January 20, 2021/Primary Care

What You Need to Know About Health Screening Tests

Why you need them and which ones you need

man having blood pressure checked in doctor's office

If you’re an adult who visits your primary care healthcare provider regularly, you’re probably used to having your blood pressure checked and having blood drawn to determine your cholesterol levels.

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These are examples of health screening tests, which help healthcare providers identify as-of-yet undetected diseases or conditions in people who feel well and don’t have any symptoms. The goal is to diagnose illnesses early so they’re easier to treat.

But there are a lot of questions surrounding health screenings — like what health screenings should I get, and are they really necessary?

“When you’re thinking of health screenings, you should remember that some screening tests do have risks and outcomes that differ from person to person, so it’s always best to consult with your healthcare provider,” says family practitioner Matthew Goldman, MD.

What are health screening tests used for?

There’s not a screening test for every health condition out there. Healthcare providers offer health screening tests for medical conditions based on the following criteria:

  1. It’s an important public health problem that’s common enough to justify the cost of screening to a population.
  2. It significantly affects a person’s quality of life and life expectancy.
  3. An acceptable treatment is available.
  4. It has an early stage during which someone wouldn’t experience symptoms – but during which detection and treatment would significantly improve long-term outcomes.
  5. A simple and affordable screening test exists.

Colorectal cancer screening: Why you need it

Colorectal cancer, for example, is a health condition that meets the above criteria.

Most colorectal cancers develop slowly over several years. But before a cancer develops, a growth of tissue or tumor usually begins as a non-cancerous polyp on the inner lining of the colon or rectum. These polyps generally don’t cause any symptoms, but they sometimes progress into cancer. So when a precancerous polyp is identified through colon cancer screening and removed, that prevents cancer from developing and has no negative effect on someone’s health or life expectancy.

However, when colorectal cancer develops and is diagnosed, the five-year survival ranges from 6% to 74%, depending on the stage of the cancer when it was found.

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“When healthcare professionals consider the criteria for health screening, colon cancer does affect a significant number of people,” Dr. Goldman says. “There are also acceptable screening methods and treatments for it, and identifying and treating precancerous or early-stage cancer in the period before any symptoms start leads to better outcomes.”

So, because it meets screening criteria and the incidence of colorectal cancer starts to increase at age 45, it’s recommended that people of this age get this type of screening (except for people at high risk, who might need to start screening sooner).

Other screening tests you need

In addition to screening for colorectal cancer, you should talk to your healthcare provider about the following:

  • Breast cancer screening is commonly recommended beginning at age 40 (except for those who are at high risk). But all women should talk to their healthcare provider about their risk factors and together decide when to start and how often they should be screened.
  • Screening for cervical cancer with a Pap test is recommended for women every three years starting at age 21. Between the ages of 30 and 65, a combination of a Pap test and a human papillomavirus (HPV) test every five years can be used in place of a Pap test alone every three years.
  • Screening for skin cancer is often performed by a dermatologist. Your doctor will recommend this especially if you are fair-skinned and prone to sun damage, or if you’ve already had skin cancer. During a skin exam, the doctor will check your skin for pigmented areas that look abnormal in size, shape, color and texture — and they’ll look at your moles and birthmarks to identify any that need further examination.
  • As an adult, you should also regularly get a blood test (annually in most cases) to check your lipid profile, which is a complete cholesterol test used to measure the amount of “good” and “bad” cholesterol and triglycerides (a type of fat) in your blood. Having a high triglyceride level can increase your risk of heart disease.
  • As an adult, you should also get a fasting blood sugar test to screen for diabetes. The U.S. Preventive Services Task Force recommends screening for abnormal blood glucose and type 2 diabetes in adults over age 45, or people over 40 who have overweight or obesity (and repeating testing every three years if the results are normal). Individuals at higher risk, including those who have family members who have diabetes, may be recommended to be screened earlier or more frequently.

Ovarian cancer screening: Why it may not be recommended

Ovarian cancer is the second-most common gynecological cancer and the fifth leading cause of cancer deaths in women in the United States.

If it’s diagnosed at an earlier stage, the five-year survival rate can top 90%. The five-year survival rate drops to 25% if the diagnosis is made at a late stage.

The goal of screening, then, would be to diagnose ovarian cancer in its earliest stages when treatment would have the most beneficial effect on outcomes, Dr. Goldman says. Screening tests can include a pelvic exam, transvaginal ultrasound and CA-125 assay.

“Although there’s evidence to show that diagnosing ovarian cancer at early, asymptomatic stages leads to better survival, screening may not detect ovarian cancer in these earlier stages,” he says. “That’s why screening tests for ovarian cancer (and fallopian tube and primary peritoneal cancer) are still being studied in clinical trials.”

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Also, existing screening strategies for ovarian cancer are associated with a high rate of false-positive tests that can lead to unneeded surgical procedures with risks of serious complications.

“As you can see in the case of ovarian cancer, there’s no evidence that screening leads to better outcomes,” Dr. Goldman emphasizes. “And with the tests currently available to diagnose ovarian cancer, screening can instead lead to significantly more potential harm than good.”

Let your healthcare provider lead the way

The overall message here is that screening recommendations vary, so it’s important to discuss the appropriateness of all screening tests with your provider.

“Your provider will review all of your risk factors and recommend the screenings they find important enough for your age and your overall health profile,” Dr. Goldman says.

Learn more about our editorial process.

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