Common Health Tests

INDEX: Importance of Health Screening What Is a Screening Test? Cholesterol and Blood Pressure Measurements Cancer Screening Breast Cancer Cervical Cancer Cancer of the Colon and Rectum Prostate and Testicular Cancers Skin Cancer Synonyms and Keywords Authors and Editors

Importance of Health Screening

Common health tests may be performed in your doctor's office or even in the pharmacy. Regular health checks and screening for certain diseases and conditions have become routine for most people.

New tests and investigations can and always are being developed. The indications (when you might have need) for some tests (mammography, for example) are still being determined. If you have any questions about exactly which tests are right for you, please discuss these concerns with your own doctor.

Screening tests for some of the less common conditions are not included here. Screening is an area where there are likely to be many advances over the coming years, with the identification of the genetic cause for more and more conditions. However, it is important to be aware that just because doctors can identify someone at increased risk for a condition, it may not necessarily be preventable. It may simply mean that you will need to work with your doctor to closely monitor your health to ensure that the condition is detected as early as possible.

What Is a Screening Test?

Screening is a method of finding diseases in people who do not yet have any signs or symptoms of the disease being screened for. Although this idea sounds great, and we could ask: "Why don't we screen for all diseases?" the answer is quite complex. The goals of screening include helping people live longer, healthier lives. It is clear that although we could screen for many diseases, in a number of cases it is also clear that even if we find the disease we are screening for, the person does not benefit in any obvious way.

• Does screening improve health outcomes? Sometimes, a person diagnosed with the condition by screening seems to have no improvement in health when compared with a person who is only diagnosed when the disease eventually shows signs or symptoms. An example of a condition in which there is still some debate is diabetes. Although it is clear that there is probably some benefit from screening people with a strong family history of diabetes—usually by means of a blood test performed when the person has not eaten any food overnight—annual screening does not necessarily seem to be useful in the general population. Some doctors do advocate screening, but usually every 3-5 years.
  
  
• When does screening help? Screening helps when a test finds the disease or problem in a large proportion of cases. In other words, if you have the disease, and don't yet know it, there is a very good chance the screening test will pick it up. Equally, if you do not have the disease, there is a good chance that the test will not suggest that you might have it. An excellent example is blood pressure. The blood pressure cuff, if used correctly, is very accurate in diagnosing high blood pressure.
  
  
• What are the risks of screening tests? Surely a test designed to diagnose a disease cannot have any risks? In fact, there are a number of potential risks involved.
  
  
  • However accurate a test may be, there will always be someone who has the disease but does not get picked up by the test. These so-called false negatives can lead you to believe that you are healthy, when you are not.
    
    
  • The reverse event can also occur. You could be told that you have the disease when in fact you do not. These results are said to be false positives. The result may be that you have to undergo further tests, which may be more complex, not to mention expensive, just to be sure that you do not actually have the disease you were told you had.
  
  
• Are common tests more appropriate for some people? All these factors are taken into account before a test is regularly and widely used as a routine health test. These widely used tests are discussed here. Although many screening tests may be appropriate for everyone—blood pressure measurement, for example—some screening tests are more appropriate for certain groups of people.
  
  
  • Examples would be Pap smears and mammography for women, or regular bowel examination for people with a family history of bowel cancer.
    
    
  • The family history is very important to a doctor because it may point out tests that the doctor would perform in one case that may not be indicated in another person.
  
  
• What are the best or most reliable screening tests, and when should they be done? Among people in the Western world, a major cause of death is coronary artery disease. There are a number of risk factors for this condition. A risk factor is something that increases the chances of developing the disease if you have that factor, when compared with a person who does not have that factor. Some risk factors for heart disease include a family history of heart disease, smoking, high cholesterol, diabetes, and high blood pressure.
  
  
  • Some of these risk factors you cannot change. You cannot change family history, for example.
    
    
  • Some risk factors are completely under your control. You can determine whether to alter that risk factor—stopping smoking is one example.
    
    
  • Some factors could be altered through medication, dietary control, exercise, or other means, if only you knew that you had that risk. Examples are high blood pressure and high cholesterol.

Cholesterol and Blood Pressure Measurements

Blood pressure checks: High blood pressure is a risk factor for heart disease and also for a number of other diseases, such as strokes, kidney failure, and eye problems. Very often, you may have high blood pressure but have no signs or symptoms at all, until one of these complications strikes. Measurement of blood pressure is relatively straightforward and reliable if performed by trained people, or on well-calibrated machines.

• The recommendation is that everyone over age 3 years should have a blood pressure recorded every 2 years or so.
  
  
• Normal blood pressure should be no higher than 140/90, although it is clear that the lower the blood pressure (up to a point), the lower the risk.
  
  
• If a high normal blood pressure reading is detected, then blood pressure should be checked more frequently. Most doctors would recommend every year. If the blood pressure is above normal on 3 readings, spaced over a period of time, then therapy should begin. This should be at the discretion of the doctor, because there are cases where it is appropriate to start treatment immediately if someone has very high blood pressure readings.

Cholesterol checks: Cholesterol is a risk factor for heart disease. This seems to be particularly predictive for middle-aged men. The evidence that lowering cholesterol, especially if only slightly elevated, in women, young people, and the elderly, reduces the risk of heart disease is not as strong.

• What is meant by high cholesterol? People with cholesterol levels over 200 mg/dL are considered to have elevated cholesterol levels.
  
  
• If the cholesterol level is between 200 and 240, then this is considered borderline high. Levels above 240 are high. Diet and exercise can often lower borderline high cholesterol levels, while medications are frequently recommended for high levels.
  
  
• In general, you should have your cholesterol checked every 5 years, or more frequently if you have a previous high level.

Cancer Screening

A very important role for screening is in detecting cancer at an early stage. Although screening does not prevent cancer, it may diagnose the condition when it is in the most treatable form. It is important to note that this is not always the case though.

• A good example of this is lung cancer. Lung cancer is the leading cause of cancer-related deaths in the United States. It may seem that a chest x-ray could be used to diagnose the cancer. In general, though, a simple screening chest x-ray does not diagnose the condition early enough to have any significant impact on survival.

Which cancers can be detected using common health tests? Several types of cancer can be screened for. These include cancers of the breast, cervix, testicles, colon and rectum, and skin. There does seem to be a definite impact on survival when cancer is detected early and treated appropriately.

• Some other cancers can be screened for, but it is not clear that identification results in an improvement in the long-term survival.

• The American Cancer Society offers a complete discussion of cancer screening and detection on its Web site.

Breast Cancer

Although breast cancer may occur in males and females, most breast cancer screening has been directed toward females. Breast cancer is the second leading cause of cancer-related deaths in women (behind lung cancer), and the most common cancer in women. A number of screening tests have been developed to try to diagnose this disease at an early, and thus more treatable, stage. The 3 main tests are breast self-examination, breast examination by a health care professional, and mammography.

• Breast self-examination: This is a simple, cheap, and easy-to-perform test. The American Cancer Society recommends that women should examine their breasts once a month starting at age 20 years. The breast self-examination should be performed in the week after the menstrual cycle, at which time the breasts are least likely to be sore or swollen. Any new lump, discharge, sore, or other change should be brought to the immediate attention of your doctor.
  
  
• Breast examination by a health care professional: It is widely agreed that all women over age 40 years should have annual breast examinations by a health care professional. For women at increased risk, for example, those with a strong family history, this should probably start earlier, at age 35 years. Between the ages of 20 and 40 years, women should have breast examinations performed at least every 3 years.
  
  
• Mammography: This technique uses x-rays to take highly detailed pictures of the breasts. Very small lesions can be detected using this technique. Most experts recommend that women over 50 years have this procedure at least every year. The screening of younger women is much more controversial. Most experts agree that mammography should be performed every other year for women between the ages of 40 and 50. If there is a family history, then this should start earlier, at age 35 years. Because of the range of opinions among experts, it is probably best for women between 35 and 50 years to discuss their options with their doctors, and then come to a decision together, taking into account factors such as family history and your own medical history.

Cervical Cancer

The incidence and death rates from cervical cancer have declined over the past 15 years or more. This is partly due to education and partly due to screening for the disease. Nevertheless, there are about 15,000 new cases, and 4,500 deaths annually, from this condition in the United States. In developing countries the rates are much higher. In some countries, cervical cancer is the leading cause of cancer-related death in women.

• Most cancers of the cervix (probably about 90%) are of the type known as squamous cell cancer. It is thought that these cancers can be recognized when they are in a very early (or so-called precancerous) condition. At this stage, the disease is localized to the cervix and can be treated relatively easily.
  
  
• Early treatment has an enormous positive impact on survival in this condition. This is an ideal disease for a screening test. The method used to screen for this disease is the Papanicolaou smear (or Pap smear or Pap test).
  
  
  • The Pap smear is performed by viewing the cervix through a speculum and then using an instrument called an Ayer speculum to gently scrape the surface of the cervix. This leaves a residue of cells on the spatula. These cells are then spread over a microscope slide and fixed with a special chemical. The slides are then viewed under a microscope.
    
    
  • All women who are sexually active, or over age 18 years, should have a regular Pap smear. How regularly they should have these is open to some debate. Most obstetrician-gynecologists (doctors who specialize in women’s health) in the United States recommend a Pap test every year. An abnormal result may require more frequent screening.

Cancer of the Colon and Rectum

The colon and rectum are common sites of cancer. It is estimated that there will be about 140,000 new cases annually in the US and about 55,000 deaths. Screening tests for colon cancer include using tests to find the presence of blood in the bowel movement. These tests are called fecal occult blood tests. Doctors may also use an instrument—the flexible sigmoidoscope—to examine the lower parts of the bowel (where cancers are most commonly found) directly.

• It is suggested that tests to look for blood in the bowel movement should be conducted annually in everyone over age 50 years. If there is a strong family history of colon cancer, then not only should testing be started much earlier, in the 30s or 40s, but testing may need to be more invasive. The doctor can take a small sample of stool and test it in the office. Sometimes it is easier for you to provide a sample or samples at home using a test kit and mailing the samples to your doctor for testing.
  
  
• For more invasive screening, a colonoscopy is performed. This test uses a long narrow flexible tube to view the inside of the bowel. Talk with your doctor about the use of this test because the doctor will take all factors into account (for example, your family history and past medical history) to determine when you need it.

• Your doctor may require you to use a strong laxative (called a bowel cleanser) to clear your bowel of fecal contents before colonoscopy. Several medications are available for bowel cleansing, including polyethylene glycol 3350 (GoLYTELY, NuLYTELY), magnesium citrate (Citroma), and senna (X-Prep). These medications produce diarrhea, which can be uncomfortable, but unless the bowel is empty of stool, the test can be limited and may need to be repeated at a later date. Your doctor may also require a special diet, such as a clear liquid diet, starting 1-2 days before your scheduled colonoscopy.

Prostate and Testicular Cancers

Prostate cancer: Screening for prostate cancer is a subject of debate among doctors. It is not yet completely clear that screening is cost effective or saves significant numbers of lives. It is also not completely clear what the best screening test is. In general, the following recommendations could be made.

• Men over age 50 years would benefit from an annual rectal examination, together with a blood test called a PSA (which stands for prostate specific antigen).
  
  
• Prostate cancer is one disease that seems to affect African American men differently from white males. In African American males, screening should probably start earlier—as young as 40 years.
  
  
• Men with a strong family history of the disease should also start screening at an earlier stage.

• Men are encouraged to conduct monthly testicular self-examinations. Currently no firm guidelines are in place. This is another area where discussion with your doctor would be in order, especially if you have a history of undescended testes or a family history of testicular cancer.
  
  

Skin Cancer

Melanoma is a type of skin cancer that, if allowed to spread, is highly dangerous. Over the past few years the number of cases of melanoma diagnosed in the US seem to be increasing. Although survival from this form of skin cancer is improving, the death rate is still increasing.

• The screening test for melanoma is a simple, relatively quick, noninvasive, and inexpensive visual examination of the skin by a trained health care professional. If there is any question about any lesion seen on this visual examination, then a skin biopsy is performed. During a biopsy or during a mole removal, a piece of tissue is removed and examined under a microscope.
  
  
• Prevention of melanoma needs to start in childhood and involves avoiding exposure to sunlight. This is achieved by wearing a hat, covering up with a long-sleeved shirt or similar clothing, and wearing sunscreen on exposed areas. The Australians developed the catchy expression "Slip Slap Slop" for slip on a shirt, slap on a hat, and slop on sunscreen.
  
  
• Although melanoma is the type of skin cancer most people are concerned about, other types of skin cancer can be equally as devastating. Again, a relatively simple visual inspection, performed on a regular basis, should be performed as part of an annual checkup. This is particularly important for people who spend a long time in the open air, or for anyone with a past history of skin cancers, or those with a strong family history.

Synonyms and Keywords

common health test, common health tests, health screening, screening, screening tests, cholesterol screening, cholesterol test, cholesterol tests, mammography, mammogram, prostate screening, prostate specific antigen, PSA, blood pressure checks, high blood pressure, cervical cancer screening, Pap smear, Pap test, breast self-examination, breast self-exam, testicular self-examination, testicular self-exam, fecal occult blood test, sigmoidoscopy, colon cancer screening, colonoscopy, skin cancer screening, cancer screening, skin biopsy, mole removal, annual checkup, yearly checkup

Authors and Editors

Author: Martin J Carey, MD, MPH, BCh, Program Director, Assistant Professor, Department of Emergency Medicine, University of Arkansas for Medical Sciences.

Editors: Marian Gambrell, MD, Clinical Assistant Professor, Department of Emergency Medicine, St Lukes-Roosevelt Hospital Center, Columbia University; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, Pharmacy, eMedicine; Steven L Bernstein, MD, Vice-Chair, Academic Affairs, Department of Emergency Medicine, Newark Beth Israel Medical Center; Assistant Professor, Department of Emergency Medicine, Mt Sinai School of Medicine.

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All Rights Reserved.

Medicine is a constantly changing science, and clearly established therapies are not always available for every condition. New research findings necessitate continual changes in drug and treatment therapies. The authors, editors, and publisher of this journal have used reasonable efforts to provide up-to-date, accurate information that is within generally accepted medical standards at the time of publication. However, as medical science is ever evolving, and human error is always possible, the authors, editors, and publisher (or any other involved party) do not guarantee total accuracy or comprehensiveness of the information in this article, nor are they responsible for omissions, errors, or the results of using this information. The reader should confirm the accuracy of the information in this article from other sources. In particular, all drug doses, indications, and contraindications should be confirmed in package inserts. FULL DISCLAIMER

HalfLytely and Bisacodyl Tablets Bowel Prep Kit is a medicine to clean out the colon (intestines) before a colonoscopy. Nausea, stomach cramping, and abdominal fullness are the most common side effects. These happen in up to 50% of patients.

You should not use this product if you are allergic to anything in it. You should also not use this product if your intestines are blocked or larger than normal or if you have a stomach problem called gastric retention, or an inflammation of your large intestines. If you have severe ulcerative colitis, tell your doctor before using this product. Any woman who is pregnant or who thinks she might be should tell her doctor before using this product. This product has not been studied in pediatric patients and pregnant women.

Do not add anything else, such as flavorings, to the solution. Do NOT chew or crush the bisacodyl delayed-release tablets. If you have severe discomfort or distention (bloating), stop drinking the solution for a while. You can also wait longer between drinking each glass of solution until the discomfort goes away. Any medicines you take within 1 hour of starting to drink the solution may be flushed out of your body by the solution. You should avoid drinking large amounts of water during or after taking this product or after a colonoscopy.

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