Health Screening Tests
What are the best health screening tests? Our initial review suggests that some health screening tests come highly recommended. Amongst those which are easy to do, reasonably accurate and provide potentially useful health benefits are:
AAA (Abdominal Aortic Aneurysm) – if you’re a man in the UK the NHS will arrange screening (a simple ultrasound scan of your abdomen) when you reach 65. The aorta is the body’s main blood vessel, so it is important to check it is in good working order.
BMI (Body Mass Index) – You just need your weight, your height and a BMI calculator to work out if you’re at risk of obesity, diabetes and heart disease and take appropriate medical advice. A BMI of less than 18.5 is considered unhealthily underweight; 18.5 – 24.9 is considered normal; 25 – 29.9 is considered overweight; and a BMI of 30 or more is considered obese.
Blood pressure – Checking your blood pressure is important because there are usually no symptoms of high blood pressure but if it isn’t treated it can damage your heart, brain and kidneys. That’s why NHS Choices describes it as ‘the silent killer’ and recommends that all adults have their blood pressure checked at least every five years. You can have your blood pressure checked when you visit your doctor. Alternatively, the British Hypertension Society lists blood pressure monitors which have been clinically validated and these can be purchased from a range of sources, including online from organisations like Amazon.
A blood pressure of up to 120/80 is considered healthy, 120 – 139/80 -89 is considered pre hypertension and 140/90 is considered high.
Breast screening – the USPSTF (US Preventative Services Task Force) has now brought its guidance in line with the NHS ie that mammogram screening start at age 50. Breast screening is likely to be particularly worthwhile if there is any family history of breast or ovarian cancer; if you began your period before the age of 12 or went through your menopause after 55; if you have been taking HRT; if you are overweight; if you drink a lot of alcohol; if you have had no children or had your first child after the age of 35; if you’ve used birth control pills; and as you get older. Regular breast self examination is also recommended. If you find a lump in your breast, if the size or shape of your breasts changes or if there is discharge from a nipple, see your doctor for a check up.
Cervical cancer/Pap test – in the UK women are invited for cervical screening every three years between the ages of 25 and 49 and every five years from 50 to 64. Some US commentators suggest screening from an earlier age and every one or two years, depending on the number of sexual partners. Screening is particularly recommended for women who smoke, have many children, have used birth control pills for a long time or have HIV. Cervical cancer is caused by HPV, a sexually transmitted disease. The New England Journal of Medicine reports that using a condom significantly reduces the risk of HPV infection, although not completely eliminating the risk
Vaccines which protect against the four types of HPV which cause most cervical cancer are now available for girls and young women and are recommended.
Cholesterol – as with high blood pressure there are usually no symptoms but high cholesterol is believed to be associated with an increased risk of narrowing of the arteries, heart attack and stroke. Fortunately the cholesterol test is very simple to administer (usually a simple pin prick) and will indicate your levels of ‘good’ cholesterol (HDL) and ‘bad’ cholesterol (LDL). The test is likely to be particularly worth taking if you have high blood pressure, diabetes, are overweight, have a high fat diet, have a family history of early cardiovascular disease or have a close family member with a cholesterol related condition.
Depression – if you have been feeling particularly down, with little interest or pleasure in doing things for more than a few weeks it may be worth seeing your doctor for a possible depression test.
Diabetes – this is another simple blood test and is particularly worthwhile if you have high cholesterol or high blood pressure. As diabetes can lead to a range of serious health complications early diagnosis is important.
Glaucoma – this can be identified through regular eye tests at the opticians (which are free in the UK if you’re over 60; or over 40 and a close family member ie parent, child, brother or sister, has glaucoma). Glaucoma results in optic nerve damage, caused by abnormally high pressure inside your eyes. It can potentially lead to blindness.
HIV – Testing is advised if you have had unprotected sex with multiple partners, or with a partner who has HIV, is bisexual or uses or has used injected drugs.
Kidney disease – an annual blood test is recommended if you are in an ‘at risk’ group ie if you have diabetes, high blood pressure, coronary heart disease, stroke or a family history of kidney disease.
Sexually Transmitted Infections – this is usually done through simple blood tests and is recommended if you are sexually active and have had unprotected sex with new partners.
Skin cancer – it is worth seeing your doctor if you see any strange changes in the moles on your body.
