Take These Tests
Regular health checkups can be vital to your well-being.
By Barbara Klink, graduate, Iowa State University
Entrance exams. Midterms. Finals. As a student, you’re bombarded with tests. They’re the bane of your existence! What more could you possibly need to do?
The correct answer: A) routine health screening.
Routine health screenings can have a greater impact on your life than all other tests combined—because they may help save it. Even if you are apparently quite healthy, it’s important to get into a regular routine for screening.
If you want an affirmation of the utility of regular exams, just talk with Tracy*, a 24-year-old graduate student at Missouri State University in Springfield. Thanks to prudent medical detective work on the part of her gynecologist, including subsequent blood work, Tracy discovered issues that needed to be addressed—when they were still very manageable. She explains, “My insulin levels were out of the normal range. Fixing my sugar intake helped lower my hormone levels and my insulin production.”
Tracy’s positive experience with screening and treatment makes her a strong advocate of regular checkups. States Tracy, “By going for a yearly visit, you are able to detect things that may be just small problems now—before they turn into larger problems later.”
Start With a Routine Physical
According to Dr. Holly Smith, clinical assistant professor of pediatrics at The University of Texas Health Science Center at Houston (UTHealth), college-aged students should go for a physical exam by a physician every two years, as recommended by the U.S. Preventive Services Task Force (USPSTF) guidelines. This exam should include a blood pressure check, as well as measurements of weight and height, and a calculation of body mass index (BMI) from the weight and height. In addition, notes Dr. Smith, students should get an influenza vaccine (flu shot) and dental evaluation every year.
Dr. Muhammad Amer, assistant professor of medicine in the Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, in Baltimore, Maryland, offers similar recommendations, with some elaboration. The exam also should include anthropometry, according to Dr. Amer. Anthropometry refers, specifically, to the measuring of body size, structure, and composition, as well as to the determination of the percent of water and fat content in the body, which can serve as an indicator of overall nutritional status and physical fitness, Dr. Amer explains.
Dr. Amer recommends taking a more traditional approach and having a general physical exam annually (if there are no specific risk factors to warrant more frequent examination). The physical should include medical history, family history, social history, surgical history, allergies, a detailed review of body systems, and current medications, he advises.
Then, at every visit, says Dr. Amer, the exam should include a check of vital signs—blood pressure, respiratory rate, pulse, and temperature—followed by a total body exam, from head to toe.
The Importance of Blood Tests
In addition to the complete physical, students may wish to consider having routine blood work done. Dr. Amer recommends a complete metabolic panel, which includes the assessment of kidney and liver function, and serum electrolytes, and also a complete blood count (CBC), which screens for such issues as anemia, infections, and coagulation disorders. Dr. Smith also advises students to get blood work, but only in particular circumstances. To find out more, read the information on diabetes and cholesterol at the bottom of this page.
To learn about other tests that can be vital to your well-being, continue reading below.
Women-Only Exams
According to Dr. Smith, women need a “well-woman exam,” which includes a clinical breast exam, a Pap smear, and a bimanual (two-hand) pelvic exam if they are over 21 years old and sexually active.
Dr. Amer also counsels women to see their gynecologist for a Pap smear and genitalia exam, and to get an HPV vaccine, which helps protect against infection by certain HPV viruses that cause genital warts and cervical cancer, if this vaccine is appropriate for them. Plus, says Dr. Amer, women should have an exam to assess secondary sexual development and to make sure that there are no developmental issues and other such gynecologic conditions as polycystic ovary disease and amenorrhea (absence of menstrual bleeding).
Men-Only Exams
Men in the college age bracket, says Dr. Amer, should see their general practitioner for an annual physical, which should include an exam for hernias and an exam of the genitalia. During this visit, says Dr. Amer, the physician should conduct a physical exam of the testicles, paying note to any such suspicious finding as a swelling or mass, which will warrant follow-up with an ultrasound exam.
Another potential issue, he notes, is varicose veins in the testicles, a condition that, while generally benign, may cause pain or may have implications for possible infertility issues.
Dr. Smith explains that although a patient can have a testicular examination to detect masses by his physician, abnormalities can be detected by the patient or the patient’s partner.
Prevention Is the Best Medicine
Dr. Amer emphasizes that the best medicine often is preventive: “Patients should follow a healthy lifestyle.” He advocates aerobic exercise three to four times a week, and a healthy diet. “Try to avoid fast food, junk food, and burgers, etc.,” says Dr. Amer, “and have a high fiber intake.”
