FIT FOR THE NEW MILLENNIUM MAKING CHANGES CAN MAKE THE DIFFERENCE.

Byline: Evan Henerson Staff Writer

Welcome to 2001. So how are you feeling?

No, we're not simply talking about the effects of that lingering cold or whether you've shaken off that post-New Year's Eve hangover. How healthy are you?

It's a question many people ask themselves around this time of year. Personal health assessments are often high on the list of Dec. 31 resolution-makers, particularly those with specific health goals (``This year, I'm really going to quit smoking, drop 15 pounds and leave half of New England in my wake at the Boston Marathon.'')

Such high-octane resolutions are laudable, say doctors, especially when they last past Feb. 1. Early in the year, health-conscious people often combine goal-setting with a standard check-up - an ``under the hood'' visit to a physician, if you will, to make sure everything is in working order and nothing is in danger of breaking. Blood pressure fine? Pap test clear? Great! Now watch your diet, cut down on the those cigars and get on with the business of living.

Of course, as most people know - particularly those who belong to an HMO - a check-up can be a knee tap, a step on the scale and a 10-minute chat with your doctor, or it can include multiple tests that take hours to perform and weeks to process. Some people feel the more tests they take (and pass), and the more time spent with a doctor, the less cause they'll have for paranoia the rest of the year.

On the other hand, not everybody needs a battery of tests and screenings. It's the rare physician who will push a colonoscopy on his 25-year-old patient. Since tests can be time-consuming and costly, causing health-care organizations, doctors and their patients to frequently disagree over just how much ``preventive medicine'' the average person requires.

Where to begin? Well, a little common sense can go a long way, says Dr. Richard Silverstein, a physician at Kaiser Permanente's Panorama City Medical Center.

``Men and women both need to be looking at smoking, drinking, exercise, healthy eating and drug use,'' says Silverstein. ``Those who are at highest risk are those who have never had any screening done, the people who haven't been doing the routine things.''

The U.S. Preventive Medicine Task Force (PMTF) puts out a set of guidelines, spelling out what they consider to be responsible screening, counseling and leading causes of death for people of all age ranges. Tests like height, weight and blood pressure tend to repeat while physicians recommend more frequent screenings for high-risk diseases like breast cancer and colon cancer as a person ages.

Published in the Task Force's Guide to Clinical Preventive Services, the guidelines are constantly changing, and they will differ slightly from similar recommendations offered by organizations like the American Cancer Society and the American Heart Association.

The PMTF's guidelines, for example, do not recommend routine tests for prostate cancer, while the American Cancer Society urges men at high risk to get both the prostate-specific antigen (PSA) blood test and the digital rectal examination annually, beginning at age 50, for men who have a life expectancy of at least an additional 10 years. Organizations will differ over whether women should start getting regularly scheduled mammograms at age 40 or 50.

``The question is always what data is there to support a test's safety and efficacy,'' says Dr. Charles Cutler, chief medical officer for the American Association of Health Plans. ``Any time you do screening tests, there are more issues than just the cost of the test.

``A lot of people diagnosed with prostate cancer die of other causes,'' adds Cutler, who says that most health plans consider the PMTF's guidelines to be ``the bible'' in determining which tests should receive coverage. ``Does screening save lives or not? Right now, many people in the medical community would say it's controversial.''

Just as important as common sense and sensible advice from a physician is a look at your family tree. If, doctors say, you have a high incidence of heart disease or diabetes in your family, then you should probably monitor your cholesterol and glucose levels sooner and more closely than any of the guidelines advise.

``There is no one-size-fits-all gold-standard check-up,'' says Dr. Richard Atkins, coordinator for the U.S. Preventive Services Task Force. ``The appropriate check-up gets tailored to the individual. We get asked all the time, 'How often do you need a check-up?' There's no answer to that.''

Atkins also recommends that patients looking to have a healthy year in 2001 shouldn't be so quick to shelve your ``get fit'' New Year's resolution. You might find some wisdom and guidance in your physician's office, but putting the advice into action is the patient's responsibility.

``In reality, for a lot of patients, the biggest thing they can do is address lifestyle changes like quitting smoking, becoming more active and adjusting your diet,'' says Atkins. ``If you can do that, it's going to have a much bigger impact than getting a chest x-ray or some new fancy screening test.''

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