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Adult Health Maintenance quick look
This chart rates treatment options according to general effectiveness, ease of use, side effects and safety.
Legend:     Excellent  Very Good  Good  Fair  Poor  Not available 
Disease Screening - Recommended
Treatment Overall Score Effective-
ness
Safety Ease
of Use
Side
Effects
Comments
High Blood Pressure
(Hypertension)
 

Very good 
 
 
 
 
National guidelines strongly recommend testing all adults regularly (at least every two years) for high blood pressure.
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High Blood Pressure

Blood pressure is usually measured in a doctor's office with a blood pressure cuff. The cut-off level for saying someone's blood pressure is high is a systolic pressure (the higher number) above 140 or a diastolic pressure (lower number) above 90. In people who have other risks for heart disease, lower cut-off points are sometimes used to determine who needs treatment. The diagnosis of high blood pressure is only made after at least 2 high blood pressure readings are recorded on at least 2 different office visits over a period of 1 to several weeks. How often blood pressure should be tested is still a matter of debate. Most experts recommend testing at least once every 2 years, and at least yearly for those whose readings are borderline high (systolic over 120 and diastolic over 80-89), and even more often for those whose readings are over that range.

 
High Cholesterol  

Very good 
 
 
 
 
Experts agree that all men over 35 and women over 45 be screened for abnormal lipid (blood fat or "cholesterol") levels. This testing measures levels of total cholesterol, "good" cholesterol (HDL), "bad" cholesterol (LDL), and triglyceride. There is disagreement over whether younger people should also be screened. Some expert groups recommend screening everyone at least once while others recommend screening younger people only if they have risk factors for heart disease.
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High Cholesterol

The US Preventative Task Force recommends testing people under 35 only if they have any of the following: diabetes, a family history of heart disease or high lipids ("cholesterol"), or more than one of the other risk factors such as smoking, being overweight, having high blood pressure, or not exercising. The reasons given for not testing everyone is that the benefits of treating someone before middle age who is found to have high cholesterol is small. Other groups such as the National Cholesterol Education Panel recommend testing all younger adults, regardless of risk, at least once. This group argues that the deterioration in the heart arteries starts at an early age and that the people at the highest long-term risk for heart disease have the highest levels of cholesterol at a young age and thus should be diagnosed and treated as early as possible. Some groups now advocate testing for children if they are obese or have strong family history of cholesterol problems.

The reason for the emphasis on early detection of cholesterol problems is because long-term elevations in total cholesterol and "bad" cholesterol (also known as "LDL-Cholesterol") lead to heart attacks and other problems with the blood vessels. Early treatment focuses on life-style changes, including weight loss, dietary changes, increasing exercise, and quitting smoking. If these measures alone don't lower cholesterol and LDL enough, drugs to lower cholesterol may be necessary.

 
Osteoporosis
(Thinning of the bones)
 

Good 
 
 
 
 
Experts recommend that all women over 65 be tested for osteoporosis with a bone density scan. Women who are over 60 and who are at higher risk for osteoporosis (including women who have had a fracture) should also be scanned. In women who are under 60 or those who are 60-64 and not at higher risk, screening can identify women with osteoporosis, but the benefits and harms of treating this group is unclear and routine testing is not recommended.

All women, and men over 40 need to be counseled about proper intake of calcium and vitamin D to help prevent development of osteoporosis.
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Osteoporosis

Factors that increase anyone's risk of osteoporosis include:

  • lower body weight (under 70 kg or 150 lbs) in proportion to height, also known as low body mass index (BMI)
  • history of tobacco use
  • family history of osteoporosis
  • decreased physical activity
  • overuse of alcohol
  • low calcium intake in the diet

The bone density test that is most accurate, and therefore most recommended, is dual-energy x-ray absorptiometry (DEXA scan) done at the femoral neck (top of thigh bone).

 
Depression screening  

Good 
 
 
 
 
A specific series of questions (depression screening questionnaire) can help identify those people who suffer from depression. People with depression benefit from treatment, whether it be psychotherapy, antidepressant drugs, or a combination of both.
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Depression screening

Studies have shown that targeted questions can help identify people who may be suffering from depression. To be sure that the diagnosis of depression is correct, your physician will have a follow-up system in place. This system may involve further discussion with your physician or with a counselor, and in some cases, may also require a physical exam and lab tests.