Dr. Smith seconds that opinion. She states, “Students should eat three balanced meals a day. Healthy meals should include low-fat meats, fruits and vegetables, low-fat dairy products, and whole-grain starches. While these items aren’t the least expensive ones at the grocery store, students should try to include some of them in their diet and reduce eating out to cut costs.”
Dr. Amer also notes that to optimize your ability to stay well, “you need to talk with your doctor routinely. If you have risk factors, you need to be sure to discuss with your doctor what’s required for further investigation into your case.”
*Name changed for privacy purposes.
BARBARA KLINK IS A FREELANCE WRITER AND THE AUTHOR OF A SATIRIC BUSINESS LEXICO, BIZ-BUZZ: THE GLIB BUSINESSPERSON'S GUIDE TO USEFUL EUPHEMISMS. SHE HAS A B.A. IN JOURNALISM FROM IOWA STATE UNIVERSITY.
Find Out More
Click for more about the health screening recommendations by age group from the National Institutes of Health.
Click for more recommendations about annual preventative health exams for women.
Click for a link to complete a mental health screening for college students.
Blood Pressure Specifics
Blood pressure, states Dr. Muhammad Amer, assistant professor of medicine in the Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, in Baltimore, Maryland, should be taken twice—in both arms—to help in diagnosis of critical vascular anomalies, such as narrowing or hardening of the aorta. If such a condition is suspected, he adds, further imaging should be done to confirm diagnosis.
For college-aged students, blood pressure below 120/80 mm Hg is considered normal, says Dr. Amer. Individuals with blood pressure in the range of 120 to 139 mm Hg/80 to 89 mm Hg are in the prehypertension category; lifestyle modifications are highly recommended to prevent complications from high blood pressure among people with blood pressure in this range, notes Dr. Amer. However, he specifies, 140/90 mm Hg is considered the starting point for high blood pressure warranting treatment. Also, he warns, blood pressure this high in a college-aged student may be indicative of a condition called early onset hypertension (or secondary hypertension, which needs to be investigated further to diagnose and treat such conditions as primary aldosteronism—an adrenal gland disorder—and Cushing’s disease—a pituitary gland disorder). If you have blood pressure as high as 140/90, your doctor may want to delve further into potential secondary causes. Be proactive by asking your doctor about measures to help lower your blood pressure. Dr. Amer suggests beginning with lifestyle changes. For example, regular exercise and decreased salt intake can help improve health at every stage of hypertension, Dr. Amer notes.
Dr. Holly Smith, clinical assistant professor of pediatrics at The University of Texas Health Science Center at Houston, offers similar counsel: “All people over age 18 years old should be screened every two years if their blood pressure remains less than 120/80. If it is 120 to 139/80 to 90, it needs to be checked every year. If the blood pressure is higher than 140/90 at least twice over a period of one week to several weeks, a diagnosis of hypertension can be made.”
Screening for Diabetes
Dr. Holly Smith, clinical assistant professor of pediatrics at The University of Texas Health Science Center at Houston, states that, according to the U.S. Preventive Services Task Force (USPSTF) guidelines, the three screening tests for diabetes include a fasting blood glucose level, a two-hour post-load glucose level, and a hemoglobin A1C test (a blood test that measures glucose level over the past three months). Diabetes is diagnosed if the fasting blood glucose level is over 125, says Dr. Smith. Asymptomatic patients with a blood pressure over 135/80 should be screened for diabetes, she notes. There is no evidence to support screening asymptomatic people with normal blood pressure, states Dr. Smith. She adds, “Many young people go to the doctor for a physical thinking that they need blood work. However, if they have no risk factors, they usually don’t need blood tests. College students may have their own student health insurance, which is reasonable in cost. To keep costs down, insurance plans [may] follow the USPSTF guidelines and students can’t request screening just because they are curious.”
Screening for Sexually Transmitted Infections (STIs)
Being sexually active increases the risk of sexually transmitted infections (STIs), warns Dr. Holly Smith, clinical assistant professor of pediatrics at The University of Texas Health Science Center at Houston. Thus, if you’re a sexually active woman under age 25, she recommends that you get screened for chlamydia and gonorrhea. This screening can be done during the well-woman exam, says Dr. Smith, or with a urine test. Early treatment of chlamydia and gonorrhea helps prevent scarring of a woman’s fallopian tubes (part of the reproductive organs) and thus helps prevent tubal pregnancies and infertility, she explains.
