Adult health check and screening

What it is

An adult health check is a set of tests offered to people who have no symptoms, each test aimed at one disease or condition and each tied to a stated age band and a stated timing. The tests in common use are mammography for breast cancer, the Pap smear with or without HPV testing for cervical cancer, colonoscopy or a fecal immunochemical test for colorectal cancer, low-dose computed tomography for lung cancer, abdominal ultrasound for abdominal aortic aneurysm, a DEXA scan for osteoporosis, HbA1c or fasting glucose for type 2 diabetes mellitus, blood pressure measurement for hypertension, a lipid profile for hyperlipidemia, and an HIV Ag/Ab test. The logic behind picking a screening test is one line: for screening you want better sensitivity, because you want to pick up almost all disease patients, and you get that by lowering the cutoff value.

Causes and risk

Who is offered a test follows from age, sex and history rather than from symptoms. Mammography covers women 40 to 74 years of age, an age band that varies by guideline. Cervical screening covers women 21 to 65 years. Colorectal screening starts at 45 years in adults at average risk. Lung cancer is the one row where the two pages do not agree. One offers low-dose computed tomography at age 50 to 80 with 20 or more pack-years, in a smoker or one who quit less than 15 yrs ago; the other gives annual screening for lung cancer with low-dose CT in adults 55 to 80 years of age who have a 30-pack-year smoking history and currently smoke or have quit within the past 15 years. Abdominal aortic aneurysm screening is offered once to men 65 to 75 years who ever smoked, and any history of smoking is what counts. Osteoporosis screening covers women 65 years and older along with younger women at high risk. HbA1c or fasting glucose is offered to overweight adults 35 to 70 years. A lipid profile is offered to adults with risk factors or by age. Blood pressure is measured in all adults, and an HIV Ag/Ab test is offered to adolescents and adults at least once, more often when risk is high. Fall risk screening is recommended in community-dwelling adults 65 years of age or older. A second page lays the same thing out disease by disease.

• Breast cancer: risk factors are nulliparity or absence of breastfeeding, early menarche and late menopause, obesity, hormonal replacement therapy, hormonal contraception, advanced age 65 yrs or more, family history, breast conditions with cellular atypia such as fibrocystic change and fibroadenoma, endometrial, ovarian or colorectal cancer, radiation therapy during childhood, smoking and alcohol. Age of screening 40 yrs; method mammogram, repeated every 2 years, until the age of 75 years.
• Cervical cancer: risk factors are those of HPV, that is multiple sexual partners, early-onset of sexual activity, multiparity, immunosuppression such as HIV infection or post-transplantation, and a history of sexually transmitted infections such as herpes simplex and chlamydia; and environmental, that is cigarette smoking, In-Utero exposure to diethylstilbestrol (DES) and low socioeconomic status. Age of screening 21-65 yrs. Method: 21-29 yrs PAP smear, cytology, every 3 years; 30-65 cotesting, cytology plus HPV, every 5 years; stop at age 65 if previous cytology is normal, and 3 results must be normal.
• Prostate cancer: risk factors family history and black race; 55-69 a shared decision-making approach, because of false positives predisposing the patient to invasive procedures and a high detection rate of clinically insignificant cancers leading to overdiagnosis; method PSA.
• Colorectal cancer: risk factors are aging over 40, family history of colorectal cancer, familial adenomatous polyposis, Peutz-Jeghers syndrome, juvenile polyposis syndrome or hereditary nonpolyposis colorectal cancer, a past history of colorectal adenomas, serrated polyps or inflammatory bowel disease, and smoking, alcohol, obesity and radiation. At what age: with no risk factors 45-75 years; with high risk factors before 10 years or at the age of 40 yrs. Methods: colonoscopy every 10 yrs; flexible sigmoidoscopy; flexible sigmoidoscopy plus FIT every 10 yrs; fecal occult blood testing (FOBT) every year; and fecal immunochemical testing (FIT) every year.
• Osteoporosis: female 65 yrs, with no age of stopping; male 70 yrs; method DEXA scan repeated every 2-3 years.
• Non-communicable diseases, that is DM, HTN, dyslipidemia, obesity and CKD: age of screening 35 yrs, screen every 3 yrs, and the tool is the national screening program, which is BMI and waist circumference, BP, plasma glucose, serum creatinine and serum total cholesterol, and urine testing for proteinuria and haematuria.
• CVD: the screening tool is the ACC/AHA ASCVD Risk Calculator, read as 20 or more high risk, 7.5-19.9% intermediate, 5-7.4% borderline, and under 5% low.

For the communicable diseases the page says there is no need to remember the age, only whom to screen and the risk factors: hepatitis B by HBs Ag in the high risk group and in pregnancy; syphilis by the Rapid plasma Reagin (RPR) test in the high risk group and in pregnancy; chlamydia and gonorrhea by NAAT in sexually active women and in pregnancy; HIV by antigen/antibody immunoassay in the high risk group and in pregnancy at the first prenatal visit; and HCV by anti-HCV antibody in the high risk group and in pregnancy at the first prenatal visit.