High-fat diets and a sedentary lifestyle can lead to a high fat (cholesterol) content in the blood causing fatty deposits on the inside of the blood vessels. This fat collection, known as plaque, results in the narrowing and hardening of the arteries, restricting the blood flow to other tissues of the body, and increasing the workload of the heart, which now has to pump with more force to move the blood through the restricted vessels. Complications of atherosclerosis include heart attacks, hypertension, strokes and TIAs' (transient ischemic attacks).

Predisposing factors to the development of cardiovascular disease include:

High cholesterol Sedentary lifestyle Hypertension

Stress Smoking Diabetes

Family history Obesity Age

PREVALENCE
Despite the efforts to educate the public about the prevention of CVD and the need for exercise, the American Heart Association reports that CVD remains the number one health problem in the United States. Heart attack is the major cause of death in CVD victims, and remains the leading cause of death in the U.S. Forty-five percent of all heart attacks occur in individuals under age 50. Hypertension is the precursor to other advanced symptoms of CVD, and ranks as one of the nation's most significant health problems. Stroke is the leading cause of disability in the U.S. today and the third leading cause of death.

POSSIBLE WAYS TO PREVENT
While only a healthcare provider can address preventive measures designed to treat or alleviate disease processes, there are ways to enhance wellness which should be of benefit. One of the best ways to reduce your risk of heart disease is to practice healthy habits. These include:

• Accumulate at least 30 minutes of endurance-type training of at least moderate intensity on most or preferrably all days of the week. See your doctor for clearance prior to beginning any exercise program.
• For greater benefits, perform aerobic exercise that maintains an intensity of 55 to 85 percent of maximum heart rate for 15-30 minutes, three to five times per week.
• Dietary habits that include less than 30 grams of fat per day.
• The elimination of smoking.
• Reduction of obesity or fat percentage of the body.
• The reduction of stress.
• Routine (annual) medical physicals including blood pressure and cholesterol screening.
• Reduction in salt intake, if your physician recommends it.

HEART ATTACKS

DEFINITION AND CAUSES
Heart attack is the most serious complication of cardiovascular disease. The cause of a heart attack is a blockage of one of the arteries that supplies blood and oxygen to the heart muscle, resulting in the death of the tissue in the affected area. Blockages causing heart attacks arise from narrowing of the coronary arteries due to fatty plaque deposits, or blood clots traveling through the narrowed arteries. The degree of damage from a heart attack depends on the location of the blocked artery and the amount of tissue affected in the area. Death of a portion of the heart muscle causes that portion of the heart to become stiff, or lose its ability to pump blood effectively, preventing the heart from supplying the necessary oxygen to the body.

SIGNS AND SYMPTOMS
Pain and squeezing pressure in the chest, often with pain also radiating to one of the arms, are among the classic signs of a heart attack. It is also common to experience pain radiating to the back, neck and jaw, a toothache feeling, and gastric pain similar to heartburn. Often, symptoms such as shortness of breath or inability to breathe are present. The individual may become extremely sweaty, cold and clammy, and may even become weak, dizzy or unconscious. The most serious complications include arrhythmias (dangerous changes in the heart patterns) and cardiac arrest or stopping of the heart beat.

WHAT TO DO?
Individuals experiencing any of the above symptoms need to seek immediate medical attention. In situations of cardiac arrest or chest pain call 911 immediately.

HYPERTENSION

DEFINITION AND CAUSES
Hypertension is abnormally high arterial blood pressure which occurs over time. The cause of this condition begins with an increase in fatty plaque deposits on the walls of blood vessels, narrowing the blood's passage and thus reducing the blood flow through the vascular system while increasing the workload of the heart.

There are two components to the measurement of blood pressure. The first measurement is the "top number," or the systolic phase, which measures the pressure of the blood leaving the heart when it contracts. The second measurement is the "lower number," or the diastolic phase, which measures how elastic the vessels are when receiving blood from the heart. A blood pressure reading of 140/90 or more would alert a physician to a possible hypertension problem.

SIGNS AND SYMPTOMS
According to many physicians, some signs and symptoms of hypertension include reoccurring headaches, pounding sensations in the neck or chest, ringing or buzzing in the ears, and periods of dizziness or nausea. Some individuals will experience no signs or symptoms at all. That is why this condition is sometimes known as the "Silent Killer." Check with your physican if you experience any of these symptoms.

POSSIBLE MANAGEMENT OF HYPERTENSION
While only a physician or other healthcare provider can render a diagnosis or provide treatment, hypertension is easily diagnosed with annual blood pressure screening. In the early stages, blood pressure can be controlled effectively by reducing fat and salt in the diet, participating in cardiovascular conditioning, and effective stress management programs. In later stages, medication may be added.

STROKE/CARDIOVASCULAR ACCIDENTS (CVA)

DEFINITION AND CAUSES
Stroke, or CVA, can be described as a sudden, often severe impairment of body function brought on by a disruption of blood flow to the brain. Strokes can be caused by a decrease of blood flow to the brain due to narrowing of arteries from fatty plaque deposits developing into a clot, called thrombosis. Strokes can also be caused by embolisms (traveling blood clots) that can lodge in blood vessels, or be caused by the rupture of an aneurysm (or weak vessels). Any of these may result in severe damage to brain tissue.

SIGNS AND SYMPTOMS
Individuals suffering a stroke may experience any of the following symptoms which must be evaluated and assessed by a healthcare provider.

• Sudden blurred vision or loss of vision in one or both eyes
• Numbness, paralysis or weakness of face, neck or limbs on one or both sides of the body
• Difficulty speaking or swallowing, drooping facial features or drooling
• Confusion or disorientation
• Dizziness, loss of balance and motor control, or unexplained fall
• Headache, usually sudden and severe, or without an explained pattern as with migraines
• Change of mood or affect
• Persistent ringing or buzzing in the ears
• Seizures or cardiac arrest

TREATMENT
Individuals experiencing any of these symptoms need to seek the immediate help of a physician. Since strokes can be correlated with cardiovascular disease, much of the treatment may be the same. In situation of severe disability, a variety of rehabilitative services may be needed.

TRANSIENT ISCHEMIC ATTACKS (TIA)
Transient Ischemic Attack (TIA) is a condition sometimes referred to as a mild stroke. An individual experiencing a TIA may have the same signs and symptoms of a stroke. However, the time frame is transient with all faculties returning after a period of time. Even when faculties return and symptoms are gone, it is important to see a physician to establish a cause, and to prevent the occurrence of a stroke.

Note: This information was derived from various medical publications, American Red Cross First Aid Manual, and materials from the American Heart Association.

Medications prescribed by physicians are powerful substances that must be taken appropriately. The substantial amount of clinical research and development that goes into producing drugs gives us an appreciation for their complexity and the potential for serious or severe consequences if not used carefully. Inappropriate use of prescription drugs and over-the-counter medications can lead to significant adverse events, permanent damage and, in some cases, death.

FACTORS THAT HAVE A POSITIVE ASSOCIATION WITH COMPLIANCE:

• Patient's perceived seriousness of illness
• Patient's perceived susceptibility to disease
• Patient's perceived efficacy of treatment
• Patients who are symptomatic
• Patients who maintain the same physician
• Patient satisfaction and relationship with physician
• Increased time spent with patient and family members
• Increased convenience of treatment
• Written instructions

• Type of medication (pills, liquid, injection)
• Safety closure containers
• Social isolation
• Increased duration of treatment
• Increased complexity of medication regimen
• Actual and perceived adverse effects of medications
• Treatment requiring behavioral change
• Expensive medication/regimen
• Frequency of pill taking

NONCOMPLIANCE IN MEDICATION TAKING CAN BE CLASSIFIED AS:

• Errors of omission (a prescribed medicine is not taken)
• Errors of commission (a non-prescribed medicine is taken)
• Dosage errors (the wrong dose is taken)
• Scheduling errors (the medicine is taken according to the wrong schedule, e.g., twice daily instead of once daily)

• Health care providers should educate patients on potential barriers to medication compliance, such as likely side effects, cost of medications, and consequences of not adhering to therapy.
• Providers should consider simplification of the treatment regimen by manufacturing drug combinations in a single product, long-acting therapy, regimens that require less frequent dosing, use of well-labeled medication containers, and pill calendars.
• Doctors should provide patients with verbal and written instructions about their drug regimen.
• Drug regimens should be tailored to the individual patient's needs and habits, and patient involvement should be enhanced through various forms of self-monitoring (e.g., checking one's own blood pressure).
• Providers should also engage in continued discussion/conversation with patients to reinforce reasons for drug therapy. This strategy may have to be continued indefinitely.

• Drug name
• Intended use and expected action
• Route, dosage form, dosage, and administration schedule
• Common adverse effects that may be encountered, including how to avoid them and what to do if they occur
• Techniques for self-monitoring of drug therapy
• Proper drug storage (as noted on container)
• Potential drug-drug or drug-food interactions
• Prescription refill information
• Action to be taken in the event of a missed dose

• Tell your physician and pharmacist about all of the medicines you are taking and about any allergies or sensitivities you may have to any drugs.
• Be sure you understand all instructions before starting to use a drug, including when to take it, with what, how long to continue, what to do if problems occur.
• Make sure you take medicines when scheduled.
• Call your physician if you notice any new symptoms or side effects.
• Keep drugs in airtight containers and store them properly (as noted on container).
• Keep a permanent record of all drugs and vaccines to which you are sensitive or allergic.
• Take the medications as prescribed. Do not change therapy unless you have talked to your physician.

note: This information was derived from various literature, and the Family Medical and Prescription Drug Guide.

When and how often to undergo health screening is a matter for you to determine in consultation with your healthcare provider. However, the following general guidelines gleaned from healthcare organizations may assist in educating you.

Pap smear for cervical cancer: First three tests to be done annually to ensure diagnostic accuracy. Every two to three years in sexually active women age 20 to 65. Every three years from age 66 to 75, regardless of sexual activity.

Fecal occult blood tests for colo-rectal cancer: Annually after age 50.

Sigmoidoscopy for colo-rectal cancer: Every three to five years after age 50.
If family history of colon cancer in parent or sibling, air-contrast barium enema and sigmoidoscopy every three to five years after age 40.

Breast cancer screening: Monthly breast self-examination, with a breast exam performed yearly by a physician. Depending on the physician, mammography should be done annually starting at age 40. Yearly mammograms may also be ordered yearly in cases of cystic disease.

Lung cancer screening: Check with your physician.

Asymptomatic coronary artery disease screening: Screening with exercise stress testing is generally not recommended for individuals with no symptoms who plan to exercise moderately. Those with symptoms or with disease, or older, higher risk clients planning to exercise vigorously should consider having a pre-exercise, diagnostic stress test with a healthcare provider.

Serum cholesterol screening: If less than 180 mg/dl, recheck every five years. If between 180 to 200, recheck within six months. For total cholesterol higher than 200, NCEP recommends a fasting lipid profile to determine LDL levels and subsequent treatment.

High blood pressure screening: Yearly; with family history every six months.

Diabetes screening: Currently, there is no across-the-board recommendation for screening people for diabetes. Instead, doctors test patients when they have some reason to suspect they may be diabetic. Symptoms can include excessive thirst, frequent urination and weight loss. Among the new federally endorsed guidelines:

• Every adult should have a diabetes test every three years starting at age 45. Those who get a high reading should have the test repeated on another day.
• The cutoff for declaring someone diabetic should be lowered from the current 140 milligrams of glucose per deciliter of blood plasma to 126 milligrams.
• Contrary to earlier recommendations, pregnant women may not need to be tested routinely if they are white, younger than age 25, of normal size and have no close family members with the disease.

Visual acuity glaucoma screening: Every two years and annually for those over 60.

Dental check-ups gum disease: Minimally annually, however every six months is recommended

RECOMMENDED IMMUNIZATION SCHEDULE

Age	Immunization
newborn	Hepatitis B (or later as directed by physician)
2 months	DPT (diphtheria, pertussis, tetanus) and oral polio (OPV) and HIB (hemophilus influenza B)
4 months	DPT, oral polio and HIB
6 months	DPT and HIB
15 months	Measles, mumps and rubella (MMR)
18 months	DPT, oral polio and HIB, diphtheria toxoid conjugate
4 - 6 years	DTap (diphtheria, tetanus, acellular pertussis) and OPV
5 - 18 years	Measles, mumps and rubella (MMR)
Every 10 years	T(d) (adult tetanus, diphtheria)
11 - 12 years	Hepatitis B (vaccines to be assessed and administered if necessary)
Age 65 and over	Influenza vaccine, pneumococcal vaccine

PREVENTIVE EXAMINATION PRIMER

Mammogram: One of the most valuable diagnostic tests, a mammogram, is an X-ray of the breast to detect breast cancer. Using a breast compression device, the mammogram can identify cancer and small tumors when still in their treatable stage. Women 40 years of age and above should participate in annual mammograms.

Pap smear: The pap smear test, developed by George Papanicolaou, M.D., is used to detect cervical cancer. Cells from the cervix and vaginal walls are microscopically examined for abnormalities. Since cervical cancer can take as long as 10 to 15 years to reach the invasive stage, authorities are divided over how often women should have this test done. Women at risk for cervical cancer should have the test annually. Risk factors include genital warts or other sexually transmitted diseases, frequent sex with many partners, early sexual activity and cigarette smoking.

Occult blood test: This test examines the stool for traces of blood and is reliable for the early diagnosis of colon cancer. A home test approved by the FDA is a guaiac test, which causes a chemical substance to turn blue in the presence of blood. This home test fails to detect colon cancer in about one third of cancer patients and should therefore be used in conjunction with a physician's advice.

Sigmoidoscopy: This procedure is also used to detect colon cancer. A long, thin, lubricated fiberoptic tube is inserted rectally and moved up the large intestine. This test should be performed every three years on persons 50 or over.

Urinalysis: This simple test provides a variety of screening information including kidney malfunction, indications of diabetes and urinary tract infections.

Blood counts: A blood sample analysis includes assays for: hemoglobin concentration in blood, red blood cell count (may detect anemia, leukemia, kidney malfunction, internal bleeding, etc.), hematocrit (ratio of red blood cells to plasma) and white blood cell count (may indicate infection, injury, leukemia, etc.).

Lipid Profile: One of the most valuable tests for the early detection of risks and heart disease is the lipid profile which specifically studies the cholesterol/fat levels in the blood. Included in this test is the total cholesterol level, measuring total fat levels, HDL and LDL levels as well as the HDL/LDL Ratio, and Triglycerides. This profile is now being called a coronary risk screening profile.

Cholesterol Levels and CHD Risk
	Total Cholesterol	LDL Cholesterol
Desirable	<200 mg/dL	<130 mg/dL
Borderline	200-239 mg/dL	130-159 mg/dL
High	>240 mg/dL	>160 mg/dL

Fasting Triglycerides
Age	Increased Risk
19-29	>140 mg/dL
30-39	>150 mg/dL
40-49	>160 mg/dL
>49	>190 mg/dL

CHD Risk Factors	Cholesterol/HDL Ratio
Ranking	Male	Female
1/2 of average	3.4	3.3
Average (normal)	5.0	4.4
Twice average (moderate)	9.6	7.0
Three times average (high)	13.4	11.0

(Data based on Framingham Study)

Note: The information which is provided is believed to be accurate and authoritative but is no substitute for individual medical advice. The recommendations which are provided are attributable only to the organization or association listed and are provided merely for reference. The recommendations may or may not fully apply in particular cases. Individualized medical attention is necessary to make such determinations. Recommendations are from: The U.S. Centers for Disease Control and Prevention, the American Medical Association and the American Academy of Pediatrics and the American Academy of Family Physicians.

When and how often to undergo health screening is a matter for you to determine in consultation with your healthcare provider. However, the following general guidelines gleaned from healthcare organizations may assist in educating you.

