Throughout adolescence, the emphasis is on immunizations and counselling to prevent illness, injury, and early death. Attention is given to accident and injury prevention as well as health risks from sexual activity and high-risk pursuits such as smoking and substance abuse. From the age of 18, cervical screening is offered to sexually active women.
Screening Tests for Young Adults
Breast cancer is extremely rare in women in their teens and uncommon in women under 35. After this age the risk begins to gradually increase, but doesn't rise dramatically until after the menopause. Mammograms are also less effective in pre-menopausal women probably because the density of the breast tissue and the fat content is higher. This makes it more difficult for a mammogram which uses x-ray technology to detect any problems.
Because of this breast screening is not offered to younger women and regular self examination or examination as part of a regular medical examination is recommended instead. However, it is important for women of all ages to self-examine regularly to detect any possible breast lumps as soon as possible.
Recently however there has been some promise in digital mammography. Whereas conventional film mammography captures images of breast tissue on x-ray film, digital mammography uses computer imaging. This has been shown to be better for screening younger women and women with denser breasts, and is equally effective as film mammography in older women. This is being implemented across the NHS Breast Screening Programme and as of July 2011, 85% of breast screening units have at least one digital mammography machine.
Despite this new technology there are no plans to lower the screening age further than 47 . This is because the risk of cancer is low in these women and there is also little evidence to show that regular mammograms for most women under the age of 47 reduce deaths from breast cancer.
Screening Tests for High Risk Patients
Some women, including younger women, may be at high risk of developing breast cancer due to their family history or certain genetic mutations. They may also be at more risk if they have had radiotherapy to their chest area at a young age. These women are usually screened with an MRI scan +/- a mammogram and screening may begin as early as age 25 depending on the condition. These women may also be screened more regularly such as annually. However, the need for screening and the frequency of screening is determined by a medical professional as opposed to the national screening programme.
A cervical screening programme is established in the UK whereby all women between the ages of 25 and 64 are eligible for a free liquid based cytology (LBC) test every three to five years, depending on age.
Women under the age of 25 are not routinely screened because cervical cancer is rare in this age group, although minor cell changes are common. The cervix is still developing in teenagers, which means young women may get an abnormal LBC result even when there is nothing wrong.
Treating mild abnormalities treated in women under 25 could prevent cancers from developing many years later. However, these early changes would be detectable on screening at age 25 allowing treatment at this stage. There is no evidence that earlier screening or treatment prevents cancer, and waiting until a woman is 25 years old provides a more reliable result. This approach prevents young women undergoing unnecessary investigation and treatment.
Any woman under 25 who is concerned about her risk of developing cervical cancer or her sexual health generally, should contact her GP or Genito-Urinary Medicine (GUM) clinic.
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.
Under 20 years old:
Population Screening for hypercholesterolaemia in children is currently not recommended in the UK. Case Finding by Family Tracing is an effective strategy for identifying most children with familial hypercholesterolaemia. Screening should be based on:
- a family history of familial hypercholesterolaemia or
- premature cardiovascular disease (before 55 years in men, before 60 years in women)
Children should be tested before the age of 10 years but usually not before the age of two years. The age chosen should take into account the onset of CAD within the family and the wishes of the parents.
BLOOD SAMPLES. Non-fasting capillary or venous samples can be used for screening measurement of total cholesterol. If the concentration is above 5.5mmol/l, which is the 95th centile in childhood, a fasting venous blood sample should be taken for measurement of total and high-density lipoprotein (HDL) cholesterol and triglyceride. The low density lipoprotein (LDL) cholesterol can then be calculated.
20 years and older:
Widespread population screening is not currently recommended in the UK. The Joint UK Guidelines recommend targeting those most at risk, ie those most likely to benefit from intervention. This is determined by the presence of 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.
Assessment is best done by a Lipid profile, a blood test conducted after a 9- to 12-hour fast, which determines your total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels.
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.
While not recommended as a general screen, screening for iron overload disease is recommended based on known risk factors.
The most common genetic disease in North European populations, with a gene frequency as high as 1 in 8, hereditary haemochromatosis, 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.
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.