This article waslast modified on
February 12, 2018.

Screening tests are an important part of your preventive health care. For people between the ages of 30 and 49, these tests are used for early detection of some of the more common and potentially deadly diseases—such as cancers, diabetes, and heart disease—that begin to affect people in their middle years. These tests can help catch certain illnesses and conditions in their earliest and most curable stages, even before you notice symptoms.

With information from screening tests, your healthcare provider can work with you to develop preventive measures that will improve your health and can even extend your healthy years. For example, a routine cholesterol test could reveal your risk for developing heart disease, allowing you to take preventive steps—like lifestyle changes—before you develop a serious condition.

The sections below provide information on the screening tests suggested for adults 30 to 49 years old. They summarize the recommendations from various authorities, and there is consensus in many areas, but not all. Therefore, when discussing screening with your healthcare provider and making decisions about testing, it is important to consider your individual health situation and risk tolerance.

For more information on preventive medicine and steps you can take to keep you and your family healthy, read Wellness and Prevention in an Era of Patient Responsibility.

Not everyone in this age group may need screening for every condition listed here. Read the sections below to learn more about each condition and to determine if screening may be appropriate for you or your family member. You should discuss screening options with your health care practitioner.

Screening Recommendations
  • Breast Cancer

    Breast cancer is the second leading cause of cancer death in American women. About 2 out of 3 breast cancers are found in women 55 or older and 1 out of 8 are found in women younger than 45. Regular screening can help to detect tumors at an early stage when they are most treatable. Several methods are available for screening, including mammography, an imaging test that is especially effective at detecting breast cancer several years before symptoms develop.

    The medical community recognizes the value of breast cancer screening and mammography, but there is no universal consensus on how often it should be done or when it should be started. However, most organizations agree that women should work with their healthcare provider to assess their personal risk of developing breast cancer and to determine what is best for them. Considerations can be given to the benefits of screening as well as the harms. While screening can detect cancer early when it is most treatable, it may also lead to false-positive results and unnecessary follow-up procedures, such as biopsies.

    Recommendations: Women in their 30s without known risk factors

    • The American College of Obstetricians and Gynecologists (ACOG) recommends a breast exam by a health professional every 1 to 3 years as part of a regular health exam.
    • Breast self-exams are an option for women starting in their 20s, according to ACOG, and women should report any changes they feel in their breasts to their healthcare provider.
    • Mammograms are generally not recommended for women younger than 40 with no known risk factors.

    Recommendations: Women in their 40s without known risk factors

    • ACOG says that, starting at age 40, women should have a breast exam by a health professional yearly as part of their regular health exam.
    • Breast self-exams are also an option, according to ACOG; women should report any changes they feel in their breasts to their healthcare provider.
    • ACOG and the American Medical Association (AMA) recommend that women be offered a mammogram annually starting at age 40.
    • The American Cancer Society (ACS) says that women aged 40-44 should be offered the choice to begin breast cancer screening with mammograms; women aged 45-54 are recommended to have a mammogram every year.
    • The U.S. Preventive Services Task Force (USPSTF) says that for women aged 40-49, the decision when to start regular screening mammography should be an individual one, taking into consideration such factors as a woman's risk tolerance.
    • The American College of Physicians (ACP) says that women aged 40 to 49 years should discuss the benefits and harms of screening mammography with a health practitioner; if the choice is to undergo screening, have it done every 2 years.

    Risk

    Family history and genetics can contribute to a high lifetime risk. Other risk factors for breast cancer include, for example, a personal history of breast cancer, obesity, beginning your period at a younger age, having your first child after age 35, never giving birth, postmenopausal hormone therapy, beginning menopause at an older age, and alcohol consumption The American Cancer Society recommends that women at high lifetime risk be screened with magnetic resonance imaging (MRI) in addition to mammography annually beginning at age 30 and continuing as long as they are in good health.

    Some of the important factors contributing to a high lifetime risk include:

    • Carrying a mutated BRCA1 or BRCA2 gene or having a close relative with the gene
    • Having had chest radiation at a young age (between 10 and 30 years old)
    • Certain family histories, such as multiple close relatives with breast or ovarian cancer

    If you suspect you are at an increased risk for breast cancer, you should consult your healthcare provider and consider developing an individualized screening program.


    Links
    Sign up for the American Cancer Society's Breast Cancer Screening Reminder
    American Cancer Society: What are the risk factors for breast cancer?
    American Cancer Society: Can breast cancer be found early?
    ACS: Clinical Breast Exam 
    ACS: Breast Awareness and Self Exam 
    National Cancer Institute: Breast Cancer Screening


    Sources Used in Current Review

    (2014 October 29). American Cancer Society Guidelines for the Early Detection of Cancer. American Cancer Society. Available online at http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer. Accessed on 4/1/15.

    Smith, R. et al. (2015 January 8). Cancer screening in the United States, 2015: A review of current American Cancer Society guidelines and current issues in cancer screening. CA: A Cancer Journal for Clinicians. Available online at http://onlinelibrary.wiley.com/doi/10.3322/caac.21261/full. Accessed on 4/1/15.

    Swart, R. et al. (2014 April 16). Breast Cancer Screening. Medscape. Available online at http://emedicine.medscape.com/article/1945498-overview. Accessed on 4/1/15.

    (2014 December). Final Recommendation Statement, Breast Cancer: Screening, 2009. U.S. Preventative Services Task Force. Available online at http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening. Accessed on 4/1/15.

    Mayo Clinic Staff (20 November 2014). Breast cancer, risk factors. Mayo Clinic. Available online at http://www.mayoclinic.org/diseases-conditions/breast-cancer/basics/risk-factors/con-20029275. Accessed on 4/8/15.

    Saslow, et al. (2007). American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography. CA: A Cancer Journal for Clinicians. Available online at http://www.penncancer.org/pdf/MR%20BreastGline.pdf. Accessed on 4/8/15.

    (26 February 2015, Revised). What are the risk factors for breast cancer? American Cancer Society. Available online at http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-risk-factors?sitearea=. Accessed on 4/8/15.

    American Cancer Society. American Cancer Society recommendations for early breast cancer detection in women without breast symptoms. Available online at http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs. Accessed November 2015.

    Kevin C. Oeffinger, MD et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA. 2015;314(15):1599-1614. doi:10.1001/jama.2015.12783. Available online at http://jama.jamanetwork.com/article.aspx?articleid=2463262. Accessed November 2015.

  • Cervical Cancer

    Most deaths from cancer of the cervix (the lower part of the uterus, or womb) could be avoided if women had regular checkups with Pap tests and/or HPV DNA tests.

    Nearly all cervical cancers are caused by human papilloma virus (HPV), but not all HPV strains cause cervical cancer. About a dozen HPV strains, such as HPV 16, 18, 33, 35, and 39, are considered "high risk" because persistent infections — those that do not resolve without treatment — are linked to an increased risk for cervical and vaginal cancer. Two HPV types, 16 and 18, cause 70% of all cervical cancers.

