Annual preventive tests to put on your calendar today


Hello, hello! It’s me, 2020 calling, with some timely tuneup tips—like starting the new year with a thorough assessment of your health. We have tests that can  “zoom in” on typical trouble spots, better than ever. So we can get a jump on fixing them, or better yet, pronouncing them untroubling—with greater confidence than ever.

Message #1:Testing, testing, testing

Every new year brings us new diagnostic tools and improved early detection tests. Nothing could be more important. Many common, dangerous diseases have a wicked habit of showing no symptoms for years. Cancer, for example, can lie dormant for up to 10 years before it ambushes you with a red-flag lump or bump.

So, when you make an appointment with your doctor for an annual physical, make sure this list of recommended screenings is part of your examination.  If you had any of these tests in 2019, move on to the next one after checking with your doctor(s).

Important note: before your doctor orders any of these tests, be sure to tell her or him about any unusual new symptoms, sensitivities, or “not-quite right” feelings you might have. The best medical outcomes happen when you and your doctor can work together as a team. So, any new information you can offer is vitally important to guiding your test regimen—keeping you steps ahead of any game a disease might be playing.

We’ll start with the standard tests, then move on to additional tests your results might say you need. We’ll finish with tests that are highly recommended—for vision, hearing, and oral health—but that aren’t usually part of a routine physical.

Tests for blood sugar

Diabetes is a disease that occurs when your blood sugar (or glucose)—your body’s main source of energy—is chronically too high.

Insulin, a hormone made by the pancreas, escorts glucose into your cells so that it can be used for energy. But when you have type 2 diabetes, your body doesn’t make enough insulin or it doesn’t use insulin properly—a condition called insulin resistance. Over time, glucose remains in your blood instead of entering your cells, which leads to consistently high blood sugar—and eventually, diabetes.

Over the long term, serious issues can develop as a result of chronically high blood sugar, including eye, kidney, nerve, and heart problems.

Hemoglobin A1C

The A1C (also called the hbA1c) test is the most accurate and trusted test for diabetes. It requires a small blood sample, which provides an average of your blood sugar levels over a 3-month span.

Hemoglobin is a protein found in our red blood cells. When glucose enters these cells, it attaches to molecules of hemoglobin. The more glucose found in your blood, the more hemoglobin molecules have been attached.

Because red blood cells have a lifespan of about 3 months, the A1C test measures how much glucose has attached itself to the hemoglobin in your red blood cells over that period of time.

The hemoglobin level is expressed as the percentage of hemoglobin in grams (gm) per 100 milliliters of blood.

Results less than 5 percent are considered normal.

Results between 5.7-6.4 percent are associated with prediabetes, meaning your blood sugar levels are elevated, but not high enough to get a full diagnosis of diabetes.

If prediabetes is your result, now is the time to change your lifestyle and diet to bring your glucose down to normal range! You can do it naturally and without drugs, but you must get started immediately.

Results equal to or greater than 6.5 percent indicate diabetes.

If people get inconclusive A1C results or have a type of hemoglobin that makes the A1C test inaccurate, additional tests are in order. Many physicians perform one or more of the following tests even for people showing normal A1C results. A second set of eyes in the lab is never a bad idea.

Fasting Plasma Glucose (or Blood Sugar) Test

This test measures your blood sugar level at a single point in time. For the most reliable results, you need to fast for at least 8 hours first. It’s best to stop eating at night and then have your test first thing in the morning.

Results of less than 100 mg/dL are considered normal.

Results from 100 -125 mg/dL could indicate prediabetes, and results greater than 126 mg/dL mean diabetes. (Doctors will often order two tests to confirm.)

Random Blood Sugar Test

This test is similar to the fasting blood sugar test, but instead of avoiding food for 8 hours before your test, you can do it no matter when you last ate.

Results of 200 mg/dL or higher signal diabetes.

Oral Glucose Tolerance Test

This test takes about two hours. After an initial blood test, you have a sugary drink, wait 2 hours and get tested again. This provides an excellent look at how your body has processed and responded to the sugar.

Again, additional tests might be ordered to provide more information to patients who have prediabetes or diabetes. Results less than 140 mg/dL are normal, between 140-199 mg/dL signal prediabetes, and equal to or greater than 200 mg/dL indicate diabetes.

