Currently, National Screening programmes for Cervical, Bowel and Breast cancer are in place although the stage of implementation of the programme for Bowel Cancer is different across England, Scotland, Wales and Northern Ireland. The NHS National Screening Committee is currently developing the screening aspects of recommendation called the 'National Service Frameworks' for Diabetes and Coronary Heart Disease, which will be important for this age group. In addition, consideration is being given to the introduction of screening for ovarian cancer. Half of all the deaths in the country are due to heart disease and cancer, so preventive services for these diseases are given widespread attention. Periodic health examinations will allow your height, weight, and blood pressure to be monitored.
Screening Tests for Adults
Breast cancer is an extremely important disease being the most common cancer in women. In 2010 it was estimated that it accounted for 31% of all cancers in women. The incidence of breast cancer is rising and it is now the second most common cause of death in women after lung cancer.
The aim of breast cancer screening is to detect breast cancers in women without symptoms at an early stage and by doing this improve survival rates. The combination of breast screening together with improved treatment strategies means that increasing numbers of women are now surviving breast cancer. In the first ten years since the introduction of the NHS Breast Screening Programme, research has shown that death from breast cancer has fallen by 21%. Currently survival rates for breast cancer are higher than those of all the other major cancers in women. The incidence of breast cancer increases with age. Eighty per cent of cases occur in post-menopausal women. Therefore, currently the NHS Breast Screening Programme provides free breast screening every three years for all women in the UK aged 50 and over. This is done by use of a mammogram which is a special x-ray of the breast. This x-ray may detect very small abnormalities that may not be felt by the woman. It is important to remember that whilst the abnormalities detected may represent cancer they may also represent benign (non--cancerous) disease. Any woman who has had an abnormality detected on a mammogram will need further tests such as a biopsy to confirm whether cancer is present.
Many deaths from cervical cancer can be prevented through screening. Detection of early cervical cancer or precancerous lesions by a liquid based cytology (LBC) test can allow treatment at an early stage when this is most effective.
In the UK, all women between the ages of 25 and 64 are eligible for a free liquid based cytology (LBC) test every three to five years. Following re-evaluation of the interval for cervical screening, the NHS Cervical Screening Programme now offers screening at different intervals depending on age.
The NHS “call and recall” system invites all eligible women who are registered with a GP for testing. This system keeps track of any follow-up investigations, and, if all is well, recalls the woman for screening in three or five years time. It is important that women ensure their GP has their correct name and address, and inform their GP if these change.
Women who have not had a recent liquid based cytology (LBC) test may be offered one when they attend their GP or family planning clinic on another matter.
Women should receive their first invitation for routine screening at the age of 25. If you have not received an invitation for screening, and are between the ages of 25 and 64, you should contact your GP for advice.
Too much cholesterol can lead to heart disease, the leading cause of death in the UK. Monitoring the amount of cholesterol in your blood can help you make changes in your eating and exercise habits to reduce your risk.
In the UK, cholesterol measurements are usually made in accordance with The Joint British Guidelines for prevention of Coronary Heart Disease (CHD). These recommend detection and treatment of those most at risk for CHD. Cholesterol testing is indicated for those individuals who have:
- A first degree relative with significant Hypercholesterolaemia or known Familial Hypercholesterolaemia
- A first degree relative with early CHD (< 55 in men; < 65 in women)
Known risk factors, such as smoking, high blood pressure, diabetes, obesity/overweight, a family history of early heart disease, high blood cholesterol (high total and high LDL), or low HDL cholesterol.Testing most frequently consist of a Lipid profile which in addition to Cholesterol measures another fat, known as Triglyceride (TG), and two subfractions of cholesterol - High Density Lipoprotein (HDL) and Low Density Lipoprotein (LDL) Cholesterol. HDL is considered 'good cholesterol' and LDL is 'bad cholesterol' in terms of the link to vascular disease. The ratio between the two is also important.