    Cervical cancer can take several years to develop and most often is seen in women 40 years of age or older. Getting routinely screened can help identify cervical cancer in its early stages, when it is highly curable. Screening even finds precancerous lesions so they can be removed before cancer ever starts.

    Recommendations

    The American College of Obstetricians and Gynecologists (ACOG), the U.S. Preventive Services Task Force (USPSTF), and the American Cancer Society (ACS) currently recommend that women aged 30 to 65 should have both a Pap test and an HPV DNA test every 5 years (preferable); a Pap test alone every 3 years is also acceptable.

    Women who haven't been screened for cervical cancer in several years or who have never been tested are especially urged to get tested.

    Significant changes to these recommendations may be on the horizon, however. The Food and Drug Administration (FDA) approved an HPV DNA test as a primary screening tool for cervical cancer, meaning it may be used without a Pap test. Individual health organizations have yet to update their screening recommendations, but an expert panel issued interim (temporary) guidelines in 2015. These guidelines say that:

    • The HPV test may be offered to women aged 25 and older without a Pap test.
    • If initial results are negative, women should be screened again no sooner than 3 years.

    Women interested in this new option should talk to their healthcare provider. The interim guidelines acknowledge that more studies are needed to further evaluate the HPV test and its role in cancer screening. For example, there are still questions about whether age 25 is the best age to start offering it as a primary screening option and how often women should be screened.

    Risk Factors

    How often you should be tested depends on your risk factors. Risk factors include high-risk HPV infection, exposure to diethylstilbestrol (DES) in utero, previous diagnosis of cervical cancer, HIV infection, or a compromised immune system. (See the section on Risk Factors in the Cervical Cancer article.) If you have any of these risk factors, you may be tested more frequently. Ask your healthcare provider for a recommendation on frequency. If you have had a hysterectomy, discuss whether continued screening is of value. In some cases, it is.

    Even if you do not need a Pap test each year, for most women an annual well-woman exam is still recommended, reminds ACOG.


    Link
    National Cancer Institute: What You Need To Know About Cervical Cancer


    Sources Used in Current Review

    (Updated 2012 August 13). HPV- Associated Cancer Diagnosis by Age. Centers for Disease Control and Prevention. Available online at http://www.cdc.gov/cancer/hpv/statistics/age.htm. Accessed 6/16/15.

    (2012 March). Screening for Cervical Cancer. U.S. Preventive Services Task Force. Available online at http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm. Accessed 6/16/15.

    Moyer, VA on behalf of the U.S. Preventive Services Task Force. (2012 June 19). Screening for Cervical Cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, 156(5). Available online at http://www.annals.org/content/early/2012/03/14/0003-4819-156-12-201206190-00424.full. Accessed 6/16/15.

    (Reviewed 2014 March 17). Cervical Cancer Prevention and Early Detection. American Cancer Society. Available online at http://www.cancer.org/acs/groups/cid/documents/webcontent/003167-pdf.pdf. Accessed 6/16/15.

    (Reviewed 2014 September 9). Pap and HPV Testing. National Cancer Institute. Available online at http://www.cancer.gov/types/cervical/pap-hpv-testing-fact-sheet. Accessed 6/16/15.

    Saslow, D. et al. (2012 March 14). American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Available online at http://onlinelibrary.wiley.com/doi/10.3322/caac.21139/full. Accessed 6/16/15.

    Barclay, L. (2015 January 9). New Guidance Recommends HPV DNA Test for Primary Screening. Medscape Medical News. Available online at http://www.medscape.com/viewarticle/837832. Accessed 6/16/15.

  • High Cholesterol

    Beginning in childhood, the waxy substance called cholesterol and other fatty substances known as lipids start to build up in the arteries, hardening into plaques that narrow the passageway. During adulthood, plaque buildup and resulting health problems occur not only in arteries supplying blood to the heart muscle but in arteries throughout the body (a problem known as atherosclerosis). For both men and women in the United States, the number one cause of death is heart disease, and the amount of cholesterol in the blood greatly affects a person's chances of suffering from it.

    Monitoring and maintaining healthy levels of cholesterol are important in staying healthy. Screening for high cholesterol, typically with a lipid profile, is important because there are usually no symptoms. A lipid profile usually includes total cholesterolHDL-cholesterolLDL-cholesterol, and triglycerides and sometimes non-HDL cholesterol. Typically, fasting for 9-12 hours (water only) before having blood drawn is required, but some labs offer non-fasting lipid testing. 

    Recommendations

    Since recommendations are not always consistent between healthcare organizations, it's important to work with your healthcare provider to develop a cholesterol-screening plan that is right for you.

    • The American Heart Association recommends that all adults 20 years of age and older have cholesterol testing (a fasting lipid profile) every 4-6 years. More frequent testing is recommended for those at increased risk.
    • The U.S. Preventive Services Task Force (USPSTF) advises healthcare practitioners and their patients to go beyond screening for high cholesterol and evaluate a person's overall risk for heart disease to determine who may benefit from treatment with statins.

      The USPSTF's 2016 guidelines do not recommend for or against cholesterol screening in people aged 21 to 39. This is based on a lack of evidence that screening before age 40 has an effect on cardiovascular health. The USPSTF recommends that clinicians use their judgment when deciding to screen people in this age group.

      For people aged 40 to 75 years, rather than screening, the USPSTF recommends assessing the individual's overall risk of heart disease and if they will benefit from statin treatment.

      The guidelines also note that statins may not be the answer for everyone with risk factors. Regardless of heart disease risk, everyone can benefit from lifestyle changes that reduce the chance of developing heart disease.

    Risk Factors

    Examples of risk factors include:

    • Family history of early heart disease (heart disease in a first degree male relative under age 55 or a first degree female relative under age 65)
    • Smoking cigarettes and using tobacco products
    • Diabetes or prediabetes
    • High blood pressure (hypertension) or you take blood pressure medications
    • Obesity or being overweight
    • Unhealthy diet
    • Physical inactivity, not getting enough exercise
    • Pre-existing heart disease or already having had a heart attack

    Links
    University of Maryland Heart Center: Heart Disease Risk Calculator
    National Heart, Lung, and Blood Institute: High Blood Cholesterol


    Sources Used in Current Review (last reviewed 7/12/17)

    (2008, June). Lipid disorders in adults (cholesterol, dyslipidemia): Screening. U.S. Preventive Services Task Force. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lipid-disorders-in-adults-cholesterol-dyslipidemia-screening. Accessed June 2017.

    (2016 February 9). High cholesterol, symptoms and causes. Mayo Clinic. Available online at http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/symptoms-causes/dxc-20181874. Accessed June 2017.

