us, with your best advice, about these screenings – it’s really been great information, Dr. Allen. Give everybody your best advice about prevention of some of these diseases and living a healthy lifestyle.
Dr. Allen: I think the most important thing is that starting at 50, you should be having regularly doctor’s appointments to discuss with your physician which screening tests are going to be appropriate for you. Prevention is just so important. Any of these things that we can take care of early are going to have so much less of an impact on long-term on people’s lives. I think having a yearly doctor’s appointment, especially starting at 50 if you haven’t already been doing so, to talk with your doctor specifically about prevention is very important and what I’d recommend.
Melanie: Thank you, so much, for being with us today. You’re listening to Health Talks with HRH, Hendricks Regional Health. For more information, you can go to Hendricks.org, that’s Hendricks.org. This is Melanie Cole. Thanks, so much for listening.