Medical Author: Daniel L. Gornel, M.D., MPH
Medical Editor: Dennis Lee, M.D.
Routine screening tests are part of basic prevention
medicine. All of the screening tests are commonly available through your doctor. Take
an active role in your own healthcare and discuss screening tests with your
doctor early in life. Following is a list of diseases for which screening is recommended. The following table discusses the screening tests which usually are safe and
simple, and can help detect many diseases before they become harmful.
High Blood Pressure (Hypertension)
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Tests or Procedures:
Blood pressure
measurements
- High blood pressure: systolic>140,
and/or diastolic>90
- Borderline blood pressure: systolic
130-140, and/or diastolic 85-90
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Who to test and how often:
- Adults with most recent normal blood pressure of
systolic <130 and diastolic<85 should be checked at least every
other year.
- Adults with borderline blood pressures (systolic
130-140 or diastolic 85-90) should be rechecked in 3-6 months
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Benefits of early detection
High blood pressure can cause arterial disease (atherosclerosis) that can lead to
heart attack, congestive heart failure,
stroke and kidney failure.
High blood pressure can cause diseases without any early warning symptoms.
There is good evidence that treatment of high blood pressure can reduce the risk of heart diseases, stroke, and kidney
failure.
There is good evidence that adults with borderline blood pressures can benefit from blood pressure lowering, thus discuss with
your doctor regarding reducing salt intake, exercise, and stress management.
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Hyper-cholesterolemia
also
referred to as Hyperlipidemia, Dyslipidemia
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Tests or Procedures:
Blood lipid panel that includes:
- Total cholesterol
- LDL cholesterol, "bad" cholesterol
- HDL cholesterol, "good" cholesterol
- Total/HDL cholesterol ratio
- Triglyceride
Table
of desirable and undesirable lipid levels
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Who to test and how
often:
-
All
adults over 20 should have a lipid panel every 5 years if LDL cholesterol is
less than 130, and every 1-3 years if LDL cholesterol is borderline (between 130
and 160)
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Benefits of early detection
Elevated LDL cholesterol or low HDL cholesterol increases the risk of developing
atherosclerosis (hardening of arteries).
Atherosclerosis can begin to develop in adolescence and progress without any symptoms for many years. It leads to
heart attack and stroke later in life.
There is good evidence that lowering elevated or borderline LDL cholesterol and increasing low HDL is beneficial in
heart attack prevention and in some cases
stroke prevention in subjects with or without known
atherosclerosis.
Treatment of elevated or borderline cholesterol is multi-dimensional. Subjects should discuss with their doctor regarding total calorie, total fat, saturated fat, and cholesterol intake as well as weight reduction and regular exercise.
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Adult
Onset Diabetes Mellitus
a condition with elevated blood sugar level (hyperglycemia)
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Tests or Procedures:
Tests for diabetes
mellitus:
- Fasting blood sugar (blood sugar test
after at least 8 hours without calories), normal level less than 126
mg/dl
- 2 hour postprandial blood sugar (blood
sugar test 2 hours after a meal), normal level less than 140mg/dl
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Who to test and how
often:
Healthy subjects over 45 years should have fasting blood glucose level checked every 3
years.
Adults at a higher than normal risk of developing diabetes mellitus should be checked more frequently than every three years. They include:
- People who are overweight
- Blood relatives with adult onset diabetes
- Certain ethnic groups such as certain Native American groups, African-Americans, Hispanics, and Asians
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Benefits of early detection
Diabetes mellitus can cause atherosclerosis that can lead to
heart
attack, stroke, and compromise of arterial circulation to the legs and feet. Diabetes mellitus also can damage nerves, eyes, and kidneys.
Diabetes mellitus commonly causes organ damage without symptoms until extensive damage is
present.
There is good evidence that controlling
hyperglycemia in diabetes with medications, diet, weight control, and regular exercise can slow the development of atherosclerosis, heart, eye, nerve, and kidney
damage.
There is good evidence that curtailing total calorie intake (especially intake of processed starches, sugar and sweets), regular exercise, and
losing excess weight can help prevent the development of diabetes mellitus, especially in adults at higher than normal risk of developing diabetes.
For more, please read the
Diabetes and
Diabetes Prevention articles.
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Cancer
of Colon and Rectum
Polyps of Colon and
Rectum
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Tests or Procedures:
- Stool occult blood test
--a chemical test to detect trace amounts of blood in stool. It is inexpensive and easy, though not always accurate. Some cancers are not detected and many positive tests not caused by cancer.
- Flexible sigmoidoscopy -- a relatively quick and easy office procedure that allows direct visualization and biopsy of suspicious lesions, but causes some discomfort, and is not as thorough as
colonoscopy.
- Colonoscopy ---the most complete and thorough test, but often requires iv sedation, much more expensive, and
is not covered by some insurance for screening.
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Who to test and how
often:
All healthy subjects should have stool occult blood tests and flexible sigmoidoscopy at age 50, followed by stool occult blood annually and flexible sigmoidoscopy every 5 years.
Alternatively, instead of flexible sigmoidoscopy, all healthy subjects can undergo screening colonoscopy at age 50 and then every 10 years if no prior history of polyps or
cancer.