    (Reviewed 2016 June). Understand your risks to prevent a heart attack. American Heart Association. Available online at http://www.heart.org/HEARTORG/Conditions/HeartAttack/UnderstandYourRiskstoPreventaHeartAttack/Understand-Your-Risks-to-Prevent-a-Heart-Attack_UCM_002040_Article.jsp#.WUsh3hPyvR0. Accessed June 2017.

    (2016 November 15). Statin Use for the Primary Prevention of Cardiovascular Disease in Adults. US Preventive Services Task Force Recommendation Statement. JAMA 2016; 316(19):1997-2007. doi:10.1001/jama.2016.15450. Available online at http://jamanetwork.com/journals/jama/fullarticle/2584058. Accessed June 2017.

    (Reviewed 2017 April). How to get your cholesterol tested. American Heart Association. Available online at http://www.heart.org/HEARTORG/Conditions/Cholesterol/HowToGetYourCholesterolTested/How-To-Get-Your-Cholesterol-Tested_UCM_305595_Article.jsp#.WUrsWxPyvEY. Accessed June 2017.

    (Reviewed 2017 June). Heart-health screenings. American Heart Association. Available online http://www.heart.org/HEARTORG/Conditions/Heart-Health Screenings_UCM_428687_Article.jsp#.WUsaFxPyvR0. Accessed June 2017.

    Family History of Early Atherosclerotic Cardiovascular Disease. National Heart, Lung and Blood Institute. Available online at https://www.nhlbi.nih.gov/health-pro/guidelines/current/cardiovascular-health-pediatric-guidelines/full-report-chapter-4. Accessed June 2017.

  • Obesity

    More than one-third of adults in the U.S. are obese, according to the Centers for Disease Control and Prevention. Over the past 20 years, the rate of obesity has increased steadily throughout the U.S. in all age ranges and remains high.

    Obesity is a health concern because it increases the risk of many conditions, such as high blood pressure (hypertension), dyslipidemias (high cholesterol and/or high triglycerides), type 2 diabetes, coronary heart disease, stroke, and some cancers.

    Calculating a person's body mass index (BMI) can be useful for assessing their body fat. It is a screening tool for determining if someone has a weight problem. For adults, the following formula and classifications are used:

    BMI = (Weight in pounds) / (height in inches squared) x 703

        BMI   < 18.5                Underweight
        BMI  18.5-24.9            Normal weight
        BMI   25.0 – 29.9        Overweight
        BMI   30 and above    Obese

    Recommendations

    The U.S. Preventive Services Task Force (USPSTF) recommends that healthcare practitioners screen all adult patients for obesity, and the American Academy of Family Physicians agrees. In 2012, the USPSTF published an updated recommendation that clinicians offer or refer obese patients to intensive behavioral interventions, which can lead to weight loss, possibly improving glucose tolerance and other cardiovascular disease (CVD) risk factors. The Task Force is currently (2016) reviewing its recommendations.


    Links
    National Heart, Lung, and Blood Institute: Calculate Your Body Mass Index


    Sources Used in Current Review

    U.S. Preventive Services Task Force. Obesity in Adults: Screening and Management. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/obesity-in-adults-screening-and-management. Accessed October 2016.

    AAFP. Clinical Preventive Service Recommendation: Obesity. Available online at http://www.aafp.org/patient-care/clinical-recommendations/all/obesity.html. Accessed October 2016.

    Centers for Disease Control and Prevention. Adult Obesity Facts. Available online at https://www.cdc.gov/obesity/data/adult.html. Accessed October 2016.

  • Human Immunodeficiency Virus (HIV)

    HIV is the virus that causes AIDS (acquired immunodeficiency syndrome), a life-threatening disease. Initially, an HIV infection may cause no symptoms or cause non-specific, flu-like symptoms that resolve after a short time period. The only way to determine whether a person has been infected is through HIV testing.

    If the infection is not detected and treated, eventually symptoms of AIDS emerge and begin to progressively worsen. Without treatment, HIV destroys the immune system over time and leaves a person's body vulnerable to debilitating infections.

    HIV is spread in the following ways:

    • By having sex with an infected partner
    • By sharing needles or syringes (such as with intravenous injection drug abuse)
    • During pregnancy or birth; if a pregnant woman is infected with HIV, the virus can be passed to and infect her developing baby.
    • Through contact with infected blood
    • In the U.S. today, because of screening blood for transfusion and heat-treating techniques and other treatments of blood derivatives, the risk of getting HIV from transfusions is extremely small. However, before donated blood was screened beginning in 1985 in the U.S. and before treatments were introduced to destroy HIV in some blood products, such as factor 8 and albumin, HIV was transmitted through transfusion of contaminated blood or blood components.

    Why Get Screening?
    Screening for HIV is now part of routine healthcare in the United States and is an important part of wellness and prevention. This is because diagnosis early in the course of infection leads to timely, effective treatment that decreases the risk of progression to AIDS. A major National Institutes of Health (NIH) clinical trial published in 2015 found that individuals with HIV have a lower risk of developing AIDS and other serious illnesses if they start antiretroviral therapy sooner rather than later.

    Early diagnosis also has important benefits for others and society at large. Thousands of people are diagnosed with HIV each year, and about 1 in 8 people in the United States with HIV are unaware that they have it. An individual can prevent further disease spread by learning their status, modifying behavior and not exposing others to infected blood or body fluids. Pregnant women who have HIV can start treatment to prevent spreading the disease to their children.

    If an HIV screening test shows a person is not infected, he or she can take steps to avoid infection. For individuals who are HIV-negative but at high risk for HIV, the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommend that they consider taking pre-exposure prophylaxis (PrEP), a daily pill to help prevent infection. For people taking PrEP consistently, the risk of HIV infection is significantly lower compared to those who did not take it.

    Know Your Risk
    Several situations put you at high risk of contracting HIV:

    • You've had unprotected sex with more than one partner.
    • You have or have had a sexually transmitted disease (STD), which appears to make people more susceptible to and at higher risk for acquiring HIV infection during sex with infected partners.
    • You're a man who has had sexual contact with another man.
    • You have exchanged sex for money or drugs or had anonymous sex.
    • You use or used injection drugs and are likely to have shared unsterilized needles.
    • You have an HIV-positive sexual partner.
    • You have had sex with anyone who falls into one of the categories listed above or are uncertain about your sexual partner's risk behaviors.
    • You've been diagnosed with or treated for hepatitis or tuberculosis (TB).

    How often you are tested should depend on your risk, activities, and sexual contacts. For example, during a long-term, truly monogamous sexual relationship, you may want just one test. However, if you or your partner have had sexual contact with more than one person in recent months, your risk of infection is greater. If you or a person with whom you've had sexual contact (even unwanted sexual contact) engaged in some risky behavior, you have even more reason to be tested.

