Month: November 2022

Screening tests, such as Pap smears or blood pressure checks, could save your life. They can detect a disease you have no reason to suspect is there. Early detection may allow treatment while a health condition is curable and before irreversible complications arise.

Some screening tests help prevent the disease they are designed to detect. For example, colonoscopies and Pap smears can identify precancerous abnormalities that can be addressed so they cannot continue to grow and become cancerous. And missed screening tests contribute to thousands of avoidable deaths each year in the US. Yet there’s a point of diminishing returns, as a new study on Pap smears illustrates. And many of us could benefit from a better understanding of the limits of screening, and how experts decide when people should stop routine screening tests.

Know the limits of screening tests

Even the best screening test has limitations. It can miss the disease it’s intended to detect (false-negative results). Or it can return abnormal results when no disease is present (false-positive results).

Equally important, as people grow older life expectancy declines and screening benefits tend to wane. Many conditions detected by routine screenings, such as prostate cancer or cervical cancer, typically take a while to cause trouble. A person in their 80s is more likely to die from another fatal condition before cervical cancer or prostate cancer would affect their health. Additionally, certain diseases, such as cervical cancer, become less common with advancing age.

As a result, many screening tests are not recommended forever: at some point in your life, your doctor may tell you that you no longer need to repeat a screening test, even one you finally got used to having.

Know when screening tests usually end

Expert guidelines for many common screening tests include an “end age” when people can reasonably stop having the test. For example:

• Pap smear: age 65
• mammogram: age 75
• colonoscopy: age 75
• chest CT scan (recommended for people with a significant smoking history): age 80.

There are exceptions, of course. For example, if a colonoscopy found abnormalities in an otherwise healthy 72-year-old, repeat testing after age 75 may be recommended.

Many women have Pap smears after guidelines suggest stopping

Pap smears screen for cervical cancer. In 1996, new guidelines recommended that women who received Pap smears at appropriate intervals before age 65 could safely stop.

Yet many women continue to have this screening after turning 65, according to a recent study published in JAMA Internal Medicine that looked at data from 15 to 16 million women per year between 1999 and 2019. Their average age was 76, most (82%) were white, and all were enrolled in Medicare.

The study found:

• In 1999, nearly three million women over age 65 (almost 19% of the study population) had Pap smears. By 2019, the number had fallen to 1.3 million (8.5%), a reduction of more than half.
• Among women older than age 80, about 3% had Pap smears.
• In 2019, the estimated cost related to Pap smears in these older women was $83.5 million.

Possibly, some women in this study had good reasons to continue having Pap smears. Perhaps they weren’t adequately screened when they were younger. Perhaps they had previous Pap smear abnormalities. Maybe their doctors recommended they continue having Pap smears despite their advanced age. We don’t know, because this study didn’t collect that information. Still, it’s quite likely that many (or even most) of these Pap smears represent overscreening: routine testing with little chance of benefit.

Why does overscreening matter?

Overscreening may cause

• discomfort that may be tolerable when there’s an expectation of benefit, but less acceptable when the test is unnecessary
• anxiety while awaiting the results of the test
• false-positive results that lead to additional testing and unnecessary treatment
• complications of testing, such as infection or bleeding after a Pap smear, or perforation or bleeding after a colonoscopy. (Fortunately, complications are rare.)
• unnecessary costs, including medical appointments and lab fees, time wasted, and taking health providers away from more valuable care.

The bottom line

Screening tests are typically performed for people without symptoms, signs, or a high suspicion of disease. In many cases, they’re looking for a condition that is probably not there. For most screening tests, we have guidelines developed by experts and backed by data suggesting when to start — and when to stop — screening.

But guidelines are only general recommendations, and individual preferences matter. If foregoing a screening test will cause you excessive anxiety, or if having a test will provide significant peace of mind, it may be reasonable to have a test even after the recommended end age. Be sure you understand potential downsides, such as additional tests and complications.

So, never hesitate to ask your doctor when your next screening tests are due — but don’t forget to also ask if they are no longer worth having.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Ah, ’tis the season for warm-weather allergies caused by trees, grass, and ragweed pollen. You know the signs: sneezing, watery eyes, stuffiness, scratchy throat, wheezing, and coughing. But what about so-called brain fog? That may be true for you, too.

Why do allergies make your brain feel so foggy?