However, the value of some screening tests has been the subject of more debate. For example:
PSA blood test for Prostate Cancer – some doctors consider this helps detect potential prostate cancer, enabling treatment to take place. Others note that two thirds of men with raised PSA don’t have prostate cancer; that prostate cancer isn’t necessarily deadly (nearly 20% of men will be diagnosed with it but only 3% will die from it); and that the side effects of treatment can include incontinence and impotence. This suggests the value of talking through the pros and cons with your doctor, in the light of your own particular circumstances. Symptoms of prostate cancer can include problems passing urine, pain with ejaculation and low back pain.
DEXA bone density testing for osteoporosis – this is seen as helpful by many doctors, as osteoporosis is a silent disease whose symptoms are usually not evident until it is too late. However, livescience.com points out that measurements can vary from scan to scan of the same person, as well as from machine to machine and that higher bone mineral density identified in the screening may not mean stronger bones. Eating a diet rich in calcium and vitamin D, taking plenty of exercise and not smoking can all reduce the risk of osteoporosis.
Doctors in the UK have often expressed concerns about private health screening, claiming that this can be inaccurate and unreliable (for example giving false positives in some areas and missing significant symptoms in others) where the technology and procedures are not subject to the same quality criteria as in the NHS – and livescience.com takes the view that full body scans are usually of little value.
Screening for bowel cancer/colon cancer has been generally recommended by the medical profession, partly because, if bowel/colon cancer is caught early it is often curable and a colonoscopy (unlike most other forms of screening) is a surgical intervention which not only detects cancerous and pre cancerous polyps but can remove them during the procedure. In Austria, for instance, men and women aged 50 are routinely invited to be screened for bowel cancer using colonoscopy. However, there are some caveats (see below). The four main types of screening here are:
FOBt (Faecal Ocult Blood testing) which seeks to identify possible tiny amounts of blood from pre cancerous polyps or bowel/colon cancer in a small stool sample. This is a potentially helpful test but, like the PSA test described earlier for prostate cancer, the test may often suggest you are at risk when you’re not – requiring a colonoscopy to clarify the position.
Sigmoidoscopy (a mini colonoscopy, exploring the lower third of the colon). The downsides are that this can sometimes be uncomfortable or painful – and very occasionally can cause perforation and bleeding, so it is worth trying to ensure the doctor has a good track record.
Colonoscopy - The NHS describes a colonoscopy as, ‘an investigation that involves looking directly at the lining of the large bowel. A sedative is given and then a thin, flexible tube with a tiny camera attached (a colonoscope) is passed into the back passage and guided around the bowel. If polyps are found, most can be removed painlessly, using a wire loop passed down the colonoscope tube. These tissue samples are then checked for any abnormal cells that might be cancerous.’ It goes on to advise, ‘About five in 10 people who have a colonoscopy will have a normal result; about four in 10 will be found to have a polyp, which if removed may prevent cancer developing; about one in 10 people will be found to have cancer when they have a colonoscopy.’
Most colonoscopies take place safely. However, the Annals of Internal Medicine notes research which identifies that complications, sometimes serious, can occur (which tends to distinguish colonoscopy from other, less invasive cancer screening tests). The risks also seem to increase with age. sciencebasedmedicine.com comments, ‘It is not yet known for certain whether colonoscopy can help reduce the number of deaths from colorectal cancer.’ This may be because some studies suggest progression to cancer is not a steady process and there may sometimes be regression; and because the main effect appears to be on left sided rather than right sided colon cancer.
Virtual colonoscopy - During a virtual colonoscopy, gas is used to inflate the bowel via a thin flexible tube placed in your back passage. CT scans are then performed with you first lying on your back and then on your front. In this way, doctors can then look at the images for polyps and signs of cancer. This is less invasive than a conventional colonoscopy and avoids potential complications. It is reasonably accurate at identifying large polyps, doesn’t require sedation or an analgesic and is quicker to perform. However, like a colonoscopy it still requires laxative and bowel cleansing beforehand. On the downside virtual colonoscopy requires exposure to a dose of radiation (greater than for dental X rays but below the level currently considered a significant health risk by the Health Physics Society); it isn’t reliable for detecting small polyps (ie less than 6mm); it finds it difficult to detect flat, depressed or indented lesions (which are more likely to be cancerous); and if polyps larger than 6 mm are detected then a colonoscopy would be recommended anyway.
Given the benefits seen by the medical profession but the questions raised by research findings into potential complications, this suggests the value of talking through the pros and cons with your doctor, in the light of your own particular circumstances – for instance whether you have symptoms such as blood in your stool or a change in bowel habits or if you have a family history of colon cancer or have Ulcerative colitis or Crohn’s disease.
Published 06/01/2012, Review date May 2015