However, notes Dr. Smith, it is not recommended that asymptomatic men routinely be screened for STIs.
For persons of both genders, ages 13 to 64 years, an HIV test is recommended. Those at increased risk for human immunodeficiency virus (HIV) and people who request the test should be screened annually, advises Dr. Smith. You’re at increased risk for HIV, she states, if you’re in one of the following categories:
- men having sex with men
- people with multiple partners
- people with IV drug abuse history
- people having sex for money
- people who have been treated for another sexually transmitted infection.
An important point: Dr. Smith reminds college students that if they’re on their parent’s insurance, issues of confidentiality arise when the students go for STI screening. To preserve confidentiality of their STI screening, Dr. Smith explains, students may need to pay cash for the tests or find a clinic that will do the screens for free.
…And be kind to your mind
With all the info you’re expecting your big bean to process this school term, don’t forget to give your brain a little TLC! Particularly if you’re a new student, or carrying an especially demanding course load on limited sleep, college life can take a toll on your mental health. And that mental toll can have very real physiologic effects on the rest of you. So it may not be a bad idea to allocate just a bit of time to focus on your emotional well-being.
Support from a mental health counselor can be important, says Dr. Muhammad Amer, assistant professor of medicine at Johns Hopkins University in Baltimore, Maryland. This is particularly true if you feel very stressed or find yourself distracted, sad, overwhelmed, or engaging in behavior that ultimately increases your stress level (such as procrastinating or drinking heavily).
Dr. Holly Smith, clinical assistant professor of pediatrics at The University of Texas Health Science Center at Houston, notes that many colleges and universities can screen students for depression, anxiety, and other mental health concerns. These assessments include questions about feelings of sadness, lack of pleasure in regular life activities, social withdrawal, and other symptoms. If you experience any of the following, seeking help is especially important:
• personal or family history of depression
• unexplained physical health concerns or chronic pain
• anxiety or panic attacks
• a history of substance abuse
There is no shame in seeking support in order to enhance your well-being. For more information on mental health from ulifeline.org, CLICK HERE.
Screening for Skin Cancer
Dr. Muhammad Amer, assistant professor of medicine at Johns Hopkins University in Baltimore, Maryland, states that students should also see a dermatologist about new, growing, or discoloring moles or unusual rashes to rule out skin cancers. Suspicious lesions or marks will likely be biopsied.
Dr. Holly Smith, clinical assistant professor of pediatrics at The University of Texas Health Science Center at Houston, says, “A whole body exam can be done by a patient’s primary care physician, but there is insufficient evidence to recommend for or against this procedure.”
Risk factors—for example, fair skin, a family history of melanoma, extensive sun exposure, or use of sun lamps or tanning beds—are considerations for determining whether to get a skin exam at a typical college student’s age, according to Dr. Amer and Dr. Smith. For more information,CLICK HERE.
Cancer-Screening Blood Tests-Only for Those at High Risk
According to Dr. Muhammad Amer, assistant professor of medicine at Johns Hopkins University in Baltimore, Maryland, specific cancer-related blood tests can be done if there are risk factors that warrant specialized screening. These factors are determined by your medical history, family history of cancer, and your physician's assessment based on your physical exam.
Dr. Holly Smith, clinical assistant professor of pediatrics at The University of Texas Health Science Center at Houston, is of a similar opinion regarding cancer-related blood screening. She states that for college-aged students, no routine cancer-specific blood work needs to be done.
As with many diseases, when it comes to cancer, an ounce of prevention may be the best medicine. For example, “to prevent pancreatic cancer,” states Dr. Smith, “it is recommended that patients quit smoking, decrease alcohol intake, and eat more fruits and vegetables.”
Specialized Cancer Blood Screens
States Dr. Smith, “The tumor markers CA-125 and CA-19-9 have been in the news for ovarian and pancreatic cancer, respectively. However, they shouldn’t be used for screening. Dr. Therese Bevers, medical director of the Cancer Prevention Center at the MD Anderson Cancer Center in Houston, Texas, says, “A CA-125 has been shown to not decrease a woman’s chance of dying from ovarian cancer. Furthermore, false positives will result in harms that are significant. Thus, a CA-125 is not recommended, except in very specialized circumstances.”