Heart disease is the leading cause of death both in the UK and the US. The risk of heart attacks rises with age and men of 45 years of age and older and women of 55 years of age and older are often at an appreciable risk. NHS UK National Screening Committee recommended in 2003 that priority be given to the identifying people with established heart disease so that they can be given advice and treatment to reduce the risk of recurrent heart attacks. In December 2005 the Joint British Societies (JBS) recommended that Coronary Artery Disease (CAD or heart disease) prevention should focus equally on people with established disease, people with diabetes and those who appear healthy but have a high risk of heart attack(≥ 20% over 10 years).
For people who are not in these high risk groups, the Joint British Societies priority is to promote lifestyle change and improve health education. Furthermore, the JBS recommend that all adults >40 years of age who do not have a history of CAD or diabetes, and are not already on treatment for blood pressure or lipids should be given a CAD risk assessment once every five years. It is suggested that although screening helps identify those with near-term risk who may benefit from drug therapy, the screening of younger adults helps promote lifestyle changes for longer term health benefits. These two recommendations are different and the National Screening Committee is leading work to integrate them with the National Service Framework for Diabetes to create the Diabetes, Heart Disease and Stroke Prevention Project.
Skin cancer is the second most common cancer in the United Kingdom, with about 40,500 new cases each year. Of theses, approx 6,000 are malignant melanomas. In the UK, approx 1 in 200 people have melanoma of whom approx 1,500 people die from the disease every year. The UK Skin Cancer Prevention Working Party Consensus statement gives advice on avoidance of sun exposure and sun induced skin damage as a means of preventing skin cancer. More information can be found on Skin Cancer Hub and SunSmart Microsite.
Current expert opinion in the UK suggests that general testing of the population detects only a few cases of overt thyroid disease and is therefore unjustified even in high risk groups such as women over 60 and those with a strong family history of thyroid disease. (Guidelines on the Diagnosis and Treatment of Hypothyroidism - British Medical Journal vol 313 pp 539-544 1996.
Testing is recommended in those patients who are at high risk of iatrogenic hypothyroidism because of previous thyroid surgery or treatment with radioiodine and those prescribed lithium or amiodarone.
Genital Chlamydia trachomatis is the commonest Sexually Transmited Disease (STD) in England. Infection is an important reproductive health problem as 10-30% of infected women develop pelvic inflammatory disease (PID). Around 9% of sexually active young women are likely to be infected and around 70% of infections are asymptomatic and so, are liable to remain undetected, putting women at risk of developing PID. Screening for genital chlamydia infection may reduce PID and ectopic pregnancy.
A National screening programme to screen for Chlamydia is currently being developed.
Bowel cancer is also known as colon, rectal or colorectal cancer. The lining of the bowel is made of cells that are constantly being renewed. Sometimes these cells grow too quickly, forming a clump of cells known as a bowel polyp (sometimes known as an adenoma). Polyps are not bowel cancers (they are usually benign), but they can change into a malignant cancer over a number of years. A malignant cancer is when cancer cells have the ability to spread beyond the original site and into other parts of the body.
Bowel cancer is the third most common cancer in the UK, and the second leading cause of cancer deaths, with over 16,000 people dying from it each year.
The UK National Screening Committee (NSC) reviewed the evidence for bowel cancer screening, and found that population screening of people over the age of 50 for non-visible (occult) blood in faeces can reduce the mortality rate for bowel cancer. A pilot screening project was conducted across two pilot sites with very encouraging results. See the English Bowel Cancer Screening Pilot and Evaluation of English Bowel (Colorectal) Cancer Screening Pilot.
The NHS Bowel Cancer Screening Programme now offers screening every two years to all men and women aged 60 to 69 in England. The age range is currently being extended to 60 to 74 and is open to individuals opting-in to be screened from age 75 and above. People within the age range are automatically sent an invitation, then their screening kit, so they can perform the test at home. After the first screening test, individuals are sent an invitation and screening kit every two years. For further information about the NHS Bowel Cancer Screening Programme see www.cancerscreening.nhs.uk/bowel/index.html. Separate screening programmes are offered in Wales, Scotland, Northern Ireland and the Republic of Ireland.
Guidelines for bowel cancer screening in higher risk groups, for example, those with a significant family history, have been produced by The British Society of Gastroenterology.