“Allergy symptoms can disrupt sleep and make people feel more tired and groggy,” says Dr. Mariana Castells, an allergist and immunologist in the division of Allergy and Clinical Immunology at Harvard-affiliated Brigham and Women’s Hospital. “Plus, your body can become weaker as it fights the inflammation triggered by allergies, contributing to overall fatigue and making it harder to concentrate and focus."

What happens to your immune system when you inhale pollen?

When you inhale pollen, your immune system generates antibodies called immunoglobulin E (IgE). Those antibodies trigger the release of chemicals called mediators, such as histamine, leukotrienes, and prostaglandins. The chemicals affect tissues in the eyes, nose, and throat,  causing symptoms like sneezing and watering eyes.

4 ways to prevent or ease brain fog stemming from seasonal allergies

Managing your allergy symptoms when they first appear — or taking preventive measures if you are prone to pollen allergies — is the best way to control the allergic immune response that can cause fatigue and brain fog. These four strategies can help.

Lower your exposure to pollen

• Keep your windows closed whenever possible, and occasionally run an air conditioner or use an air purifier with a HEPA filter to help remove pollen from indoor air.
• Pollen is usually highest from about 4 a.m. to noon, so restrict outside time to the late afternoon or evening.
• You can check daily pollen counts in your area and sign up for high pollen alerts at www.pollen.com.
• Wearing a mask outside when pollen is high can block about 70% to 80% of pollen, says Dr. Castells.

Be prepared with over-the-counter allergy medicines

Over-the-counter (OTC) allergy medicines treat many symptoms, thus helping to lift brain fog. It’s best to talk to your doctor or pharmacist before starting any new medicine, especially if you have any health problems or take other medicines.

Options include:

• Non-drowsy antihistamine pills and nasal sprays. Antihistamines block the effects of excess histamine that causes itchy and watery eyes, sneezing, and a runny nose. Sprays also help with congestion and postnasal drip. “Be aware that even non-drowsy brands have potential for some sedation that can affect thinking,” says Dr. Castells. “People tolerate antihistamines differently, so you may have to try more than one brand to assess effectiveness and potential side effects.” Loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra) are less sedating than first-generation antihistamines such as diphenhydramine (Benadryl).
• Decongestant pills, such as phenylephrine (Sudafed PE) and pseudoephedrine (Sifedrine, Sudafed). Decongestants shrink tiny blood vessels, which decreases fluid secretion in nasal passages, helping to unclog a stuffy nose. However, they can increase heart rate and blood pressure. They are not recommended for prolonged use, so check with your doctor if you have heart or blood pressure problems. Decongestant nasal sprays, such as oxymetazoline (Afrin), may be used for several days, but continued use can lead to worsening nasal congestion.
• Combined antihistamine and decongestant medicines have “D” added at end of brand names, such as Zyrtec-D, Allegra-D, and Claritin-D, which combine different antihistamine medicines with the decongestant pseudoephedrine.
• Nasal steroid sprays, such as triamcinolone (Nasacort), budesonide (Rhinocort), and fluticasone (Flonase), reduce inflammation that causes congestion, runny or itchy nose, and sneezing. “It's often best to take them before pollen season begins, especially if you are susceptible to allergies,” says Dr. Castells. Side effects may include nasal dryness and, rarely, nose bleeds. People with glaucoma should take these cautiously, as they can raise the pressure inside the eye, leading to potential vision loss.

Consider prescription allergy shots or tablets

If allergies are severe or OTC remedies aren’t sufficient, an allergist may recommend allergy shots, or possibly tablets designed to treat certain allergies.

• Allergy shots are regular injections of small amounts of your allergen, with the dose gradually increasing over time. “Allergy shots do not completely eliminate your allergy but change your immune response to better tolerate it,” says Dr. Castells. During a buildup phase, the allergen dose increases gradually in once or twice weekly shots for three to six months. During the maintenance phase, you get monthly injections for three to five years. "When you're finished, the protective effect can last several years," says Dr. Castells.
• Tablets to treat grass and weed allergies offer similar protection as injections. These tablets are dissolved under the tongue. Dr. Castells says they should be used daily before and during the pollen seasons for at least five seasons.

