I wrote previously about the change that has occurred in screening mammograms. The recommendation for women is now that the procedure be initiated at age 45 rather than age 40, and that women below the age of 50 should get the examination only every two years — not every year — unless there is a strong family history of breast cancer.

There is also the recommendation that those over the age of 50 should reduce mammogram frequency to every two years, not every year.

Questions are now being raised about other screening tests as well. For instance, when a patient has a persistent headache a doctor will often order a CT scan or an MRI scan of the brain. This approach is now being questioned.

Of particular note is the fact that new documentation suggests that a number of MRIs with contrast can produce cognitive defects in patients. These defects are caused by the buildup of gadolinium in the brain.

Therefore, if there is no clear indication to perform an MRI of the brain — for instance because of chronic headaches or other obvious brain problems — the procedure should be performed initially without contrast. Later, if necessary, a doctor can come back and add contrast material.

The data suggest that screening CTs and MRIs performed for headaches and other initial brain symptoms have a low probably of positively identifying the cause of the symptoms. Therefore, consensus is forming that these early procedures should be delayed until a physician has a better idea of what he is looking for.

The use of CTs and MRIs for initial evaluation of back pain is also coming into question. Growing data indicate that a standard X-ray procedure should be the first approach. Then — and only if symptoms persist — would CT and/or MRI be indicated.

In my experience, the MRI is a better procedure for evaluation of back problems because it does not expose the patient to radiation, and it actually does a better job of evaluating discs and other areas of the back.

There has also been the question about testing for lyme disease, absent better clinical indication of exposure to the ticks that carry the disease. This approach has given rise to a number of false negative reports and false positive reports with the lyme disease tests. Therefore, it is right that their utilization is being questioned.

Coronary artery screening has long been recommended, but questions are now being raised about this procedure as well. However, in my experience coronary artery studies are particularly valuable if you are aware of the need to look for nanobacteria infections when there is calcification in the coronary artery.

Another test that is now being questioned is the HpA IC Tests for diabetics. If you’re a Type 2 diabetic whose condition has been stable, there is no reason to undergo this test more than once or twice per year.

Likewise, chest X-Rays are coming under review. They can provide a significant benefit, but when a chest X-ray is requested it is important to ask your doctor about the specific need for the procedure, and to be sure that you’ve had a full physical examination prior to the chest X-ray.

In fact, you should always ask your doctor about the need for screening procedures, and not undergo them if a good explanation can’t be given.