    Screening Tests
    Different types of tests are available for HIV screening:

    • Combination HIV antibody and HIV antigen test—this is the recommended screening test for HIV. It is available only as a blood test. It detects the HIV antigen called p24 plus antibodies to HIV-1 and HIV-2. (HIV-1 is the most common type found in the United States, while HIV-2 has a higher prevalence in parts of Africa.) By detecting both antibody and antigen, the combination test increases the likelihood that an infection is detected soon after exposure. These tests can detect HIV infections in most people by 2-6 weeks after exposure.
    • HIV antibody testing—all HIV antibody tests used in the U.S. detect HIV-1, and some tests have been developed that can also detect HIV-2. These tests are available as blood tests or tests of oral fluid. HIV antibody tests can detect infections in most people 3-12 weeks after exposure.

    Various options are available for getting tested:

    • A blood or oral sample can be collected in a healthcare provider's office or a local clinic and sent to a laboratory for testing. In these same settings, a rapid test may available in which results are generated in about 20 minutes.
    • A home collection kit approved by the U.S. Food and Drug Administration (FDA) is available for HIV antibody testing. This allows a person to take a sample at home and then mail it to a testing center. Results are available over the phone, along with appropriate counseling.
    • The FDA has approved an HIV test for home use. The testing kit is the same as that used in many healthcare providers' offices and clinics in which an oral sample is collected for testing and results are available in about 20 minutes. Though the home test is convenient, it has limitations. It is less sensitive than a blood test so the home test may miss some cases of HIV that a blood test would detect and it is not as accurate when it is performed at home by a lay person compared to when it is performed by a trained healthcare professional. Care must be taken to avoid errors when performing the test. (For more, see the article on Home Testing, Avoiding Errors.)

    Screening tests have limitations, so it is important to remember that:

    • A negative screening test means only that there is no evidence of disease at the time of the test. If you have increased risk of HIV infection but negative screening results, it is very important to get screening tests on a regular basis.
    • HIV tests will not detect the virus immediately after infection. Still, talk to your healthcare provider immediately if you think you’ve been infected. If exposure to the virus is recent, then antibody levels may be too low to detect. If an initial test is negative, it may be necessary to repeat testing at a later time with another antibody test or combination HIV antibody/antigen test. In the case of a negative result, the CDC recommends retesting three months after likely exposure.
    • A positive screening test is not a diagnosis. A positive result must be followed by a second antibody test that differentiates between HIV-1 and HIV-2 to establish a diagnosis.

    For more details on HIV screening, see the article on HIV Antibody and p24 Antigen.

    Screening Recommendations

    • The Centers for Disease Control and Prevention (CDC) recommends that everyone 13 to 64 years old have an HIV screening test at least once. The CDC recommends getting tested each year if you've engaged in an activity that can put you at increased risk of infection and spreading the disease. Additionally, men who have sexual contact with other men should be tested be tested every three to six months.
    • The United States Preventive Services Task Force (USPSTF) recommends that all teens and adults ages 15 to 65 be screened for HIV infection. It also recommends that younger adolescents and older adults at increased risk undergo screening for HIV. As for how often, the Task Force says a reasonable approach is one-time testing for all people ages 15 to 65 and at least annual screenings for those at very high risk of HIV, such as men who have sex with men, injection drug users, and those who live or receive medical care in areas where the rate of HIV infection is high. Individuals at increased but not very high risk may be screened less frequently than every year. The USPSTF recommends every three to five years as a guideline. The Task Force points out that risk is "on a continuum" and health professionals should use their own discretion in deciding how frequently to test people for HIV.
    • The American College of Physicians agrees with the CDC that everyone aged 13 to 64 be offered an HIV screening test in healthcare settings. It also recommends that healthcare practitioners should determine the frequency of repeat screening on an individual basis.
    • The American Academy of Pediatrics (AAP) recommends targeted HIV screening for all sexually active youth. In addition, the academy advises routine testing starting at age 16 for all teens who live in areas where prevalence is high; that is, where more than 1 in 1,000 individuals are infected.
    • For recommendations specific for pregnant women, see the article on Pregnancy.

    Aside from these recommendations, certain individuals should get tested and learn their status. These include:

    • People diagnosed with hepatitis, TB, or an STD
    • People who received a blood transfusion prior to 1985 or had a sexual partner who received a transfusion and later tested positive for HIV
    • A healthcare worker with direct exposure to blood on the job
    • Any individual who thinks he or she may have been exposed

    Talk to your healthcare provider
    Don't be surprised if a healthcare practitioner, in any care setting, offers you an HIV screening test, in keeping with CDC recommendations. If your healthcare provider does not bring up sexual health topics, you can simply ask for a test or a risk assessment. You can also use confidential services to obtain testing or counseling.


    Resources & Links

    For confidential information, you can call the STDs and HIV/AIDS hotline of the CDC: 800-CDC-INFO (232-4636).
    To find a testing site near you, visit National HIV and STD Testing Resources
    KidsHealth.org: HIV and AIDS
    MedlinePlus: Screening and diagnosis for HIV
    Mayo Clinic: HIV/AIDS - Preparing for your appointment
    AIDSinfo: HIV Testing


    Sources Used in Current Review

    Qaseem, A. et al. (2009 January 20). Screening for HIV in health care settings: A guidance statement from the American College of Physicians and HIV Medicine Association. Annals of Internal Medicine. Available online at http://annals.org/aim/article/744218/screening-hiv-health-care-settings-guidance-statement-from-american-college. Accessed 11/6/2016.

    (2011 October 31). The pediatrician's role in preventing HIV infection. American Academy of Pediatrics. Available online at https://healthychildren.org/English/news/Pages/The-Pediatricians-Role-in-Preventing-HIV-Infection.aspx. Accessed 11/6/2016.

    (2013 April). Human Immunodeficiency Virus (HIV) infection: Screening. U.S. Preventive Services Task Force. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/human-immunodeficiency-virus-hiv-infection-screening. Accessed 11/6/2016.

    (2015 May 27). Press release: Starting antiretroviral treatment early improves outcomes for HIV-infected individuals. National Institutes of Health. Available online at https://www.nih.gov/news-events/news-releases/starting-antiretroviral-treatment-early-improves-outcomes-hiv-infected-individuals. Accessed 11/6/2016.

    (Updated 2016 January 22). Working in healthcare and HIV. AVERT. Available online at http://www.avert.org/hiv-transmission-prevention/working-healthcare. Accessed 11/6/2016.

    (2016 May 23). Recommendations for HIV prevention with adults and adolescents with HIV. Centers for Disease Control and Prevention. Available online at http://www.cdc.gov/hiv/guidelines/personswithhiv.html. Accessed 11/6/2016.

    (2016 October 27). HIV and AIDS: Testing. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/hiv/basics/testing.html. Accessed 11/6/2016.