Dr. Smith also notes that “BRCA1 and BRCA2 genes are in the news a lot. However, [these tests] shouldn’t be drawn by primary care physicians. If a person has risk factors for these genes (specifically, two first-degree relatives with breast cancer, two first-degree relatives with ovarian cancer, or breast cancer in a male relative, to name a few), the person should be referred for genetic counseling. There are also some colon cancer syndromes that run in families that require earlier colonoscopies (before age 50).”
Screening for High Cholesterol
Dr. Holly Smith, clinical assistant professor of pediatrics at The University of Texas Health Science Center at Houston, suggests following the U.S. Preventive Services Task Force guidelines. Men aged 20-35 and women 20-45 years old should be screened for elevated cholesterol levels if they have risk factors for atherosclerosis (fat deposits in the arteries), such as diabetes, family history of atherosclerosis, smoking, hypertension, and obesity. The cholesterol level found determines when the next screening test should take place, she notes.
If there are family issues of hypercholesterolemia (high cholesterol) or obesity, says Dr. Muhammad Amer, assistant professor of medicine at Johns Hopkins University in Baltimore, Maryland, a student should get a fasting blood test. Done after not eating for 8 hours, this test demonstrates whether or not the student has an impaired glucose tolerance range or a diabetic range. It also provides a lipid profile. These tests, says Dr. Amer, highlight risk for familial hypercholesterolemia and should be repeated annually, if no risk is identified, or every 2 to 6 months after treatment and lifestyle intervention, if there are risk factors.
Pap Smear
The American College of Obstetricians and Gynecologists recommends that Pap smears should begin at age 21, states Dr. Muhammad Amer, assistant professor of medicine in the Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, in Baltimore, Maryland.
Dr. Holly Smith, clinical assistant professor of pediatrics at The University of Texas Health Science Center at Houston, states that, according to new U.S. Preventive Services Task Force (USPSTF) guidelines, which just came out in mid-March, Pap smears should be done every three years in women between the ages of 21 and 29. Dr. Therese Bevers, medical director of the Cancer Prevention Center at the MD Anderson Cancer Center in Houston, Texas, notes that the American Cancer Society (ACS) and the American Society for Colposcopy and Cervical Pathology (ASCCP) also recommend that Pap smears be done every three years for women beginning at age 21. In women ages 30 to 65, notes Dr. Smith, Pap smears should be done every three years or, alternatively, Pap smears plus human papillomavirus (HPV) testing should be done every five years. She says that having had the HPV vaccine series doesn’t affect this recommended interval.
Dr. Amer notes that, according to the American Cancer Society, smoking, genital infections (warts) with certain types of human papillomavirus, pelvic infections from chlamydia, long-term use of oral contraceptive pills, and systemic infection with human immunodeficiency virus (HIV) are among the leading risk factors for cervical cancer.
According to Dr. Bevers, a Pap smear for women is the only cancer screen recommended by the American Cancer Society, the American College of Obstetricians and Gynecologists, and other leading organizations, for a college-aged population. This screen should be taken every three years, beginning at age 21, but not before that age. There is an important reason why Pap smears should not be administered to younger women, according to Dr. Bevers—the complications of treatment for abnormalities detected in younger women far outweigh the benefits of screening. Dr. Bevers states that some data have shown that young women who had cervical dysplasia (abnormal changes in the cells on the surface of the cervix that are seen underneath a microscope), and who had procedures to remove the abnormal tissue, were at increased risk later, when they became pregnant, of not being able to carry the pregnancy to full term. Thus, notes Dr. Bevers, because the incidence of cervical cancer in women below the age of 21 is negligible, the harms associated with treating young women with cervical abnormalities far outweigh the benefits of screening.
Breast Exam
According to Dr. Muhammed Amer, assistant professor of medicine at Johns Hopkins University in Baltimore, Maryland, women of college age don't need routine mammograms unless risk factors such as family history suggest a high risk of breast cancer. However, he says, complete physical exams should include a thorough breast exam, which can be done by a primary care physician or gynecologist.
Women can also learn to do self-breast exams on a monthly basis; this is one of the keys to early detection of breast tissue changes. According to Dr. Therese Bevers, medical director of the Cancer Prevention Center at MD Anderson Cancer Center in Houston, Texas, breast awareness means that women know how their breasts normally look and feel-- and promptly report any change to their healthcare provider.
Dr. Bevers states, "As per current American Cancer Society guidelines, annual breast exam and mammogram should begin at age 40. For women in their twenties and thirties, a clinical breast exam should be conducted every 3 years."
Prostate cancer screening CLICK HERE
Testicular cancer self-exam CLICK HERE
