They Can Even Be Harmful

You expect your doctor to order tests during routine checkups or to investigate unexplained symptoms. But do you need all of those tests?

Maybe not.

The American College of Physicians and other groups have joined a project called Choosing Wisely that uses evidence-based medicine to identify tests, treatments and medical screenings that most people don’t need. Common offenders…

CT Scans for Headaches

If you start getting migraines or pounding headaches, you’ll want to know why. So will your doctor. Result: About one in eight patients who sees a doctor for headaches or migraines winds up getting scans.

Yet CT scans find abnormalities in only 1% to 3% of cases—and many of those abnormalities will be harmless or have nothing to do with the headaches. The scans are highly unlikely to change your diagnosis or affect your treatment options. But doctors order them anyway.

The tests create their own problems. Excess radiation is one concern. So is the likelihood that a scan will reveal “incidentalomas,” a somewhat tongue-in-cheek name for unimportant abnormalities that can lead to additional (and unnecessary) tests.

Bottom line: CT scans are rarely needed because doctors can ­readily diagnose headaches just by talking with ­patients and taking detailed ­medical histories.

Who might need it: You might need a scan if your headaches are accompanied by neurological symptoms (such as a seizure or fit, change in speech or alertness or loss of coordination) or if you suffered from an accident that involved a sharp blow to the head.

Preoperative Chest X-ray

If you’ve ever had an operation, you almost certainly had one or more chest X-rays. Many hospitals require them to “clear” patients for surgery.

What are the X-rays for? No one really knows. They have become a part of the presurgical routine even though a study published in JAMA found that only 2% of the X-rays provided useful information for the surgeon/anesthesiologist. Most patients don’t need them.

Bottom line: If you’re generally healthy, tell your doctor you don’t want the X-ray.

Who might need it: Patients who have been diagnosed with heart or lung disease or who are having surgery on the heart, lungs or other parts of the chest should get the X-ray. So should those who are older than 70 and haven’t had a chest X-ray within the last six months (the likelihood of an abnormal X-ray is higher in these people).

Heart Disease Stress Test

If you’re between the ages of 40 and 60, there’s a chance that you’ve had (or been advised to have) an exercise stress test to determine your risk for heart disease and heart attack. A 2010 study that looked at nearly 1,200 people in this age group found that nearly one out of 10 had been given a stress test.

Unless you’re having symptoms of heart disease—such as chest pain and shortness of breath—a stress test will probably be useless. The cost is considerable—you can expect to spend $200 to $300.

Stress tests tend to produce unclear results. This can lead to additional tests, including coronary angiography—an expensive test that exposes you to as much radiation as 600 to 800 chest X-rays.

Bottom line: You’re better off reducing your particular risks—giving up smoking, controlling hypertension and lowering cholesterol—than getting a stress test.

Who might need it: Agree to an exercise stress test only if you’re having symptoms of heart disease or your doctor suspects that you already have heart disease.

Imaging for Back Pain

There’s a good chance that your doctor will order an MRI or a CT scan if you complain of sudden back pain. Yet 80% to 90% of patients will improve within four to six weeks. You might need an imaging test when symptoms are severe or don’t improve, but there’s no reason to rush it—or to expose yourself to unnecessary radiation from a CT scan.

Bottom line: Don’t agree to a test that’s unlikely to change your diagnosis or treatment options. Since most back-pain patients will recover with physical therapy, over-the-counter painkillers and other “conservative measures,” ­imaging tests usually are unnecessary.

Who might need it: A scan typically is warranted if your doctor suspects a compression fracture from osteoporosis…you have burning pain down a leg that doesn’t improve…or you’re also having numbness, muscle weakness, a loss of bowel/bladder control or other neurological symptoms.

Pelvic Exam

Some gynecologists and primary-care physicians believe that a pelvic exam is a good way to detect ovarian cancer or problems with the ovaries, uterus, vulva or other pelvic structures. It’s usually combined with a Pap test to screen for cervical cancer.

A study published in JAMA concluded that routine pelvic exams are unlikely to detect ovarian cancer. Nor are they likely to help women with ­uterine fibroids or cysts.

Bottom line: The routine pelvic exam is a low-yield test that should be discontinued, particularly because it makes women anxious and uncomfortable.

Important: Don’t forgo regular Pap smears—you can get them without having a pelvic exam. Women 30 years old and older should have a Pap smear—along with testing for the human papillomavirus (HPV), which is done at the same time—every five years. For those with a family history of cervical cancer or other risk factors, the Pap test should be repeated every three years.

PSA Test

For a long time, men were routinely advised to have this blood test, which measures prostate-specific antigen (PSA) and screens for prostate cancer. Now the American Cancer Society and some other groups advise against it.

The test can’t differentiate harmless cancers (the majority) from aggressive ones. Studies have shown that men who test positive are only marginally less likely to die from prostate cancer than those who were never tested…and they’re more likely to have biopsies, surgeries and other treatments that will make no difference in their long-term health, that pose serious risks of their own and that cause unnecessary ­anguish.

Bottom line: Men between the ages of 50 and 74 should discuss the test and the possible risks and benefits with their doctors.

Who might need it: Those with a family history of prostate cancer—particularly a cancer that affected a close relative, such as a sibling or parent—may want to get tested.