    (2016 June 20). HIV testing. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/hiv/testing. Accessed 11/6/2016.

  • Chlamydia and Gonorrhea

    Chlamydia and gonorrhea are the most common bacterial sexually transmitted diseases (STDs) in the United States today, but many infected people have no symptoms. These infections usually affect the genitals but may also cause infections of other mucous membranes, eyes, or joints. Pregnant women may transmit the infections to their newborns. Often progressing silently, these diseases can cause infertility and other health complications if left untreated. However, both diseases can be cured with antibiotics. 

    While rates of chlamydia and gonorrhea are highest in younger people, any sexually active person can get a chlamydia or gonorrhea infection. Many people have both chlamydia and gonorrhea infections at the same time.

    Recommendations for Women

    • The U.S. Centers for Disease Control and Prevention (CDC), the U.S. Preventive Services Task Force (USPSTF), the American Academy of Family of Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG) recommend chlamydia screening for all sexually active adult women who have risk factors, such as a new or multiple sex partners. The CDC specifically recommends annual screening.
    • The CDC, USPSTF, AAFP, and ACOG suggest gonorrhea screening for all sexually active adult women at increased risk.

    For screening recommendations during pregnancy, see Pregnancy & Prenatal Testing.

    Recommendations for Men

    These organizations do not recommend routine screening for healthy, sexually active, heterosexual men. Health care providers may, however, use their judgment and consider risks, such as prevalence in the community. It is important to remember that an infected male can spread these diseases and even re-infect a partner if he does not complete treatment.

    • For sexually active males who have sex with other males, the CDC recommends chlamydia and gonorrhea screening at least annually.

    Risk

    You are at risk of contracting chlamydia and gonorrhea if you:

    • Have had one or both of these infections before
    • Have other STDs, especially HIV
    • Have new or multiple sex partners
    • Use condoms inconsistently
    • Exchange sex for money or drugs
    • Use illegal drugs
    • Live in a detention facility
    • Are a man who has sex with other men

    Because reinfection rates are high, the CDC recommends that both women and men who are treated for chlamydia or gonorrhea infection be retested approximately 3 months after treatment or at their next health care visit, regardless of whether they believe that their sex partners were treated. It is important to continue annual screening for these diseases because reinfection is always possible.


    Links
    CDC: Chlamydia 
    CDC: Gonorrhea 


    Sources Used in Current Review

    United States Preventive Service Task Force. USPSTF Recommendations for STI Screening. Available online at http://www.uspreventiveservicestaskforce.org/uspstf08/methods/stinfections.htm through http://www.uspreventiveservicestaskforce.org. Last updated March 2008. Accessed May 24, 2012.

    Kimberly A. Workowski and Stuart Berman. Sexually Transmitted Diseases Guidelines, 2010. Morbidity and Mortality Weekly Report. PDF available for download at http://www.cdc.gov/std/treatment/2010/STD-Treatment-2010-RR5912.pdf through http://www.cdc.gov. Published December 27, 2010. Accessed March 24, 2012.

    U.S. Centers for Disease Control and Prevention. Chlamydia and Gonorrhea — Two Most Commonly Reported Infectious Diseases in the United States. Available online at http://www.cdc.gov/Features/dsSTDData/ through http://www.cdc.gov. Last reviewed April 22, 2011. Accessed May 23, 2011.

    U.S. Centers for Disease Control and Prevention. STD Prevention Conference 2012. Available online at http://www.cdc.gov/nchhstp/newsroom/stdconference2012summaries.html through http://www.cdc.gov. Last reviewed March 14, 2012. Accessed May 23, 2012.

    American College of Obstetricians and Gynecologists. Well-Woman Care: Assessments and Recommendations. Available online through http://www.acog.org/. Issued March 29, 2012. Accessed June 1, 2012.

    American Academy of Family Physicians. Gonorrhea. Available online at http://www.aafp.org/online/en/home/clinical/exam/gonorrhea.html through http://www.aafp.org. Accessed June 4, 2012.

    American Academy of Family Physicians. Chlamydia. Available online at http://www.aafp.org/online/en/home/clinical/exam/chlamydia.html through http://www.aafp.org. Accessed June 4, 2012.

    U.S. Centers for Disease Control and Prevention. 2010 Treatment Guidelines, Special Populations. Available online at http://www.cdc.gov/std/treatment/2010/specialpops.htm#msm through http://www.cdc.gov. Accessed June 2012.

    U.S. Centers for Disease Control and Prevention. Chlamydial Infections - 2010 Treatment Guidelines. Available online at http://www.cdc.gov/std/treatment/2010/chlamydial-infections.htm through http://www.cdc.gov. Accessed June 2012. 

    Screening for Gonorrhea: Recommendation Statement. Annals of Family Medicine 2005 May; 3(3): 263–267. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466867/#r7 through http://www.ncbi.nlm.nih.gov. Accessed June 2012. 

  • Colorectal Cancer

    Colorectal cancer is the third most common non-skin cancer in adults and the second leading cause of cancer deaths in men and women in the United States. Cancer of the colon and rectum is both preventable and treatable if detected early. Studies show that regular screening could prevent one-third of colorectal cancer deaths in the U.S. The five-year survival rate is 90% if detected early.

    Screening tests that look for and remove polyps and lesions in the colon can prevent colorectal cancer. These are found most often in people 50 years of age and older, so experts do not recommend universal screening of average risk people until the age of 50. However, if you have one or more risk factors for colon cancer, described below, you should talk to your healthcare provider. He or she can help you assess your individual risk factors and determine if you should begin screening before age 50 and what tests are appropriate based on your risks. As the Centers for Disease Control and Prevention (CDC) notes, any of the recommended tests is better than no test.

    Risk

    Earlier, more frequent screening is appropriate at a younger age, often beginning at age 40, if you have certain risk factors and fall into the categories for increased or high risk. Screening can begin even earlier in some cases.

    • Increased risk:
      • If you have a family history of colorectal cancer or adenomatous polyps, a specific type of polyp associated with higher risk of colorectal cancer, you are at increased risk and may need earlier screening. Most of these cancers occur in people without a family history of colorectal cancer. Still, as many as 1 in 5 people who develop colorectal cancer have other family members who have been affected by this disease.

        Specifically, if you have a first-degree relative (parents, siblings or children) who had colorectal cancer or adenomatous polyps before age 60, or two or more first-degree relatives who had either of these findings at any age, you have increased risk for colorectal cancer. The risk is about doubled in those with one affected first-degree relative. It is even higher if the first-degree relative is diagnosed at a young age, or if more than one first-degree relative is affected.