Try a nasal rinse

Prefer to skip medications? Try clearing your nasal cavity twice daily using saline solution in a small bulb syringe or neti pot, which resembles a small teapot with a long spout. Both are sold at drugstores and online. Performed once in the morning and in the evening, this simple technique rinses away pollen.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Howard LeWine, M.D., is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Experiencing discrimination in the workplace — where many adults spend one-third of their time, on average — may be harmful to your heart health.

A 2023 study in the Journal of the American Heart Association found that people who reported high levels of discrimination on the job were more likely to develop high blood pressure than those who reported low levels of workplace discrimination.

Workplace discrimination refers to unfair conditions or unpleasant treatment because of personal characteristics — particularly race, sex, or age.

How can discrimination affect our health?

“The daily hassles and indignities people experience from discrimination are a specific type of stress that is not always included in traditional measures of stress and adversity,” says sociologist David R. Williams, professor of public health at the Harvard T.H. Chan School of Public Health.

Yet multiple studies have documented that experiencing discrimination increases risk for developing a broad range of factors linked to heart disease. Along with high blood pressure, this can also include chronic low-grade inflammation, obesity, and type 2 diabetes.

More than 25 years ago, Williams created the Everyday Discrimination Scale. This is the most widely used measure of discrimination’s effects on health.

Who participated in the study of workplace discrimination?

The study followed a nationwide sample of 1,246 adults across a broad range of occupations and education levels, with roughly equal numbers of men and women.

Most were middle-aged, white, and married. They were mostly nonsmokers, drank low to moderate amounts of alcohol, and did moderate to high levels of exercise. None had high blood pressure at the baseline measurements.

How was discrimination measured and what did the study find?

The study is the first to show that discrimination in the workplace can raise blood pressure.

To measure discrimination levels, researchers used a test that included these six questions:

• How often do you think you are unfairly given tasks that no one else wanted to do?
• How often are you watched more closely than other workers?
• How often does your supervisor or boss use ethnic, racial, or sexual slurs or jokes?
• How often do your coworkers use ethnic, racial, or sexual slurs or jokes?
• How often do you feel that you are ignored or not taken seriously by your boss?
• How often has a coworker with less experience and qualifications gotten promoted before you?

Based on the responses, researchers calculated discrimination scores and divided participants into groups with low, intermediate, and high scores.

• After a follow-up of roughly eight years, about 26% of all participants reported developing high blood pressure.
• Compared to people who scored low on workplace discrimination at the start of the study, those with intermediate or high scores were 22% and 54% more likely, respectively, to report high blood pressure during the follow-up.

How could discrimination affect blood pressure?

Discrimination can cause emotional stress, which activates the body’s fight-or-flight response. The resulting surge of hormones makes the heart beat faster and blood vessels narrow, which causes blood pressure to rise temporarily. But if the stress response is triggered repeatedly, blood pressure may remain consistently high.

Discrimination may arise from unfair treatment based on a range of factors, including race, gender, religious affiliation, or sexual orientation. The specific attribution doesn’t seem to matter, says Williams. “Broadly speaking, the effects of discrimination on health are similar, regardless of the attribution,” he says, noting that the Everyday Discrimination Scale was specifically designed to capture a range of different forms of discrimination.

What are the limitations of this study?

One limitation of this recent study is that only 6% of the participants were nonwhite, and these individuals were less likely to take part in the follow-up session of the study. As a result, the study may not have fully or accurately captured workplace discrimination among people from different racial groups. In addition, blood pressure was self-reported, which may be less reliable than measurements directly documented by medical professionals.

What may limit the health impact of workplace discrimination?

At the organizational level, no studies have directly addressed this issue. Preliminary evidence suggests that improving working conditions, such as decreasing job demands and increasing job control, may help lower blood pressure, according to the study authors. In addition, the American Heart Association recently released a report, Driving Health Equity in the Workplace, that aims to address drivers of health inequities in the workplace.

Encouraging greater awareness of implicit bias may be one way to help reduce discrimination in the workplace. Implicit bias refers to the unconscious assumptions and prejudgments people have about groups of people that may underlie some discriminatory behaviors. You can explore implicit biases with these tests, which were developed at Harvard and other universities.

On an individual level, stress management training can reduce blood pressure. A range of stress-relieving strategies may offer similar benefits. Regularly practicing relaxation techniques or brief mindfulness reflections, learning ways to cope with negative thoughts, and getting sufficient exercise can help.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Howard LeWine, M.D., is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD