ENJOYING good health is one of the most important things in life. As we age, different diseases and conditions become prevalent. In order to maintain optimal health for quality life, having regular health screening is one of the ways to achieve this.
So, what is screening? Screening is the application of tests, examinations or procedures to the general population to detect unrecognised diseases or conditions at a stage where intervention may significantly modify its natural course and outcome. It should be a continuous process.
The principles for screening include:
·The condition should be an important health problem.
·It should have a recognisable latent phase or early symptomatic stage where intervention can improve outcome.
·Its natural history should be understood.
·The screening test must be acceptable, widely available and inexpensive.
·The test must be accurate.
·Facilities for diagnosis and treatment are available.
There are many screening tests and conflicting sets of guidelines and recommendations from different authorities. Many people have the misconception that getting a battery of blood tests and investigations done annually is an effective way of health screening that will assure them of good health. Little attention is paid to the importance, relevance and implications of what health screening really means.
It has become increasingly apparent that doing a “blind” annual examination with a whole string of tests without consulting the physician is either useless or misdirected, in terms of time and resources spent. Mildly abnormal results on screening tests can leave the physician uncertain of what action, if any, is indicated.
While the purpose of screening is to detect early evidence of abnormality, it should be done based on adequate evidence so that it is effective and is of benefit to the community and the individuals screened.
The potential harm from screening such as anxiety, false reassurance from false negative results (the test is negative although the patient has the disease), the increased investigations with possible adverse effects following false positive results (the test is positive but the patient does not have the disease), the psychological stress of waiting for results, the uncertainty of the possibility of abnormal tests, the time and money spent on the process and procedures have to be considered.
Health screening can be done on a population basis or carried out individually by the doctor.
The doctor will take a medical history and do a focused examination. After stratifying the risks of each individual, the doctor can then make appropriate recommendations on what screening needs to be done, if any.
Recommended health screenings include:
High blood pressure (i.e., hypertension) is defined in adults as a systolic blood pressure (SBP) of 140 mm Hg or higher, or a diastolic blood pressure (DBP) of 90 mm Hg or higher. It is diagnosed only after two or more elevated readings are obtained on at least two occasions over a period of one to several weeks to account for variability.
Blood pressure (BP) measurement can identify adults at increased risk for cardiovascular disease (CVD) due to high BP. Treatment of hypertension substantially decreases the rates of stroke and results in reductions in death due to heart attack, stroke, and heart failure. Adults aged 18 and older should be screened for high BP at least once every two years for those with SBP and DBP below 130 mm Hg and 85 mm Hg, respectively.
All adults should be screened for obesity. Obesity is associated with an increase in relative risk of diabetes mellitus, hypertension, coronary heart disease and premature death. Body mass index (BMI), calculated as weight in kilograms divided by height in meters squared, is reliable and valid for identifying adults at increased risk for disease and death due to overweight and obesity.
According to the World Health Organisation, a BMI of 25-29.9 kg/m square is considered overweight while that over 30 is obese. The figure is lower for Asians, and a BMI of 23 and over is considered overweight.
Measuring one’s waist circumference can also indicate the risk of coronary heart disease. A waist circumference of 80cm or more in women and 94cm or more in men is associated with increased risk of coronary heart disease.
Cholesterol and HDL-cholesterol (the good cholesterol) measurement can identify middle-aged people at increased risk of coronary heart disease. Drug therapy that lowers lipid levels substantially decreases the incidence of coronary heart disease in people with abnormal lipids.
Screening is recommended for men aged 35 years and older and women aged 45 years and older every five years. Younger adults (men aged 20 to 35 and women aged 20 to 45) can be screened for lipid disorders if they have other risk factors for coronary heart disease such as diabetes mellitus, smoking, family history of early death due to heart attack and hypertension.
Diabetes mellitus is common in our country. Adults who have any of the following should be screened: 35 years or older, obese, hypertensive, has abnormal lipids, family history of diabetes mellitus, history of diabetes mellitus in pregnancy or history of big baby (birth weight more than 4kg).
There is insufficient evidence to recommend screening middle-aged and older men and women with no symptoms for coronary heart disease, using elecrocardiography (ECG) or stress test.
Each pregnant woman at her booking visit to the doctor will be offered screening of blood pressure, blood tests to detect iron deficiency anaemia, syphilis, hepatitis B carrier status, human immunodeficiency virus (HIV) infection, rubella status and urine tests. They will be asked to stop smoking and drinking during pregnancy.
Cancer is one of the leading causes of death in our country. It has imposed a heavy health burden to our health system, communities and economies and thus carries important implications on the role of wellness and screening programmes.
According to the first National Cancer Registry report, one in 5.5 Malaysians are at risk of getting cancer during their lifetime. Screening some of these cancers has been shown to be effective.
Breast cancer, the commonest female cancer in all ethnic and age groups, accounted for about 30% of newly diagnosed cancer cases in Malaysian women in the year 2002. Each Malaysian woman had a one in 19 chance of getting breast cancer in her lifetime. The peak age it occurs is after 50 years.
Mammography screening with or without clinical breast examination by doctors every one or two years is recommended by most guidelines in developed countries in women aged 50-75 years.
For women who have a past history of breast and/or ovarian cancer, family history of breast cancer in one or more first or second degree relatives before the age of 50 years, and a history of previous abnormal breast biopsy, mammography screening should be considered every one or two years from 40-75 years.
Women on hormone replacement therapy (HRT) should have a screening mammography before therapy and every one or two years thereafter after more than five years on HRT.
Cervical cancer was the second most frequent female cancer in Malaysia. In comparison with other Asian and western countries, Malaysia had a higher incidence (1).
Pap smear screening has been widely accepted as an effective screening tool. Screening should begin within three years of onset of sexual activity, or age 21 to 65 years. If the first two to three consecutive Pap results are negative, screening can be done every three years.
Screening can stop in women over the age of 65 years who had normal results with adequate recent screening (three or more consecutive results within the last 10 years) and are not at high risk. Women who have had a total hysterectomy for benign disease do not need routine screening.
In Malaysia, colon cancer is the third commonest cancer, while rectal cancer is in the top eight of the commonest cancers for both genders in this country. Mass screening for the general population is not recommended, except for those in high risk groups with family history of colorectal polyps, cancer in one or more first degree relatives.
An annual examination of the rectum by the doctor and faecal occult blood test (test on the faeces) should begin at age 35 years. Colonoscopy can start at 40 years and repeat at three to five yearly intervals.
Carcinoembryonic antigen (CEA) is commonly done in blood tests when the public takes up health screening through commercial blood testing. It is not a good test for detecting colorectal cancer and should not be done for screening purposes.
Liver cancer (Hepatocellular cancer)
Hepatocellular cancer (HCC) is among the top 20 commonest cancers in Malaysia. Screening is recommended for high risk groups, which include all cirrhotics (liver has hardened), hepatitis B carriers who are over 40 years of age, hepatitis B carriers less than 40 years of age with at least two risk factors, including a family history of HCC and hepatitis C positive individuals who are more than 40 years of age.
A six-monthly blood test of alpha fetoprotein and ultrasound are done for non-cirrhotics (liver has not hardened), while a three monthly alpha fetoprotein and a six monthly ultrasound are carried out for cirrhotics.
Other cancers: lung cancer and prostate cancer
In Malaysia, although lung cancer is the most common male cancer, screening using chest X-ray is not recommended as it has not been demonstrated to decrease death.
Prostate cancer is the sixth most common male cancer in Malaysia. Screening for prostate cancer using prostate specific antigen (PSA) testing from blood tests has not been recommended as this cancer is not as common in Malaysia compared to the western world and there is inconclusive evidence that this improves health outcomes.
Osteoporosis is more common in the female. The risk for osteoporosis and fracture increases with age. Bone mineral density (BMD) measurements accurately predict the risk for fractures in the short-term.
However, screening is not recommended as it is not cost effective. It can be offered if there are presence of strong risk factors such as advancing age, menopause before 45 years, slender build, family history of osteoporosis in a first degree relative, on steroid therapy for more than a year, previous history of fracture of hip, spine or wrist, excessive alcohol and caffeine intake and smoking.
If you feel sad, losing interest in things that you normally enjoy and your sleep and appetite have reduced, you should see your doctor, who will ask you questions to screen for depression. There are effective treatments for depression, and the doctor can easily make a diagnosis.
Vision and hearing
For the elderly, screening for diminished vision can be done with the Snellen visual acuity chart, a chart that is commonly used by doctors and opticians. Hearing impairment is screened through periodic questioning by the doctor.
Alcohol and tobacco use
All adults should be screened for smoking and excessive drinking of alcohol. These are done through direct questioning by doctors. Smoking cessation lowers the risk for heart disease, stroke and lung disease.
For pregnant mothers, there are substantial health benefits for both the baby and the expectant mother. So if you are smoking, you should stop it; and if you are drinking excessive amounts of alcohol, it’s time to cut it down.
Health screening is important to decrease illnesses and death from diseases associated with ageing. Prevention is better than cure, so we should take care of our health in order to enjoy a rewarding life and achieve successful ageing.
This article is a contribution of The Star Health & Ageing Panel, a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public.
The members of the panel include: Datuk Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; A/Prof Sarinah Low, psychologist; Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Keith Lim, consultant rheumatologist; Dr Ting Hoon Chin, consultant dermatologist.
The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care.
The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.
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