Are Screening Centers Worth The Money?
DEAR DR. ROACH: I see screening tests advertised often. For $160 I can get screened for conditions that might cause stroke, heart disease, aneurysms, etc. My partner and I are in our early and mid-60s. Should we get these done? -- K.S.
ANSWER: Sometimes, screening tests make a great deal of sense; other times, they don't. It all depends on how likely it is that a person would have the condition in question. For example, screening for an aneurysm of the aorta has been proven to save lives in men between 65 and 75 with any history of smoking, and can be considered in other people, especially if there is a family history of an abdominal aortic aneurysm.
On the other hand, many stand-alone screening centers offer ultrasound evaluation of the carotid arteries in the neck, but expert groups such as the US Preventive Services Task Force recommend against it in people without symptoms. They have concluded that screening for blockages of the carotid arteries in people without symptoms is more likely to result in harm than benefit.
The main harm comes from false-positive ultrasounds, which often must be confirmed by an angiogram. About 1% of people get a stroke during an angiogram, which is more than the expected benefit of finding and treating blockages in a person with no symptoms. Some people would be helped by the screening, but more people are expected to be harmed.
I have also seen an unfortunate lack of timely follow up. I had a family member get the screening done, and shortly after he died of a heart attack, a letter came from the center saying he should follow up with a cardiologist.
In my opinion, screening tests should be decided on by your doctor, who knows your medical history. I don't recommend going to places that just do screening, even if the price (in money) is affordable.
DEAR DR. ROACH: I am an 81-year-old man in fairly good health, I think, except for osteoporosis. Three years ago, I had a very weak pulse rate and was hospitalized. My wife thought I was having a stroke. The cardiologist had a pacemaker implanted, and I've been good since. But two months ago, the cardiologist listened to my chest and said I had a murmur, a word I didn't know. She also said "sinuses" and "plaque" and "valve." She ordered an echocardiogram, which I've had, but don't know the results yet. Am I in danger? If so, how much? -- W.C.G.
ANSWER: By now, I hope and expect that your cardiologist will have told you not to worry. A "murmur" is just a sound that doctors can hear from the heart, which sometimes mean that there is damage to one of the four valves of the heart. Guessing by the terms she used, I think your cardiologists is concerned you may have calcium ("plaque") in the aortic valve, which is supported by the sinuses of Valsalva in the aortic root.
Calcium in the aortic valve by itself may not cause problems, but it can keep the valve from being able to open all the way, a condition called aortic stenosis. It isn't always easy to hear the difference between aortic valve calcification and aortic stenosis, but an echocardiogram gives a very accurate measurement of the aortic valve opening.
If you have aortic stenosis, she will discuss your options, which may include surgery if it is severe. However, if you have the more common calcification without stenosis, she will make sure your blood pressure and cholesterol are controlled, and will likely redo the echo in a few years.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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