      • You may also be at increased risk for colorectal cancer if you have been diagnosed with colon cancer in the past or if you have had a history of polyps on a prior colonoscopy.
      • Race and ethnicity can increase risk. African Americans have the highest incidence of colorectal cancer and Ashkenazi Jews have the highest risk of developing colorectal cancer.
    • High risk: You are at high risk for colorectal cancer if you have inflammatory bowel disease, including chronic ulcerative colitis or Crohns disease. If you have a genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (HNPCC), or if you are at an increased risk of HNPCC based on your family history, you are also in the high-risk category.

    Types of Tests Used for Screening

    • A colonoscopy is usually recommended for people who are at intermediate or high risk of colorectal cancer and require screening before the age of 50. The procedure uses a probing scope and a video camera to view the entire length of the colon. This allows any polyps or other suspicious tissue to be removed and tested for the presence of cancer. Though the most costly and invasive, colonoscopy is the most accurate and thorough test and is especially appropriate for those with risk factors.

    Other types of screening tests may be options for people who are considered to be similar to those of average risk. This may include, for example, people with a first degree relative who had colon cancer after the age of 60.

    Some of these testing options include laboratory tests performed on stool samples that mainly detect existing cancers:

    If the findings on one of these are abnormal, you will need a colonoscopy.

    Besides colonoscopy, other imaging procedures may be used for screening.

    • Flexible sigmoidoscopy is similar to colonoscopy in that it uses use a probing scope and a video camera, but it uses a shorter probe that views the entire rectum and only the lower third of the colon. This approach is also able to remove any polyps that are found and allows for them to be tested for the presence of cancer cells.
    • Two other procedures use X-rays; however, these approaches only allow visualization of polyps. Removal of the polyps would require a follow-up colonoscopy or flexible sigmoidoscopy:
      • Virtual colonoscopy (computed tomography (CT) colonograph) combines many cross-sectional images into 2-D and 3-D views of the colon. This procedure is less invasive and does not require sedation, thus may be appropriate for those who cannot tolerate a colonoscopy.
      • Double-contrast barium enema (DCBE), also known as air-contrast barium enema or lower GI series, provides X-ray views of lumps, polyps, and/or other abnormalities in the outline of the colon.

    Stool sample testing and sigmoidoscopy are easier than colonoscopy but not as accurate. Stool testing and sigmoidoscopy are best used in conjunction with each other.

    Recommendations

    Several health organizations have colon cancer screening recommendations. While they may differ on which tests to use and how often, they each support screening for colon cancer. In March 2008, screening guidelines for the early detection of pre-cancerous polyps and colon cancer were released jointly by the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Similar guidelines have also been proposed by the U.S. Preventive Services Task Force (USPSTF) and the American College of Gastroenterology. These comprehensive screening guidelines include people who are at increased risk for colorectal cancer, thus candidates for screening before age 50. If you are at increased or high risk for colorectal cancer, your healthcare provider can help you assess the best combination(s) of preventive tests and how frequently you should have them.

    The guidelines suggest:

    • If you have a family history of colorectal cancer or adenomatous polyps in any first-degree relative diagnosed before the age of 60, or in at least two second-degree relatives at any age, they recommend screening to begin at age 40 or 10 years before the youngest case in the immediate family; if after the age of 60, then options are the same as those offered to someone of average risk.
    • Inflammatory bowel disease: the guidelines recommend that screening begin 8 years after the onset of the disease.
    • Hereditary non-polyposis colon cancer (HNPCC): the guidelines recommend that screening begin when you are 20 to 25 years old, or 10 years before the youngest case in the immediate family.
    • Familial adenomatous polyposis (FAP) diagnosed by genetic testing, or suspected FAP without genetic testing: ACS recommends that screening begin at 10 to 12 years of age.
    • People of African descent should begin testing at age 45. However, the USPSTF states that its recommendations for average risk individuals are intended to apply to all ethnic and racial groups.

    Decision Aids

    Because any invasive procedure carries some level of risk, you should talk to your healthcare provider about the screening tests recommended for you. Some employers, health plans, and health practitioners offer decision aids.

    Also, don't neglect the protection of getting re-tested at the interval recommended by your healthcare provider.


    Links
    MyBiopsy.org: Colon, Adenomatous polyps
    National Cancer Institute: Colorectal Cancer Risk Assessment Tool
    Centers for Disease Control and Prevention: Colorectal (Colon) Cancer


    Sources Used in Current Review

    American Cancer Society recommendations for colorectal cancer early detection. American Cancer Society. Available online through http://www.cancer.org/index. Accessed February 2015.

    Final Recommendation Statement Colorectal Cancer Screening. U.S. Preventive Services Task Force. Available online at http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectal-cancer-screening through http://www.uspreventiveservicestaskforce.org. Accessed February 2015.

    Tests to Detect Colorectal Cancer and Polyps. National Cancer Institute. Available online at http://www.cancer.gov/cancertopics/factsheet/detection/colorectal-screening through http://www.cancer.gov. Accessed February 2015.

    (February 26, 2014) Centers for Disease Control and Prevention. Colorectal (Colon) Cancer: What are the Risk Factors? Available online at http://www.cdc.gov/cancer/colorectal/basic_info/risk_factors.htm through http://www.cdc.gov. Accessed January 2015.

    (Published online 2008 February 13). Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline From the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. American Gastroenterology Association [On-line information]. Available online at http://www.gastrojournal.org/article/S0016-5085%2808%2900232-1/fulltext through http://www.gastro.org/practice/medical-position-statements. Accessed February 2015.

  • Diabetes

    Diabetes is the seventh leading cause of death in the United States. The Centers for Disease Control and Prevention (CDC) estimates that 30.2 million people age 18 and older, or 12.2% of all people in this age group, have diagnosed or undiagnosed diabetes. Of these, 4.6 million are 18-44 and 14.3 million are 45-64 years old. Type 2 diabetes accounts for 90-95% of all diagnosed cases of diabetes among adults. Unhealthy weight and physical inactivity, also significant national health problems, are both contributing factors to the rising incidence of type 2 diabetes.

    Another 84.1 million American adults age 18 years or older have prediabetes, meaning that their blood glucose levels are higher than normal but not yet high enough to be diagnosed with diabetes. Detecting prediabetes allows individuals to take steps to stop or slow the development of type 2 diabetes and its complications. These complications include heart attack, stroke, hypertension, blindness and eye problems, kidney disease, and nervous system maladies. More than 60% of lower limb amputations occur in people with diabetes.

    Risk Factors
    Being overweight – having a body mass index (BMI) equal to or greater than 25 kg/m2 – is a major risk factor for type 2 diabetes.

