10 Tests or Treatments You Don’t Need

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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More is not always better. More tests, more treatments and more visits to the doctor may not always be the way to go. Unnecessary tests or medications can lead to anxiety, side effects, and follow-up tests that are more harmful than helpful to your health. The saying in medicine is “imaging begets more imaging,” and radiology studies often bring about a cascade of unnecessary follow-ups.

Is that to say that all screening tests are bad? No—and many save lives. Here are ten interventions, however, that have not been shown to be helpful.

  1. Aspirin, for young folks. Most young people taking aspirin for prevention of stroke and heart disease don’t need it. The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of cardiovascular disease or colorectal cancer in adults younger than 50 years. So, there’s that.
  2. A urine test and urine culture during a physical. For men and non-pregnant women, screening for bacteria in the urine if you are not having symptoms is not recommended nor is it helpful.
  3. A Pap smear in women who have had a hysterectomy and have no cervix. If you’re a woman who has had a hysterectomy with removal of the cervix and you do not have a history of cervical cancer, or a high-grade precancerous lesion (cervical intraepithelial neoplasia [CIN] grade 2 or 3), you do not need screening with a pap. There is nothing to screen.
  4. A Pap smear in women younger than 21. Current recommendations say no to screening for cervical cancer with a Pap in women younger than 21, even if they’ve been sexually active. Newsflash: women can wait until they are 21 to have their first Pap.
  5. Carotid artery ultrasound (also known as a carotid artery duplex scan). Current recommendations do not support screening for carotid artery stenosis in the general adult population if you are not having any symptoms of stroke or mini-stroke (TIA). So unless you have unexplained weakness, numbness, tingling, visual changes, or dizziness, you do not need this done.
  6. Screening for abdominal aortic aneurysm. Though recommended for some adults, like men who are heavy smokers, most of you do not need an ultrasound to screen for an aneurysm. For women who have never smoked, there is no need to screen for an abdominal aortic aneurysm.
  7. EKG and heart stress test for adults at low risk. Adults who are not having symptoms (chest pain, shortness of breath, decreased exercise tolerance etc.) and are low risk do not need screening with a resting or exercise electrocardiography (ECG or EKG) for the prediction of coronary heart disease events. Low risk means you don’t have: diabetes, family history of early heart attacks, uncontrolled hypertension, and so on. A routine EKG in a healthy person without symptoms is not needed and does not save lives.
  8. Genetic tests for breast cancer. Genetic counseling or BRCA testing (BRCA 1 or 2 genes) for women whose family history is NOT associated with increased risk is NOT recommended. How do you know if your family is at risk? Check out this article.
  9. Herpes blood test in people without any symptoms/genital lesions. Routine blood tests for HSV (herpes simplex virus) is not recommended for teens and adults who have no symptoms. Remember, the blood test is positive in many people who have been exposed but may never develop a lesion. The blood test is not helpful to predict who may have outbreaks and who may not. A viral culture done on an actual sore in the mouth or genitals is the way to make the diagnosis of herpes.
  10. Hormone replacement therapy (HRT) in all postmenopausal women. To prevent chronic conditions (heart disease and stroke) in postmenopausal women, the combined use of estrogen and progestin is not recommended. Downsides outweigh upsides here.

Dr O.

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