Pap smear for cervical cancer: First three tests to be done annually to ensure diagnostic accuracy. Every two to three years in sexually active women age 20 to 65. Every three years from age 66 to 75, regardless of sexual activity.

Fecal occult blood tests for colo-rectal cancer: Annually after age 50.

Sigmoidoscopy for colo-rectal cancer: Every three to five years after age 50.
If family history of colon cancer in parent or sibling, air-contrast barium enema and sigmoidoscopy every three to five years after age 40.

Breast cancer screening: Monthly breast self-examination, with a breast exam performed yearly by a physician. Depending on the physician, mammography should be done annually starting at age 40. Yearly mammograms may also be ordered yearly in cases of cystic disease.

Lung cancer screening: Check with your physician.

Asymptomatic coronary artery disease screening: Screening with exercise stress testing is generally not recommended for individuals with no symptoms who plan to exercise moderately. Those with symptoms or with disease, or older, higher risk clients planning to exercise vigorously should consider having a pre-exercise, diagnostic stress test with a healthcare provider.

Serum cholesterol screening: If less than 180 mg/dl, recheck every five years. If between 180 to 200, recheck within six months. For total cholesterol higher than 200, NCEP recommends a fasting lipid profile to determine LDL levels and subsequent treatment.

High blood pressure screening: Yearly; with family history every six months.

Diabetes screening: Currently, there is no across-the-board recommendation for screening people for diabetes. Instead, doctors test patients when they have some reason to suspect they may be diabetic. Symptoms can include excessive thirst, frequent urination and weight loss. Among the new federally endorsed guidelines:

• Every adult should have a diabetes test every three years starting at age 45. Those who get a high reading should have the test repeated on another day.
• The cutoff for declaring someone diabetic should be lowered from the current 140 milligrams of glucose per deciliter of blood plasma to 126 milligrams.
• Contrary to earlier recommendations, pregnant women may not need to be tested routinely if they are white, younger than age 25, of normal size and have no close family members with the disease.

Visual acuity glaucoma screening: Every two years and annually for those over 60.

Dental check-ups gum disease: Minimally annually, however every six months is recommended

RECOMMENDED IMMUNIZATION SCHEDULE

Age	Immunization
newborn	Hepatitis B (or later as directed by physician)
2 months	DPT (diphtheria, pertussis, tetanus) and oral polio (OPV) and HIB (hemophilus influenza B)
4 months	DPT, oral polio and HIB
6 months	DPT and HIB
15 months	Measles, mumps and rubella (MMR)
18 months	DPT, oral polio and HIB, diphtheria toxoid conjugate
4 - 6 years	DTap (diphtheria, tetanus, acellular pertussis) and OPV
5 - 18 years	Measles, mumps and rubella (MMR)
Every 10 years	T(d) (adult tetanus, diphtheria)
11 - 12 years	Hepatitis B (vaccines to be assessed and administered if necessary)
Age 65 and over	Influenza vaccine, pneumococcal vaccine

PREVENTIVE EXAMINATION PRIMER

Mammogram: One of the most valuable diagnostic tests, a mammogram, is an X-ray of the breast to detect breast cancer. Using a breast compression device, the mammogram can identify cancer and small tumors when still in their treatable stage. Women 40 years of age and above should participate in annual mammograms.

Pap smear: The pap smear test, developed by George Papanicolaou, M.D., is used to detect cervical cancer. Cells from the cervix and vaginal walls are microscopically examined for abnormalities. Since cervical cancer can take as long as 10 to 15 years to reach the invasive stage, authorities are divided over how often women should have this test done. Women at risk for cervical cancer should have the test annually. Risk factors include genital warts or other sexually transmitted diseases, frequent sex with many partners, early sexual activity and cigarette smoking.

Occult blood test: This test examines the stool for traces of blood and is reliable for the early diagnosis of colon cancer. A home test approved by the FDA is a guaiac test, which causes a chemical substance to turn blue in the presence of blood. This home test fails to detect colon cancer in about one third of cancer patients and should therefore be used in conjunction with a physician's advice.