Other Important Diabetes Tests

Along with your other tests, you should discuss these additional recommended tests with your doctor:

Eye exam with dilation. High blood sugar damages the tiny blood vessels in your eyes, which can lead to diabetic retinopathy. Your eye doctor will probably check for damaged blood vessels during your regular exam. Check, just in case.

Podiatry exam. Diabetes can slow circulation to your extremities, leading to loss of feeling (neuropathy). A podiatrist can check for cracks, redness, sores, nerve damage, and other abnormalities.

Tests for Cholesterol

We used to blame cholesterol for the plaque and clogged arteries that caused heart trouble, weight problems, and strokes.

We now know we were only half right. There are two different kinds of cholesterol.

High-density lipoprotein (HDL) is absolutely essential to good health, so we call it “good” cholesterol. Our bodies use the sun’s UV rays to convert HDL into vitamin D3 and to produce other vital hormones.

Low-density lipoprotein, (LDL) on the other hand, does clog our arteries, playing a significant role in heart diseases and other health threats.

When you have your cholesterol levels checked, as part of a lipid blood panel, your lab or doctor will use your scores to determine your relative risk of heart disease—your total cholesterol ratio.

Good Ratio? 5 to 1 or lower. Optimal ratio? 3.5 to 1.


The lipid blood panel also tests for triglycerides, the fats created as our foods are broken down, converted into sugar, used for fuel, and stored in our bodies as fat.

Triglycerides have two essential jobs:

  1. Transport oxygen throughout our bodies, a health-or-illness matter for every cell we’ve got.
  2. Serve as a reserve store of fat, which our bodies tap into when we need energy but no food is available for fuel.

A healthy triglyceride count means not too low, which can slow or stall those oxygen transport duties, and not too high, which can lead to excess fat buildup. This can lead, of course, to weight gain, pre-diabetes and diabetes, heart disease, and all the usual bad outcomes.

Triglycerides results:

  • Healthy: Below 150 mg/dL (1.70 mmol/L)
  • Borderline high: 150-199 mg/dL(1.7-2.2 mmol/L)
  • High: 200-499 mg/dL (2.3-5.6 mmol/L)
  • Very high: Above 500 mg/dL (5.6 mmol/L)

Tests for cancer

Our US Centers for Disease Control and Prevention (CDC) found that these vital tests are being skipped by an alarming and growing number of adults.

In 2013:

  • 20 percent of women were not up to date with cervical cancer screening
  • 25 percent of women were not up to date with breast cancer screening
  • 40 percent of adults were not up to date with colorectal cancer screening

This is playing with fire, and for no good reason—most insurance covers these screenings, usually at 100 percent. And for the uninsured, clinics across the country offer screenings for no or minimal cost.

Currently, the US Preventive Services Task Force recommends the following schedule:

  • Colorectal cancer: Starting at age 50 using either fecal occult blood testing (yearly), sigmoidoscopy (every 5 years), or colonoscopy (every 10 years).
  • Cervical cancer: Start at age 21 using a Pap test, every 3 years.
  • Breast cancer: Starting at age 50, every 2 years, alternating traditional mammography with thermography, to reduce radiation exposure from mammography.

Depending on many factors—genetics, family and personal history, current state of health—you might need additional, or more frequent, tests, including one that many physicians recommend for all patients. It’s called the Creatine Reactive Protein, or CRP, test.

It’s a simple but wide-ranging blood test that looks all over your body for this protein—which is always present where there’s inflammation. Elevated CRP levels doesn’t immediately mean there’s cancer—something else could be causing the inflammation, which is the start point for nearly every disease we know.

But chronically elevated CRP always means something is wrong, and you should rule out cancer before anything else.

For patients with chronically elevated levels of CRP (score above 1), a high risk for cancer, or other test results signaling trouble, an oncoblot test is in order. It looks for the enox2 protein, which is produced by malignant cancer cells. If you test positive, then you search immediately for the source of the cancer. The test can identify the presence of 26 types of cancer.

Another test looks for circulating tumor cells (CTC.) These are the cancer cells produced by a tumor—and cut loose into the bloodstream to find vulnerable cells, like at inflammation sites—where they dig in and replicate the “parent” tumor. This is metasticy, and it’s major, major trouble.

The bad news is, you can have CTC or enox2 proteins in your body for years, and never know it. Don’t get ambushed.