Once the diagnosis of depression is made, your physician will want to be sure that appropriate treatment and follow-up can be provided including a referral to a mental health professional if necessary.

 

Legend:     Excellent  Very Good  Good  Fair  Poor  Not available 
Disease Screening - Possibly Recommended
Treatment Overall Score Effective-
ness
Safety Ease
of Use
Side
Effects
Comments
Diabetes
(High blood sugar)
 

Fair 
 
 
 
 
There is a lack of agreement about who should be tested for diabetes. Some experts believe that all adults should be tested while other do not. Experts agree that people with an increased risk of diabetes should be tested (those with high blood pressure or high cholesterol, those with a family history of diabetes, overweight individuals, women who give birth to babies over 9 pounds, and high risk ethnic/racial groups such as African Americans, Hispanic-Americans/Latinos, and Native Americans).
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Diabetes

A blood test called the "fasting plasma glucose" is accurate for identifying individuals with diabetes. Early diagnosis of diabetes is important in people at risk for heart disease (such as those with high blood pressure or high cholesterol), since even slight elevations in blood sugars increases heart disease risk. People at risk should be tested for diabetes even if they don't have symptoms.

Some experts believe that all adults should be screened for diabetes since there is evidence that full-blown diabetes can be delayed in pre-diabetic individuals (people with slight elevations in blood sugars) if treatment (with changes in diet, weight and exercise) is started early. Other experts disagree since screening all adults is expensive and studies have not yet shown if delaying the start of diabetes in adults will also delay diabetes complications.

 

Legend:     Excellent  Very Good  Good  Fair  Poor  Not available 
Disease Screening - Recommended in Special Situations
Treatment Overall Score Effective-
ness
Safety Ease
of Use
Side
Effects
Comments
Heart disease screening with resting electrocardiogram (ECG), exercise treadmill test (ETT), or scanning for coronary calcium using electron beam computerized tomography (EBCT)  

Not available 
 
 
 
 
Experts do not recommend using these tests for people who do not have symptoms of heart disease, and who are not at high risk for heart disease. National guidelines indicate that there is not yet enough information to recommend these tests, except in special situations, even for individuals in the high risk group.
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Heart disease screening with resting electrocardiogram (ECG), exercise treadmill test (ETT), or scanning for coronary calcium using electron beam computerized tomography (EBCT)

Risk factors for heart disease include: smoking, high cholesterol, diabetes, older age, family history of heart disease, male gender, being overweight, and not exercising. It is possible to calculate a person's risk of having heart disease based on these factors. (To try such a calculation go to: http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof).

Heart disease can be detected earlier through the use of certain tests: an electrocardiogram (ECG), exercise treadmill test (ETT) or electron beam computerized tomography (EBCT). However, the potential benefits and risks of these tests have not been studied. A possible problem that could result from widespread use of these tests is that a certain percentage of individuals receiving them will be inaccurately identified as having heart disease when they do not. This could lead to further testing which is costly, and could result in complications.

These tests are recommended for people in certain occupations whose risk of heart attack while at work could impact the public safety including pilots and heavy equipment operators, even if they don't have symptoms of heart disease.

 
Hepatitis C
(Only for high risk groups)
 

Not available 
 
 
 
 
Testing for Hepatitis C is only recommended for people who are at high risk for infection with this disease.
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Hepatitis C

Factors that increase a person's risk of getting hepatitis C infection include: using intravenous drugs (either now or in the past), having a blood transfusion before 1990, being the child of a mother with hepatitis C, being positive for HIV/AIDS, and having sex without a condom (particularly if the partner has hepatitis C or is in one of the high risk groups).

When the test is performed on individuals who are at low risk of infection with Hepatitis C, the blood test is falsely positive (the test indicates that the disease is present when it is not) in almost half of the cases that test positive. Also, people who do not have any risk factors for hepatitis C almost never develop the infection. Therefore, experts feel that the harms of testing in low-risk individuals outweigh the benefits.