    Other risk factors related to your own health include:

    • Physical inactivity
    • Having high blood pressure (hypertension), meaning blood pressure 140/90 mmHg or higher or receiving therapy for hypertension
    • History of cardiovascular disease
    • Having a HDL-cholesterol level less than 40 mg/dL (1.00 mmol/L) and/or a triglyceride level greater than 150 mg/dL (1.70 mmol/L)
    • Having a previous hemoglobin A1c test result equal to or greater than 5.7%, impaired glucose tolerance (glucose tolerance test result 140 to 199 mg/dL (7.8 to 11.1 mmol/L)), or impaired fasting glucose (fasting glucose level 100 to 125 mg/dL (5.6 to 6.9 mmol/L))
    • Having conditions associated with insulin resistance, such as severe obesity and acanthosis nigracans

    Family-related risk factors are:

    • Having a parent or sibling with diabetes
    • Being of African American, Latino, Native American, Asian American, or Pacific Islander descent

    Women's risk factors include:

    Screening tests for men and non-pregnant women

    • Fasting glucose (fasting blood glucose, FBG) – this test measures the level of glucose in the blood after an 8-12 hour fast.
    • Hemoglobin A1c (also called A1c or glycated hemoglobin) – this test evaluates the average amount of glucose in the blood over the last 2 to 3 months and has been recommended as another test to screen for diabetes.
    • 2-hour glucose tolerance test (OGTT) – this test involves drawing a fasting blood sample for glucose measurement, followed by having the person drink a solution containing 75 grams of glucose and then drawing another sample two hours after the person begins to consume the glucose solution.

    If any of these results is abnormal, the test is repeated on another day. If the repeat result is also abnormal, a diagnosis of diabetes is made.

    Recommendations
    The American Diabetes Association (ADA) and the U.S. Preventive Services Task Force (USPSTF) recommend the following:

    • If you are age 45 or older, you should be screened.
    • If you are younger than 45 but overweight or have any of the other risk factors, consider diabetes screening.
    • Even if initial screening results are normal, get repeat testing at least every 3 years, say the ADA and USPSTF. If you are identified as having prediabetes, get tested yearly.

    The American Association of Clinical Endocrinologists (AACE) also recommends diabetes screening for asymptomatic people with these risk factors, as well as those on antipsychotic therapy for schizophrenia or who have severe bipolar disease.

    As public health experts work to educate Americans on what to do to avoid diabetes and its serious complications, be aware that healthy eating habits and activity choices can lower your risk of developing type 2 diabetes and of suffering complications from the disease.


    Links
    NIDDK: Preventing Type 2 Diabetes
    American Diabetes Association
    National Diabetes Education Program 
    Centers for Disease Control and Prevention: Type 1 or Type 2 Diabetes and Pregnancy 


    Sources Used in Current Review (last reviewed 9/18/17)

    (2017). National diabetes Statistics Report, 2017. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed on 8/06/17.

    (2015 October). Abnormal Blood Glucose and Type 2 Diabetes Mellitis: Screening. U.S. Preventive Services Task Force. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/screening-for-abnormal-blood-glucose-and-type-2-diabetes?ds=1&s=diabetes. Accessed on 8/06/17.

    (2017 July 27, Updated). What’s New in Diabetes. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/diabetes/new/index.html. Accessed on 8/06/17.

    (2017 July 25, Updated). Who’s at Risk? Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/diabetes/basics/risk-factors.html. Accessed on 8/06/17.

    Genzen, J. et. al. (2017 July, Updated). Diabetes Mellitus. ARUP Consult. Available online at https://arupconsult.com/content/diabetes-mellitus. Accessed on 8/06/17.

    (2016 November). Diabetes Tests & Diagnosis. National Institute of Diabetes and Digestive and Kidney Diseases. Available online at https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis. Accessed on 8/06/17.

    (2015). Screening and Monitoring of Prediabetes. American Association of Clinical Endocrinologists. Available online at http://outpatient.aace.com/prediabetes/screening-and-monitoring-prediabetes. Accessed on 8/06/17.

    Diabetes Management Guidelines, American Diabetes Association (ADA) 2016 Guidelines. National Diabetes Education Initiative. Available online at http://www.ndei.org/ADA-2013-Guidelines-Criteria-Diabetes-Diagnosis.aspx.html#children. Accessed on 8/06/17.

  • Prostate Cancer

    Prostate cancer is the most frequently diagnosed cancer in men, after skin cancer, and the second leading cause of cancer death, after lung cancer. As many as 1 in 7 American men will develop it during their lifetime, with most cases diagnosed in men 65 years of age or older. Some prostate cancers progress quickly and cause death within months or a few years, but most grow slowly and never pose a health threat.

    Screening for prostate cancer is important for men to discuss with their healthcare providers. Many complicated issues are involved:

    • Current technology cannot tell a slow-growing cancer from a fast one, and the cancer may never affect a man's health or life expectancy.
    • Screening tests for prostate-specific antigen (PSA) do not detect all cases, and many positive PSA results do not prove to be cancer.
    • Diagnosis through biopsy (potential infection and bleeding) and side effects of treatment (impotence and incontinence) can be more harmful than the cancer itself. Most prostate cancers are slow-growing and may not cause any trouble.
    • Results from long-term trials on whether PSA testing improves prostate cancer survival rates have been inconclusive.

    Informed decisions
    In spite of the questions surrounding prostate cancer screening, most health organizations agree that men should receive balanced information about prostate cancer screening and recommend that men discuss it with their healthcare provider. You need to know the risks, uncertainties, benefits, and limits of prostate cancer testing and treatment and should work with your healthcare provider to understand your options and decide what is best for you. Before choosing prostate screening, you should weigh the pros and cons based on your age, life expectancy, family history, race, overall health, previous test results, and individual risk tolerance.

    Risk
    One important factor to consider is your personal risk of developing prostate cancer:

    • Average risk: Healthy men with no known risk factors
    • Increased risk: African American men or men who have a father or brother who was diagnosed before they were 65
    • High risk: Men with more than one relative who was affected at a young age

    Tests
    If you choose to undergo screening, the following tests may be recommended:

    Recommendations
    Most organizations do not recommend prostate cancer screening for men 49 and younger, unless they have increased or high risk. The exception is the National Comprehensive Cancer Network.

    • The National Comprehensive Cancer Network recommends a baseline test at age 45 for men who want screening, which will determine when and how often to have future tests. It advises using the DRE and the PSA test, in combination, for the broadest detection of cancer in its early stages. If the result is greater than 1.0 ng/mL, or the man is higher risk, it recommends an annual DRE and PSA test.
    • The U.S. Preventive Services Task Force (USPSTF) advises against PSA screening in men of any age, concluding that screening does not improve survival rates for prostate cancer for healthy men. The decision is based on the harm that can come from diagnoses that lead to false-positive test results or harm from the treatment of cases that are slow-growing and non-lethal.
    • The American Cancer Society (ACS) recommends that healthy men with average risk who wish to be screened consider waiting to get tested until age 50. The ACS recommends considering earlier testing for higher-risk groups.
      • If you are African American or have a father or brother who was diagnosed before they were 65, the ACS recommends considering starting testing at 45 years of age.
      • If more than one relative was affected at a young age, you could begin testing at 40 years; then, depending on the results, get tested again at age 45 or earlier as results warrant.