Higher risk subjects (individuals with family history of colon polyps and cancer, long standing ulcerative colitis, or prior personal history of colon polyps or cancer) need colonoscopy earlier and at shorter intervals.
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Benefits of early detection
Stool occult blood
test, Flexible sigmoidoscopy, and Colonoscopy are documented to reduce colon cancer mortality
by:
- Preventing colon cancer by identifying and removing polyps before they become
cancerous
- Increasing cancer cure rate by identifying early cancer at a treatable stage before the cancer has spread
(metastasized.)
For more, please read the
Colon Cancer Prevention
article.
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Prostate Cancer
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Tests or Procedures:
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Who to test and how
often:
All healthy men should undergo
a digital rectal examination annually beginning at age 40 with the addition of an annual PSA test beginning at age 50, at least up to age
70.
Men with a higher than normal risk of developing prostate cancer should have
an annual digital rectal examination and PSA blood tests both beginning at age 40. The higher risk men include African-American men, and men with father, grandfather, or blood-related uncle with prostrate cancer.
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Benefits of early detection
The purpose of the screening is to detect early, tiny, or even microscopic cancers that are confined to the prostate gland. Early treatment of these malignancies (cancers) can stop the growth, prevent the spread, and possibly cure the cancer.
However, the evidence is not conclusive that screening and treatment of early and localized prostate cancer is beneficial, particularly in men over 70; some elderly men may live with prostate cancer for many years and die from other conditions rather than from the prostate cancer, and treatment of prostate cancer (surgery, radiation, chemotherapy, or hormones) can have side
effects.
On balance, younger men (between 50-70) are more likely to benefit from screening and early treatment.
For more, please read the
Prostate Cancer article.
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Glaucoma
a condition with abnormally elevated intra-ocular pressures (pressure within the eyes.)
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Tests or Procedures:
- Eye pressure
measurements (Eye care specialist required for adequate examination)
- Note that a check up for vision does not measure intra-ocular pressure.
- Measurement of intra-ocular pressure should be a standard component of a comprehensive eye examination.
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Who to test and how
often:
Subjects at a higher than normal risk of developing glaucoma (African-Americans over 40, adults with severe myopia, diabetes, or a family history of glaucoma) should have eye pressures checked
yearly.
Although there is no formal screening recommendation for healthy subjects with normal risk, everybody over 60 years should have eye pressure measurements periodically, perhaps yearly.
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Benefits of early detection
Glaucoma causes extensive damage to retina and irreversible loss of vision without waning symptoms and before the individual becomes aware of loss of vision.
There is good evidence that treatment of elevated eye pressure in glaucoma can prevent blindness.
For more, please read the
Glaucoma article.
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Melanoma
and other skin
cancers. Melanoma is the most serious form of skin cancer
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Tests or Procedures:
Total body skin
examination
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Who to test and how
often:
Although there is no formal screening recommendation for healthy adults, everybody should have
a total body skin examination periodically.
Adults with a higher than normal risk for
melanoma (family history of melanoma, middle age adults with frequent sun exposure or serious sunburn) should be particularly vigilant.
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Benefits of early detection
Skin cancer is the most common cancer. Even though the benefit of skin cancer screening is uncertain, early treatment of skin cancer can be effective. Prognosis of melanoma is closely associated with the thickness of the cancer at the time it is first detected.
For more, please read the
Skin Cancer and
Melanoma articles.
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Bladder
Cancer
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Tests or Procedures:
Urine examination for blood cells. This may be done by dipstick with confirmation by microscopic examination of the urine, or by initial microscopic
examination.
Bladder cancer can cause either gross hematuria (visible blood in the urine) or microscopic hematuria (blood in the urine only visible with a
microscope).
(Note that bladder cancer is only one of many causes of blood in the urine.)
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Who to test and how
often:
All subjects who are current or former cigarette smokers or who have a history of occupational exposure to certain chemicals often used in the dye, leather, tire and rubber industries should have a urine examination for blood periodically after age 60.
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Benefits of early detection
Early bladder cancer may produce no symptoms and no visible bleeding in the urine, and blood in urine commonly microscopic.
Treatment can be effective if cancer detected early, and survival strongly associated with stage of disease at time of
treatment.
Cessation of cigarette smoking always advisable.
For more, please read the
Bladder Cancer article.
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Hyper-homocystinemia
abnormally elevated homocysteine in blood
|
Tests or Procedures:
Blood total
homocysteine level
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Who to test and how
often:
Screening recommendations have not yet been established. Possible screening candidates
include:
- Middle-aged and older subjects with family history of heart attacks
- Individuals with known coronary artery disease or prior heart attacks
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Benefits of early detection
Elevated homocysteine in the blood is associated with increased risk of heart
attacks.
Homocysteine is elevated with deficiencies of thiamin, folic acid and vitamin B12.
Elevated homocysteine levels revert to normal with replacement of the deficient vitamins. But there is not yet conclusive proof that lowering blood homocysteine levels with vitamin therapy actually prevents heart
attacks.
Benefit of screening has not been established.
For more, please read the
Homocysteine Test
article.
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Last Editorial Review: 2/1/2005
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