Sigmoidoscopy: This procedure is also used to detect colon cancer. A long, thin, lubricated fiberoptic tube is inserted rectally and moved up the large intestine. This test should be performed every three years on persons 50 or over.

Urinalysis: This simple test provides a variety of screening information including kidney malfunction, indications of diabetes and urinary tract infections.

Blood counts: A blood sample analysis includes assays for: hemoglobin concentration in blood, red blood cell count (may detect anemia, leukemia, kidney malfunction, internal bleeding, etc.), hematocrit (ratio of red blood cells to plasma) and white blood cell count (may indicate infection, injury, leukemia, etc.).

Lipid Profile: One of the most valuable tests for the early detection of risks and heart disease is the lipid profile which specifically studies the cholesterol/fat levels in the blood. Included in this test is the total cholesterol level, measuring total fat levels, HDL and LDL levels as well as the HDL/LDL Ratio, and Triglycerides. This profile is now being called a coronary risk screening profile.

Cholesterol Levels and CHD Risk
	Total Cholesterol	LDL Cholesterol
Desirable	<200 mg/dL	<130 mg/dL
Borderline	200-239 mg/dL	130-159 mg/dL
High	>240 mg/dL	>160 mg/dL

Fasting Triglycerides
Age	Increased Risk
19-29	>140 mg/dL
30-39	>150 mg/dL
40-49	>160 mg/dL
>49	>190 mg/dL

CHD Risk Factors	Cholesterol/HDL Ratio
Ranking	Male	Female
1/2 of average	3.4	3.3
Average (normal)	5.0	4.4
Twice average (moderate)	9.6	7.0
Three times average (high)	13.4	11.0

(Data based on Framingham Study)

Note: The information which is provided is believed to be accurate and authoritative but is no substitute for individual medical advice. The recommendations which are provided are attributable only to the organization or association listed and are provided merely for reference. The recommendations may or may not fully apply in particular cases. Individualized medical attention is necessary to make such determinations. Recommendations are from: The U.S. Centers for Disease Control and Prevention, the American Medical Association and the American Academy of Pediatrics and the American Academy of Family Physicians.

When and how often to undergo health screening is a matter for you to determine in consultation with your healthcare provider. However, the following general guidelines gleaned from healthcare organizations may assist in educating you as to these matters.

WHY PARTICIPATE IN HEALTH SCREENING?
The old saying goes, "An ounce of prevention is worth a pound of cure." Similarly, health screening is a vital part of your overall preventive outlook. Many diseases can be detected early, prior to the development of symptoms, and can be successfully treated and cured. Other conditions, when detected on a screening evaluation, require specific lifestyle interventions which can help to prevent complications (e.g., a diagnosis of high cholesterol requires dietary changes in order to minimize the risk of heart disease).

Perhaps the most successful screening test ever developed is the Papanicolaou test, or "Pap smear" as it is more widely known. Millions of cases of cervical cancer have been detected and treated at an early stage as a result of this relatively inexpensive, painless test. The mammogram (breast x-ray) is another widely utilized screening procedure that can often detect cancer at an early, treatable stage.

There are several different types of screening tests, including those:

• you can perform at home yourself
• that a physician can perform during a routine physical exam
• that require a laboratory analysis, X-rays, ultrasounds, exploratory examination, as well as a variety of monitoring or scanning devices

Also, examine yourself monthly for suspicious skin growths (pigmented, irregular, bleeding, itching, or changing in appearance) and, again, consult your physician if one is found. Screening at home means taking an active role in your healthcare. Your next step is to make an appointment with your physician.

SCREENING BY A DOCTOR'S EXAM
Many groups recommend that you obtain a comprehensive physical every one to three years, depending on your age and general health. The visit begins with your doctor asking you a series of questions to ascertain your state of health, and the nurse may perform certain exams that are part of health screening. For example, your blood pressure, your vision, height and weight should be checked.

The doctor will then examine you, including your eyes, throat, neck, thyroid, lymph nodes, heart and lungs. Especially important for women are the breast and pelvic exams.