For more hepatitis information, the CDC website is quite useful: http://www.cdc.gov/ncidod/diseases/hepatitis/a/fact.htm

 
Aspirin prophylaxis
(To prevent cardiovascular disease)
 

Not available 
 
 
 
 
Considering the use of one baby aspirin (81mg) per day is recommended for all post-menopausal women, men above age 40, and younger men and women who are at increased risk of coronary heart disease (people with obesity, diabetes, high cholesterol, high blood pressure, strong family history of early heart disease, as well as those who avoid exercise).
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Aspirin prophylaxis

Aspirin is NOT recommended for those who have allergies to it, who have bleeding problems, who have stomach or duodenal ulcers, or who are on blood thinning medication. Before starting aspirin, have a discussion with your physician about the benefits as well as the possible risks. Do not start aspirin without a physician's recommendation since complications can occur.

 
Chlamydia screening
(Only necessary for sexually active women, their partners, and men who have sex with men)
 

Not available 
 
 
 
 
Screening for chlamydia, an infection that can be sexually transmitted, is recommended for all sexually active women under the age of 25; for all older women who have unprotected sexual intercourse with more than one male or female partner; and for men who have sex with men.
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Chlamydia screening

Chlamydia is a common sexually transmitted disease (STD) caused by the bacteria, "Chlamydia trachomatis", which can damage a woman's reproductive organs. Chlamydia is the most frequently reported bacterial sexually transmitted disease in the United States. In 2006, 1,030,911 chlamydial infections were reported to CDC from 50 states and the District of Columbia. Under-reporting is substantial because most people with chlamydia are not aware of their infections and do not seek testing.

Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth.

Any sexually active person can be infected with chlamydia. The greater the number of sex partners, the greater the risk of infection. Because the cervix (opening to the uterus) of teenage girls and young women is not fully matured and is probably more susceptible to infection, they are at particularly high risk for infection if sexually active. Untreated chlamydia can cause serious infections of the reproductive organs, chronic pain, and infertility.

Since chlamydia can be transmitted by oral or anal sex, men who have sex with men are also at risk for chlamydial infection.

For more information about chlamydia, a useful fact sheet can be found at:

http://www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm

 
Vision and hearing screening
(Adults over age 65)
 

Not available 
 
 
 
 
Adults over age 65 are prone to a variety of eye diseases that are related to aging. Many of these diseases are much more treatable if they are detected early. Consequently, any change in vision should be noted, and an ophthalmologist (eye specialist) should be consulted if necessary.

Hearing loss can also be associated with aging, and your doctor should be a resource for counseling about hearing aid devices and/or further evaluation if necessary.

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Vision and hearing screening

Younger adults are also at risk for eye and ear problems, but if they don't have any symptoms, routine screening is not considered necessary.

 
Alcohol and tobacco screening
(Only for those who have used or continue to use alcohol and/or tobacco)
 

Not available 
 
 
 
 
Alcohol overuse can contribute to many health problems. Your doctor will ask you questions known as the "cage" test:
  • 1. Do you feel you should cut down on your drinking?
  • 2. Are you annoyed when others discuss your drinking?
  • 3. Do you feel guilty about your drinking?
  • 4. Do you have a morning "eye opener" to calm your nerves or treat a hangover?

Answering yes to one or more of the questions suggests that your alcohol use may be excessive.

Any form of tobacco use also can be bad for your health in many ways. Your doctor should have information about a variety of techniques that can be used to help you quit tobacco.

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Alcohol and tobacco screening

A good source for further information about alcohol treatment is: http://findtreatment.samhsa.gov/

A useful link for help with quitting smoking can be found at: http://www.smokefree.gov/

 
Abdominal aortic aneurysm screening
(Recommended for men over age 65 who have smoked more than 100 cigarettes in their lifetime)
 

Not available 
 
 
 
 
The aorta is the main artery that carries blood from the heart to the chest, abdomen and legs. In older men who have a smoking history, the portion of the aorta that runs through the abdomen can balloon out (an "aneurysm"). Once an aneurysm gets to a certain size (more than 4-5 cm) it can rupture. Ruptured aneurysms are often fatal but can be prevented if they are diagnosed early.
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Abdominal aortic aneurysm screening

The most accurate screening test is an abdominal ultrasound exam (looking at the inside of the abdomen using sound waves transmitted through the skin). It is quick, painless, and accurate. If an aneurysm is seen, further testing and possible referral for surgical repair may be required.

 
Sexually transmitted disease (STD) screening
(Only for those at risk)
 

Not available 
 
 
 
 
Those at risk for STDs are individuals who have sex with more than one partner, or whose regular partner may be having sex with other people. This includes people of all ages who are sexually active. Since the use of Viagra and similar drugs has become widespread, there has been an increase in STDs in older people. Even HIV is increasing in the older adult population.

Your doctor should be able to discuss your sexual history with you in a frank and unembarrassed way, and to perform screening tests that are appropriate for the type or types of sex you have been having. Most STDs are easily treated if they are diagnosed early.

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Sexually transmitted disease (STD) screening

A thoughtful and comprehensive guide explaining STDs that includes how to screen for them can be found at: http://www.mayoclinic.com/health/std-testing/ID00047

 

Legend:     Excellent  Very Good  Good  Fair  Poor  Not available 
Disease Screening - Insufficient Evidence
Treatment Overall Score Effective-
ness
Safety Ease
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Comments
Alzheimer's disease
(Dementia)
 

Not available 
 
 
 
 
There is not sufficient evidence to know whether screening for Alzheimer's disease (or other memory problems) is useful in adults who don't have symptoms.
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Alzheimer's disease

The screening test that is most widely used is a series of questions called the Mini-Mental Status Examination. Studies have shown that this test is inaccurate almost half of the time (the test suggests that a problem with memory is present when it is not). People who have signs of memory loss or loss of brain function should be tested.

Treatment for early Alzheimer's disease, while not perfect, is improving, and early diagnosis may be helpful.

 
Thyroid Disease  

Not available 
 
 
 
 
There is not enough information to know whether screening for thyroid disease in people without symptoms is of benefit. Most experts feel that thyroid testing should be restricted to those who have some signs or symptoms of early thyroid disease.
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Thyroid Disease

Early symptoms of low thyroid hormone (hypothyroidism) can be very subtle. Some of the most common ones include:

  • Cold intolerance
  • Constipation
  • Depression
  • Fatigue
  • Joint or muscle pain
  • Paleness
  • Thin and brittle hair
  • Thin, brittle fingernails
  • Weakness
  • Weight gain (unintentional)

Common early symptoms of too much thyroid hormone (hyperthryroidism) can include some or all of:
  • Weight loss (unintentional)
  • Increased appetite
  • Nervousness
  • Restlessness
  • Heat intolerance
  • Increased sweating
  • Fatigue
  • Frequent bowel movements
  • Goiter (visibly enlarged thyroid) may be present

If any of these symptoms are present, thyroid disease can be identified with simple blood tests, and treated successfully.

 
Additional screening
(Obesity screening, skin cancer screening, injury prevention, screening for stress and anxiety, nutrition and physical activity counseling, etc)
 

Not available 
 
 
 
 
National guidelines have not found enough evidence to make recommendations about whether or not screening for certain problems are relevant for all people. Some of these problems will be screened for if you or your doctor feel that you are at high risk for them.
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Additional screening

Other preventive services that are sometimes offered include:

  • Advance directives and living will creation
  • Anxiety and stress counseling
  • Dental and periodontal disease screening
  • Domestic violence and abuse screening and counseling
  • Menopause and hormone therapy counseling
  • Drug abuse screening and counseling

There is some evidence that accident rates increase during mid-life when people overdo their involvement in challenging physical activities (skiing, mountain biking, hockey, etc) because they think it's their last chance for these experiences. Common sense is recommended when engaging in high risk sports or hobbies, particularly during and after mid-life.

 

Legend:     Excellent  Very Good  Good  Fair  Poor  Not available 
Cancer Screening - Recommended
Treatment Overall Score Effective-
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Colorectal Cancer  

Very good 
 
 
 
 
All people over age 50 should be screened for colon cancer. Because of the increased risk for early cancer in African-American men, screening for an individual in this group is recommended to start at age 45. Those at higher risk of colorectal cancer need to be screened earlier and more frequently.
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Colorectal Cancer

In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed in men and women and the second leading cause of death from cancer. In 2008, it is estimated that 148,810 men and women will be diagnosed with CRC and 49,960 will die from this disease. As with many other diseases, early diagnosis is lifesaving.

There are several different approved screening methods:

  • Colonoscopy every ten years - a test in which a flexible tube with a "fiber optic" camera is inserted into the anus. A colonoscopy allows the physician to view the entire colon which is approximately 5 feet long, and also to remove any polyps/growths that are seen. It is the most accurate test for colon cancer screening, but also involves more discomfort and risk.
  • Fecal DNA every year - a test that looks for signs of cancer cells in the stool. This test is relatively new and very expensive. Home test kits are available for roughly $200. This test is not currently covered by insurance.
  • Flexible sigmoidoscopy every 5 years - a tube-shaped instrument inserted into the rectum. With this test, the physician is able to view only the last two feet of the colon (out of a total of 5 feet).
  • Fecal occult blood testing (FOBT) every year - a simple stool test performed at home on 3 stool samples. This test looks for blood in the stool which may be present with cancer. For improved accuracy, three separate stools should be tested each year. Your doctor will give you the "take-home" cards and instructions.
  • Sigmoidoscopy plus fecal occult blood test (FOBT) every 5 years - this method is preferred over FOBT or sigmoidoscopy alone since it is more accurate.
  • Barium enema ("double contrast barium enema") every 5 years - an x-ray study performed after drinking a liquid dye and having air inserted into the rectum.
  • Virtual colonoscopy every 5 years - a test which involves emptying the bowel with strong laxatives, inserting air into the rectum, and performing a CT scan (an imaging study using x-ray beams). The advantage of this test is that it is "non-invasive" (does not require insertion of an instrument into the rectum) but the disadvantage is that polyps/growths cannot be removed. Because of the newness of this test, it is recommended that it be repeated at 5 year intervals, rather than the ten year interval for actual colonoscopy.

People considered at higher risk for colorectal cancer include those who have: a personal history of polyps in the colon (small growths that can turn cancerous); a family history of colon cancer in a parent, sibling, or child younger than age 60 (or two such relatives of any age); a personal history of inflammatory bowel disease (Crohn's disease or ulcerative colitis); or a family history of an inherited type of colorectal cancer (such as "familial adenomatous polyposis" or "hereditary non-polyposis colon cancer)".

Ideally, your doctor will discuss the range of testing options available to you, and help you to decide which test or combination of tests is best for you.

 
Breast Cancer - Mammography  

Good 
 
 
 
 
It is recommended that all women over age 40 have a mammogram performed every one to two years. Women at high risk (family history of breast cancer, hormone use, breast lumps) should have the test done yearly. After the age of 50, women at low risk only need mammograms every two years, and after age 75, guidelines state that mammograms can be discontinued.
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Breast Cancer - Mammography

The benefits of testing for breast cancer increase with age as the likelihood of having the disease increases. However, for women over 75, unless there is a reason for a mammogram (a lump that can be felt, or other breast symptoms), quidelines state that they can be safely discontinued as a part of routine screening.

 
Cervical Cancer-PAP test
(The cervix is the tip of the uterus/womb)
 

Good 
 
 
 
 
All women should have periodic Papanicolaou (PAP) smears to test for cervical cancer. Testing should begin at age 21 or three years after first sexual intercourse, whichever is earlier. After 3 consecutive normal PAPs, the interval can be decrease to once every three years.

Women 65 years and older with a new sexual partner should resume routine screening. Otherwise, women over 65 no longer need PAP smears if they have had a recent normal Pap smear, and if they are not at higher risk for cervical cancer.
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Cervical Cancer-PAP test

Women have an increased risk for cervical cancer if any of the following apply: a history of pre-cancerous changes detected with PAP smears; infection with a virus called the "human papilloma virus (HPV)" or any other sexually transmitted disease; or high risk sexual behavior (multiple sexual partners without a condom).

There is controversy over how often to perform Pap tests. Studies have shown that screening every 3 years is as good as every year. Most groups recommend screening every year and switching to every 3 years if a woman has had at least 3 normal tests in a row, and if she is not at higher risk for cervical cancer. The American Cancer Society recommends waiting until age 30 to consider screening only every 3 years.

The first Pap test should be performed within 3 years of becoming sexually active, or by age 21, whichever comes first.

Women who no longer have a cervix (have had a total hysterectomy with removal of the cervix) no longer need to be tested for cervical cancer.

 

Legend:     Excellent  Very Good  Good  Fair  Poor  Not available 
Cancer Screening - Insufficient Evidence
Treatment Overall Score Effective-
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Breast Cancer - Self breast exam  

Poor 
 
 
 
 
There is not enough evidence to recommend that all women be taught to do a self-breast exam.
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Breast Cancer - Self breast exam

Studies have not shown that self-breast exam decreases a woman's risk of dying from breast cancer. Studies have shown that doing a self-breast exam does result in higher falsely positive results (women feeling a 'lump' when there is no disease) and higher numbers of unnecessary breast biopsies.

 
Prostate Cancer  

Not available 
 
 
 
 
Men over age 50 should be screened for prostate cancer with a blood test called the prostate-specific antigen (PSA), and a rectal examination of the prostate. The US Preventive Services Task force now (2008) recommends that screening tests need no longer be done for men over age 75, as the harm of testing and follow-up (biopsy) outweighs the potential benefit.

Men at higher risk (African Americans and men who have a close relative with prostate cancer) should be tested starting at age 45.

According to guidelines, there is not enough evidence to recommend that men over age 75 get this test. All men should receive information about the benefits and limitations of testing so that an informed decision about whether to have the test can be made.
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Prostate Cancer

Both the PSA and the rectal examination of the protate can detect prostate cancer in its early stages. However, many early prostate cancers are extremely slow growing, and early treatment may produce more harm than benefit in these cases. Unfortunately, it is not possible to predict which prostate cancers will be aggressive and which ones will be slow growing.

Also, tests for prostate cancer result in many falsely positive results (the test indicates cancer in a person who does not have the disease). People who have false positive tests often proceed to a needless biopsy of the prostate (an uncomfortable and costly procedure). Since the biopsy can be inaccurate as well, some men without prostate cancer will actually receive cancer treatment. Treatment for prostate cancer involves radical surgery or radiation treatments, both of which have significant risks and side effects.

Therefore, if the whole population is screened, many men will have unnecessary biopsies and cancer treatment, and may suffer harmful effects from these interventions.

 

Legend:     Excellent  Very Good  Good  Fair  Poor  Not available 
Immunizations - Recommended
Treatment Overall Score Effective-
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Tetanus and diphtheria Vaccine  

Good 
 
 
 
 
All adults should receive a booster shot for tetanus and diphtheria every 10 years.
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Tetanus and diphtheria Vaccine

Tetanus is a highly fatal infection that occurs when the tetanus bacteria enter through a break in the skin. Tetanus is also called 'lockjaw'. Diphtheria is a respiratory infection that can also be fatal. The most frequent side effects of the vaccine are local pain and fever. Rarely, serious side effects can involve the nervous system.

 
Measles, Mumps, Rubella Vaccine  

Good 
 
 
 
 
Everyone born after 1956 should receive 2 doses of measles vaccine. If a person has never been immunized against measles, he/she should receive the measles/mumps/rubella vaccine.
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Measles, Mumps, Rubella Vaccine

Generally this vaccine is given to children around one year of age, and the 2nd dose is given before the child enters school (usually age 4-6). Some adults never received the 2nd vaccine, and should get one. People born before 1957 probably had measles as a child and don't need the vaccine.

Women should be immunized for rubella (German measles) before becoming pregnant. The fetus is at risk of serious complications if a woman who is pregnant develops rubella (German measles). The vaccine may be given before pregnancy but should not be given to pregnant women.

The most common side effects for this vaccine are fever and rashes. A few rare side effects involving the brain and blood occur one in every 2 million vaccine doses.

 
Pneumococcal Vaccine
(Pneumococcal pneumonia vaccine)
 

Good 
 
 
 
 
Everyone over age 65 should be immunized once. They should get a 2nd dose in five years if the first dose was received before age 65. People under 65 who are considered high risk should be immunized every 5 years.
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Pneumococcal Vaccine

People at high risk for pneumococcal pneumonia include: people with chronic diseases like diabetes; severe asthma; heart disease; and those with lowered immunity such as people who have had chemotherapy, have had their spleen removed, or who have HIV.

The most common side effects of the vaccine are redness and pain at the area of the injection. Rare allergic reaction have been reported.

 
Varicella Vaccine
(Chickenpox vaccine)
 

Good 
 
 
 
 
People under age 50 should have a blood test for chickenpox if they don't know whether or not they have had this disease in the past. If the blood test suggests that they have not had chickenpox, they should get the vaccine, which consists of two doses of vaccine with at least 28 days between the first and second doses. People over 50 are assumed to have had chickenpox and are not usually vaccinated.
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Varicella Vaccine

Chickenpox is a serious illness in adults, causing more severe skin lesions, pneumonia, and even death. Once someone has had chickenpox, a blood test should generally indicate that they have had the disease and have built up an immunity (the ability to successfully fight the infection). The most common side effect of the vaccine is a rash.

People who have problems with the immune system (have had chemotherapy recently, have a severe illness, or are infected with HIV) should not get the vaccine.

Also, people with allergies to neomycin (a type of antibiotic) or gelatin cannot receive the vaccine.

Pregnant women should not get the vaccine and women should be instructed not to become pregnant for at least a month after receiving the vaccine.

 
Hepatitis B Vaccine  

Good 
 
 
 
 
Everyone under age 40 should be vaccinated. Most children receive the vaccine series in infancy. People over age 40 who are at higher risk of getting hepatitis B should be vaccinated.
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Hepatitis B Vaccine

Hepatitis B infection can cause a serious and, possibly, fatal liver disease. The vaccine is given as a series of three shots over several months.

People considered to be at higher risk of getting hepatitis B include: health care workers, dialysis patients, people who are transfused with certain blood products, homosexual males, people who use intravenous drugs, people who have sex with more than one partner, and household or sexual contacts of intravenous drug users and household or sexual contacts with people who have an on-going hepatitis B infection. Because of improved screening of the blood supply in the US, the risk of getting Hepatitis B from a routine transfusion is now less than 1 in 137,000.

Travelers who plan to spend time in areas of the developing world where Hepatitis B is very common should also consider the series of vaccinations. Because the full series of vaccines takes 6 months to develop immunity, travelers should try to plan ahead. For more hepatitis information, the CDC website is quite useful: http://www.cdc.gov/ncidod/diseases/hepatitis/a/fact.htm .

Side effects of the vaccination are generally only local skin irritation and fever. Except for an allergic reaction, there are very few reported serious side effects.

 
Influenza Vaccine
(Flu shot)
 

Good 
 
 
 
 
People over 50 should get the vaccine every year between September (or as soon as the vaccine is available) and the end of the flu season, usually in March. Generally, the earlier in the flu season the better for getting good results from the vaccine.

People considered at "high risk" should also get the vaccine.

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Influenza Vaccine

High risk people include those with lung disease, HIV, asthma, diabetes or other chronic diseases, and health care workers.

Side effects of the vaccine are rare. There are rare cases of a condition called "Guillain Barre Syndrome (GBS)", a severe illness that can occur with the flu shot. The benefits of the shot greatly outweigh the small risk of serious side effects.

People who are allergic to eggs cannot receive the vaccine.

 
Hepatitis A Vaccine  

Good 
 
 
 
 
People considered to be at high risk for getting hepatitis A should be vaccinated.
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Hepatitis A Vaccine

Hepatitis A is a liver infection that causes nausea, abdominal pain, fatigue, and other symptoms. It is almost never life-threatening. Hepatitis A is transmitted from person to person by putting something in the mouth (even though it may look clean) that has been contaminated with the stool of a person with hepatitis A.

Experts recommend that the following group of people get the vaccine: people traveling to countries that have high rates of hepatitis, people who live in states with higher levels of hepatitis A outbreaks. For a list of these countries and states go to: http://www.cdc.gov/ncidod/diseases/hepatitis/a/fact.htm . Other groups at risk include men who have sex with men, people who have sex with multiple partners, people who use illegal drugs, and people who get regular transfusions with blood clotting factors.

People with chronic liver disease may be at increased risk of severe hepatitis A and should be vaccinated as well.

 
Meningococcal Vaccine  

Good 
 
 
 
 
This vaccine is recommended to prevent meningitis for: people who live in crowded conditions (such as college students and military recruits); people who have had their spleen removed; and those who plan to spend a prolonged period in a country that has epidemics of meningococcal disease.
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Meningococcal Vaccine

A single dose of the vaccine is very effective in preventing meningitis (a serious infection of the covering of the brain) caused by the meningococcus germ. Outbreaks of meningococcal meningitis occur in colleges, military facilities, and countries in the "meningitis belt" of sub-Saharan Africa (which stretches from Senegal to Ethiopia).

Side effects associated with meningococcal vaccine are mild and consist primarily of pain and redness at the injection site. More than 40% of recipients have reported local reactions (at the area of the injection) in some studies, but in other studies reactions have been much more infrequent.

 
Zostavax/Herpes Zoster vaccine
("Shingles" vaccine)
 

Not available 
 
 
 
 
This vaccine is now recommended for all adults at or over age 60, whether or not they've ever had chickenpox or previously had the chicken pox (varicella) vaccine.

Zostavax is a new vaccine that helps to reduce the risk of getting herpes zoster (shingles) in individuals 60 years of age and older. The virus that causes chickenpox can remain in the body for many years afterwards and sometimes reactivates to cause shingles.

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Zostavax/Herpes Zoster vaccine

Anyone who has had chicken pox is at risk for developing shingles. It is estimated that 1 million or more cases occur each year in the United States. Shingles can occur in people of all ages, but most commonly in those over 60 years of age, and this risk increases as people get older. When shingles develop, a rash or blisters appear on the skin, generally on one side of the body. This is a sign that the virus, that has been dormant (asleep) in the nerve cells, has reactivated and traveled on a path from the nerves to the skin. Because the nerves along the path become inflamed, shingles can also be painful. Pain that lasts for months after the rash has healed is called post herpetic neuralgia or PHN. For some people, this pain can be severe and chronic.

For more information about this new vaccine, the FDA webite has useful information and can be found at http://www.fda.gov/CbER/products/zosmer052506qa.htm

 
Polio vaccine
(Inactivated (IPV) polio vaccine)
 

Not available 
 
 
 
 
Immunization recommended only if not previously immunized. A booster shot is recommended for those who will be traveling to areas where polio is common. Live polio vaccine is no longer recommended for adults.
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Polio vaccine

Most adults do not need polio vaccine because they were already vaccinated as children. But three groups of adults are at higher risk and should consider polio revaccination with a single one-time booster shot:

  • (1) people traveling to areas of the world where polio is common (parts of Asia and Africa),
  • (2) laboratory workers who might handle polio virus, and
  • (3) health care workers treating patients who could have polio.

Adults in these three groups who have never been vaccinated against polio should get 3 doses of IPV: The first dose at any time, the second dose 1 to 2 months later, the third dose 6 to 12 months after the second. Adults in these three groups who have had 1 or 2 doses of polio vaccine in the past should get the remaining 1 or 2 doses. It doesn't matter how long it has been since the earlier dose(s).

For more polio vaccine information, see the CDC site: http://www.immunize.org/vis/vis_polioipv.asp

 
Human papillomavirus (HPV) vaccine
(Gardasil)
 

Not available 
 
 
 
 
Recommended only for women age 19-39 who have not had the full series of shots and need to "catch-up" so that they eventually will have had all three doses of vaccine. Not recommended for men or women over age 39.
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Human papillomavirus (HPV) vaccine

HPV (Gardasil) is a new vaccine that helps prevent infection with the virus that causes genital wart (human papilloma virus or HPV). This virus has been associated with development of cancer of the cervix (tip of the uterus/womb). Preventing the HPV infection prevents cervical cancer. This vaccine is new and has only been available for a few years.

GARDASIL may not fully protect everyone, and does not prevent all types of cervical cancer, so it's important to continue routine cervical cancer screenings. GARDASIL will not protect against diseases caused by other HPV types or against diseases not caused by HPV.

Most side effect reactions to Gardasil/HPV vax include headache, fever, nausea, and dizziness; and local injection site reactions (pain, swelling, redness, itching, and bruising). Fainting has been reported following vaccination with GARDASIL and may result in falling with injury; so the child or woman should remain under observation for 15 minutes after administration is recommended. Severe allergic reactions have been reported following vaccination with GARDASIL, but occur less than 0.01% of the time. The vaccine is given in 3 doses, the second 2 months after the first, and the third 4 months later.

 

 
     
NOTE: Just because a drug or combination of drugs can cause a symptom does not mean it is actually causing your symptom. Symptoms can be caused by medical conditions as well. Make sure that your physician is aware of any symptoms you are experiencing so he/she can work with you to determine the cause. Please DO NOT STOP MEDICATIONS without first consulting a physician since doing so could be hazardous to your health.
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