Tests for prostate cancer

For decades, the PSA test for prostate health was the go-to routine. But evidence kept arriving that put a stop to that. There were too many men who were told that their PSA test showed they needed a biopsy to find the presence of threatened or threatening cells. But biopsy after painful, hit-or-miss biopsy found no evidence of precancerous or cancerous cells. The PSA test lost its go-to status.

Other data found that prostate cancer is, thankfully, a very slow moving variety. Even men in their 60s were more likely to die with prostate cancer than because of it.

That said, prostate cancer remains the second most frequent killer of men, among cancers (following lung cancer).

Today, we have a more reliable test for prostate cancer called gene3 (PCA3). All it takes is a urine test that looks for active genes found only in prostate cancer cells. In 95 percent of diagnosed prostate cancer cases, those active gene3 cells were highly visible.

In those cases, another test is in order. The Color Doppler Ultrasound exam is non-invasive, painless, and takes only about 30 minutes. It spots prostate tumors—even identifies the type, location, and stage—and other abnormalities.

Even if tumors are found, it’s not yet time for treatment.

Many, but not all, physicians recommend starting with a PSA test for a benchmark, then getting another one after a year to highlight changes, if any. Only if changes are significant should the additional tests we’ve just covered be prescribed.

Tests for oral health

Our mouths are more vulnerable to serious health threats than most people realize.  Unlike our skin, a barrier between the toxin-rich outside world and the wet, “raw” tissue beneath it, our mouths are pretty much nothing but raw tissue. Every breath, bite, or swallow we take is swarming with pathogens.

Making matters worse, our delicate oral tissues are easily damaged. Bleeding gums after flossing or brushing? Hello, bacteria and inflammation, welcome to our systems.

Indeed, poor oral health can be a player in diabetes, Alzheimer’s, osteoporosis, cardiovascular diseases, and more. People with periodontal diseases have up to a 46 percent greater chance of dying than those with healthy gums.

Our mouths are target-rich, vulnerable to cancers of the lips, tongue, cheeks, floor of the mouth, hard and soft palate, sinuses, and pharynx (throat). These can be life threatening if not diagnosed and treated early.

The American Cancer Society recommends oral cancer screening exams annually for those older than age 40.

How Is Oral Cancer Diagnosed?

Your routine dental exam should include oral cancer screening. Your dentist should watch for and manually feel for sores or discolored tissue, lumps, irregular tissue changes under your tongue and the linings of the cheeks, and in your neck, head, face, and oral cavity.

The most common symptoms of oral cancer include:

  • Swellings/thickenings, lumps or bumps, rough spots/crusts/or eroded areas on the lips, gums, or other areas inside the mouth
  • Velvety white, red, or speckled (white and red) patches
  • Unexplained bleeding
  • Unexplained numbness, loss of feeling, or pain/tenderness in any area of the face, mouth, or neck
  • Persistent sores on the face, neck, or mouth that bleed easily and do not heal within 2 weeks
  • Soreness or feeling that something is caught in the back of the throat
  • Difficulty chewing or swallowing, speaking, or moving the jaw or tongue
  • Hoarseness, chronic sore throat, or change in voice
  • Ear pain
  • A change in the way your teeth or dentures fit together
  • Dramatic weight loss

Any of these symptoms should be considered a signal, not a green light, of the need for a biopsy.  That’s never a decision to be taken lightly. A traditional biopsy is a painful, hit-or-miss procedure with mixed success. Fortunately, there are ways to get the information needed that are far less invasive—using lasers, for example, or swabs and screens to test your mouth for dangerous bacteria. Make sure your doctor knows about these alternatives before deciding which procedure is best.

To really stay in touch with your oral health, conduct a self-exam at least once a month. Using a bright light and a mirror:

  • Look at and feel your lips and the front of your gums
  • Tilt your head back and look at and feel the roof of your mouth
  • Pull your checks out to see the inside of your mouth, the lining of your cheeks, and the back gums
  • Pull out your tongue and look at all surfaces, including under the tongue
  • Examine the floor of your mouth
  • Look at the back of your throat
  • Feel for lumps or enlarged lymph nodes in both sides of your neck and under your lower jaw

Self-exams don’t excuse you from regular dentist visits. Danger spots in the mouth can be very tiny and difficult to see on your own.

Call your dentist immediately if you notice any changes in the appearance of gums and tongue.

Tests for vision

Believe it or not, as we age, more of us suffer some degree of vision loss than hearing or cognitive function.

On the menu of unhappy outcomes:

  • Age-related macular degeneration (AMD)
  • Cataracts
  • Diabetic eye disease
  • Glaucoma
  • Dry eye
  • Low vision
  • Blindness

The first thing we want to test for, and correct, is signs of macular degeneration, the most common type of vision loss.

We don’t yet know the exact causes, but we know you’re more susceptible if you’re:

  • Older than 50
  • A smoker, overweight, or diabetic
  • Eating unhealthy food

Additional risk factors:

  • Light eyes and fair skin
  • History of cataracts
  • Female

There are two types of AMD—early and late.

In early AMD, your sight is unaffected, so you have no idea your vision is threatened. Only your eye care professional can detect the early signals, so regular eye exams are critical.

Some people with early AMD develop late AMD, where loss of vision can begin.

Late AMD can be either dry or wet AMD.

Dry AMD is more common—around 85 percent of people with late AMD have this type. Fortunately, it’s the less severe type—vision deteriorates slowly, over a longer period of time.

With wet AMD, vision degenerates more rapidly. It’s caused by abnormal blood vessels that bleed and leak fluid, causing distorted vision.

Glaucoma is another common condition that can hide for years before showing symptoms. Glaucoma is a buildup of pressure inside your eye. When this intraocular pressure damages the optic nerve, its ability to transmit images to your brain is impeded. If the damage continues, it can lead to permanent vision loss, even blindness, within just a few years.

There are two types of glaucoma. Open-angle or wide-angle glaucoma is the most common type. It occurs when your eye’s drainage network prevents fluid from flowing out properly.

Angle-closure glaucoma (or acute, chronic or narrow-angle glaucoma) is caused by the eye’s drainage passageway narrowing. This can cause a buildup of ocular fluid and pressure in your eye. Obstructed drainage is also linked to cataracts, a clouding of the lens inside your eye.

When you’re tested, your eye doctor will use drops to open your pupils. He or she will check your optic nerve for signs of glaucoma, and do a tonometry test to check your eye pressure. He might also do a visual field test to see if you’ve lost peripheral vision.

You’re more likely to get glaucoma if you:

  • Are of African-American, Irish, Russian, Japanese, Hispanic, Inuit, or Scandinavian descent
  • Are over 40
  • Have a family history of glaucoma
  • Have poor vision
  • Have diabetes
  • Take certain steroid medications, like prednisone
  • Have had trauma to the eye or eyes

Don’t avoid these tests. They’re painless and take very little time.

Tests for hearing

Hearing loss already affects roughly one-third of Baby Boomers older than 65. And as they continue to age, it’s inevitable that many more will join their ranks.

The microscopic, hair-like cells in our ears, inside the cochlea, serve to receive and transmit to the brain every sound we hear.

These tiny hairs can be damaged by:

  • Free radicals
  • Noise
  • Some drugs
  • Circulatory problems
  • Some diseases
  • Infections
  • Genetics
  • Lack of antioxidants

There are 5 common tests audiologists use to diagnose hearing loss:

  • Pure-tone test
  • Speech test
  • Middle ear test
  • Auditory brainstem response
  • Otoacoustic emissions

The Pure-Tone test determines the highest and lowest sounds you can hear compared to normal hearing.

The Speech test has you listen on headphones to conversation in quiet and noisy environments. This helps determine your speech reception threshold, that is, how well you can pick up words in those environments.

The Middle Ear test involves pushing air into your ear, causing the eardrum to vibrate. Measuring the vibration helps identify problems like a perforated eardrum or obstructions in the ear’s ventilation tubes.

The Auditory Brainstem Response test provides data about the inner ear and the neural pathways necessary for hearing. You’ll have electrodes on your head to record brain wave activity.

The Otoacoustic Emissions test identifies the various sounds produced by the inner ear when the cochlea are stimulated. The sounds are measured to pin down different types of hearing loss. You’ll have a small probe inserted into the ear canal.

Thanks for getting the message

I hope these recommendations make 2020 a great year for building health and happiness for many years to come. Always make sure you and your doctor(s) are on the same page when it comes to which tests happen when.



Last Updated: January 11, 2020
Originally Published: January 15, 2019