For men, a testicular and prostate exam is usually included. Testicular cancer is a disease of young men, usually in their twenties and thirties, and therefore testicular self-exam needs to be learned at a young age. Prostate disease is more common over age 40 and an annual exam is usually recommended after this age. A test for occult (non-visible) blood in the stool can be performed at the same time as the prostate or pelvic exam. This test may help to detect colon cancers or polyps, which can bleed in small amounts.

With the rising frequency of skin cancers, your doctor should also check your entire body for suspicious growths. Anything he is concerned about will typically be biopsied, removed, frozen, and/or evaluated by a dermatologist.

LABORATORY SCREENING TESTS
High total cholesterol, low HDL (the good cholesterol), and high triglycerides (especially in women) are significant risk factors for developing heart disease according to multiple studies. Cholesterol should be checked every five years or so when you're in your twenties or thirties. If it is elevated, diet, exercise and/or medication may be recommended by a healthcare provider to achieve a more healthy blood cholesterol level.

The prostate specific antigen (or PSA) test is a relatively new, and somewhat controversial, screening test for prostate cancer that is performed on men in their fifties. The controversy primarily concerns the use of this test with older men diagnosed with "low grade" or microscopic prostate cancer, as their life span may not actually be affected by such a level of the disease.

SCREENING BY X-RAY
Mammography (a special breast X-ray) is the most widely used screening test involving an X-ray. This is usually recommended for women, beginning with an initial screening between the ages of 35 and 40, every two years in one's forties, and annually after age 50. Mammography can detect cancers that are too small to be determined during a doctor's manual exam. However, a negative (normal) mammogram may not preclude the biopsy of a suspicious lump that has been palpated.

RECTAL SCREENING TESTS
This category includes sigmoidoscopy-the insertion of a tube through the anus to look at the rectum and parts of the colon. This is a test designed to identify the earliest precursors of colon cancer, i.e. polyps, before they have developed into full-blown invasive cancers. The fiberoptic instrument used for this test can not only detect the growths, but can be used to remove them, without even cutting the skin. This test is recommended every three to five years for those over age 50; and sooner and/or more frequently if there is a strong family history of colon cancer.

OTHER SCREENING TESTS
Your doctor will delve into your family history to determine if other testing is required because of a genetic tendency toward a specific illness, e.g., cardiac disease (treadmill testing may be recommended), ovarian cancer (ultrasounds are sometimes advised), or thyroid disease (lab tests or scans can give further information). Also, your own occupational exposures (e.g., asbestos) or personal habits (smoking) may put you at higher risk and merit specific screening tests such as pulmonary function tests or chest X-rays.

SUMMARY
Health screening is an important part of your overall health and fitness program. Be sure to see a doctor regularly and discuss your interest in health screening. These appointments and the relatively minor discomfort and inconvenience of some of the tests mentioned here could save you from premature death. The following is a timetable summarizing the current recommendations from a number of national medical organizations. Note that different organizations may offer diverse advice and the ultimate screening plan must be determined by you and your physician.

HEALTH SCREENING TIME TABLE

EXAM	Age 19-39	Age 40-64	Age 65+
Breast self-exam Testicular self-exam Physical exam by physician	monthly	monthly	monthly
Physical exam by physician with blood pressure, etc.	1-3 years	1-3 years	annually
Breast and pelvic exam	annually	annually	annually
Digital rectal exam w/ occult blood	N.A.	annually	annually
Skin exam by MD	1-3 years	1-3 years	annually
Lab and X-ray
Cholesterol and lipids	every 5 years	1-3 years	1-3 years
Pap smear	1-2 years	1-3 years	1-3 years
Mammogram	once	annually	annually
PSA (prostate blood test)	N.A	age 50+ annually
Sigmoidoscopy	N.A.	age 50+ every 3 years

Note: The information which is provided is believed to be accurate and authoritative but is no substitute for individual medical advice. The recommendations which are provided are attributable only to the organization or association listed and are provided merely for reference. The recommendations may or may not fully apply in particular cases. Individualized medical attention is necessary to make such determinations. Recommendations are from: The U.S. Centers for Disease Control and Prevention, the American Medical Association and the American Academy of Pediatrics and the American Academy of Family Physicians.