On 28 April 2010 the Lancet published ‘Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial’. This paper was the culmination of over 10 years work inspired by UK academic Professor Wendy Atkin. In October 2010 the Prime Minister announced that flexible sigmoidoscopy would become a new screening modality for the national screening programme. Poor cancer survival rates in the UK relative to other European countries provided the backdrop to this initiative with the prospect that a once-only flexible sigmoidoscopy would save 3000 lives a year. The National Screening Committee approved this modality in April 2011. Since 2013, men and women living in 6 pilot sites have been invited to participate in “Bowel scope screening” around the time of their 55th birthday. The Bowel scope screening programme aspires to be fully rolled out to all 55 year olds by the end of 2016 and will function in addition to the existing NHS bowel cancer screening program.
The Screening Programme in England also intends moving the population-based screening from the current guaiac-based system (gFOBT) to a faecal immunochemical test (FIT). The immunochemical test is analytically superior, conferring increased analytical specificity for human haemoglobin, and through the use of sensitive detection systems, increasing test sensitivity to low blood concentrations. Instrumentation used for quantitative measurement also provides an opportunity to manually adjust the cut-off limit below which a test is reported as negative. FIT devices are currently being evaluated for the NHS by the Screening Hub in Guildford and a 6 month trial of FIT screening will commence in two areas in March 2014.
This difficult-to-manage disease is now occurring with alarming frequency, affecting Britons at a younger age and certain ethnic groups in particular. Many are unaware that they have the disease, and there is concern about the complications that can develop. The current view from the UK National Screening Committee is that there is no justification for population screening for diabetes in the United Kingdom. However, there is some support for screening and commencing intense treatment in population sub-groups in whom undiagnosed diabetes and coronary heart disease are especially prevalent. In individuals opportunistically identified as being at high risk of heart disease, additional testing for hyperglycaemia may be of benefit. Although the complications of diabetes are of public health importance, an appropriate strategy is to optimise management of blood pressure and hyperglycaemia in people with known diabetes and to ensure universal screening for eye disease and prompt treatment. It is unclear whether population screening for diabetes would significantly improve outcomes.
Obesity, hypertension, high cholesterol, inactivity, and a family history of diabetes are some of the factors that increase your risk of developing diabetes. Some ethnic groups, particularly South Asians and Afro-Caribbeans have a higher prevalence of the condition.
For further information see the Diabetes UK website.
The most common genetic disease in North European populations, with a gene frequency as high as 1 in 8, hereditary hemochromatosis, or iron overload disease, causes the iron from a person’s diet to accumulate in the body’s organs. Over a lifetime and without treatment, serious and even fatal health effects can result. The National Screening Committee’s most recent review of the evidence for screening for haemochromatosis (to be reviewed in 2005) concluded that screening should not be recommended.
Currently in the UK there is no organised screening programme for prostate cancer but an informed choice programme "Prostate Cancer Risk Management" has been introduced. Its aim is to ensure that men who are concerned about the risk of prostate cancer receive clear and balanced information about the advantages and disadvantages of the PSA test and treatment for prostate cancer. This will help men decide whether they want to have the test. General Practitioners have received advice about counselling and supplies of patient information sheets. There is also an online decision aid called PROSDEX that describes the facts clearly and will help you understand the advantages and disadvantages of having your PSA measured. For further information see the NHS Cancer Screening Website.
While not recommended as a general screen, screening for tuberculosis is usually recommended based on known risk factors.
In the UK, the number of TB cases is rising. Alcoholics, HIV-positive individuals, some recent immigrants and healthcare workers are at increased risk. The disease is most commonly found in places such as hostels for the homeless, prisons, and centres for immigrants arriving from areas with high rates of HIV infection or inadequate health provision.
Typically, you may not feel ill or have symptoms. If you are at risk of infection, for example you have come into contact with a person infected with tuberculosis, are HIV-positive or receiving immunosuppressive therapy, you may be given a tuberculin (Mantoux) skin test, a chest X-ray and sample of sputum or phlegm may be taken for laboratory examination.
It is recommended by the Health Protection Agency that individuals working as healthcare workers who are previously unvaccinated, and who are negative or grade 1 on tuberculin testing, should receive BCG vaccination.