    The ACS recommends re-screening every two years if your PSA level is less than 2.5 ng/mL and annual screening if it is 2.5 ng/mL or higher.

    • The American Urological Association recommends waiting to have a baseline PSA and DRE done at age 55 for men who wish to be screened. For those at increased or high risk, the group advises that decisions regarding prostate cancer screening be individualized based on patient preferences and an informed discussion about benefits and harms.
    • The American College of Physicians advises screening men 50-69 years old who request to be screened.

    Links
    National Cancer Institute: Prostate Specific Antigen Test Fact Sheet
    National Cancer Institute: Screening and Testing to Detect Prostate Cancer
    American Cancer Society: Prostate Cancer, Should I be tested?
    Ottawa Health Research Institute: Decision Aids


    Sources Used in Current Review

    Brosman, S. (2015 January 13, Updated). Prostate-Specific Antigen Testing. Medscape Drugs & Diseases [On-line information]. Available online at http://emedicine.medscape.com/article/457394-overview. Accessed 06/15/15.

    (2015 January 6, Revised). Prostate Cancer Prevention and Early Detection. American Cancer Society [On-line information]. Available online at http://www.cancer.org/cancer/prostatecancer/moreinformation/prostatecancerearlydetection/prostate-cancer-early-detection-tests. Accessed 06/15/15.

    Mayo Clinic Staff (2013 May 7). Mayo Clinic. [On-line information]. Available online at http://www.mayoclinic.org/tests-procedures/psa-test/basics/definition/prc-20013324?p=1. Accessed 06/15/15.

    Miller, S. (2013 October 2, Updated). Prostate-specific antigen (PSA) blood test. MedlinePlus Medical Encyclopedia. [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003346.htm. Accessed 06/15/15.

    Moyer, V. (2012 July 17). Screening for Prostate Cancer: U.S. Preventive Services Task Force. USPSTF Recommendation Statement. Annals of Internal Medicine v 157 (2) 121. [On-line information]. Available online at http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/prostate-cancer-screening?ds=1&s=PSA. Accessed 06/15/15.

    Genzen, J. et. al. (2015 March, Updated). Prostate Cancer - PSA. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/PSA.html?client_ID=LTD. Accessed 06/15/15.

    Pagana, K. D., Pagana, T. J., and Pagana, T. N. (© 2015). Mosby's Diagnostic & Laboratory Test Reference 12th Edition: Mosby, Inc., Saint Louis, MO. Pp 756-759.

    (2015 March 12 Revised). What are the key statistics about prostate cancer? American Cancer Society [On-line information]. Available online at http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics. Accessed 9/29/15.

    Mulcahy, N. (2014 March 19). New NCCN Guide Seeks 'Middle Ground' on PSA Testing. Medscape Medical News [On-line information]. Available online at http://www.medscape.com/viewarticle/822185. Accessed 9/29/15/.

  • Tuberculosis

    Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria. TB primarily targets the lungs but may affect any area of the body. It can be spread through the air from person to person through droplets of respiratory secretions such as sputum or aerosols released by coughing, sneezing, laughing, or breathing.

    Most people who become infected with M. tuberculosis manage to confine the mycobacteria to a few cells in their lungs, where they stay alive but in an inactive form. This latent TB infection does not make the person sick or infectious and, in most cases, it does not progress to active tuberculosis. However, some people - especially those with compromised immune systems - may progress directly from initial TB infection to active tuberculosis. People who have HIV are much more likely to become sick if they contract TB. A person who has latent TB and their immune system becomes weakened may then develop active TB. Another increasing concern is drug-resistant forms of TB that are resistant to the antibiotics typically prescribed to treat the disease.

    TB is one of the world's deadliest diseases, although it is relatively uncommon in the U.S. Still, it is a large health issue among at-risk groups. Current guidelines call for targeted screening among such groups.

    At Risk

    • People who have close contact with a person who has known or suspected TB disease
    • People with weakened immune systems such as resulting from HIV infection, malnutrition, advanced age, or substance abuse including alcohol and drugs
    • Immigrants from countries with a high rate of TB disease (many countries in Latin America, Africa, Asia, Eastern Europe, and Russia)
    • Medically underserved people, such as those from a low-income environment
    • Residents of long-term care facilities (such as nursing homes, mental health facilities, prisons, AIDS care facilities, and homeless shelters)
    • People who live in unclean or crowded environments and/or without a healthy diet
    • Healthcare workers who work in any of the above situations or with patients who are at increased risk
    • Laboratorians who work with specimens that may contain TB or with TB cultures

    Recommendations

    The U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF) recommend use of TB tests to identify people who will likely benefit from treatment, including those at increased risk for M. tuberculosis infection or for progression to active TB if they are infected. There are two types of tests that might be performed (see TB Screening Tests):

    • Tuberculin skin test (TST) also called the Mantoux tuberculin skin test, the TST (or PPD for Purified Protein Derivative) is performed by injecting a small amount of fluid (called tuberculin) into the skin in the lower part of the arm. Following this test, you must return within 48 to 72 hours for a trained healthcare worker to measure the reaction and determine if it indicates exposure to M. tuberculosis.
    • TB blood test: also known as IGRA (Interferon gamma release assay); requires a blood sample to be drawn.

    Your healthcare provider will choose which TB test to use. Factors in selecting the test include the reason for testing, logistical considerations, prior vaccination with BCG, and test availability. Generally, it is recommended to be screened with either a TST or an IGRA, but not both.


    Link
    CDC: Tuberculosis (TB)


    Sources Used in Current Review

    Screening for Latent Tuberculosis Infection in Adults. US Preventive Services Task Force Recommendation Statement. JAMA. 2016;316(9):962-969. doi:10.1001/jama.2016.11046. Available online at http://jama.jamanetwork.com/article.aspx?articleid=2547762. Accessed October 2016.

    U.S. Centers for Disease Control and Prevention. TB Testing & Diagnosis. Available online at http://www.cdc.gov/tb/topic/testing/. Accessed October 2016.

  • Hepatitis B

    According to the United States Preventive Services Task Force (USPSTF), approximately 700,000 to 2.2 million people in this country have chronic infection with hepatitis B virus (HBV). Many of these people are unaware that they are infected.

    HBV is one of five "hepatitis viruses" identified so far that are known to mainly infect the liver. It is spread through contact with blood or other body fluids from an infected person, such as during sex or by sharing needles, razors or toothbrushes, and can also be passed from an infected mother to her baby during or after birth.

    HBV infection can be acute or chronic, with the course of infection varying from a mild form that lasts only a few weeks to a more serious form lasting years that can lead to complications such as cirrhosis or liver cancer. According to the Centers for Disease Control and Prevention (CDC), approximately 2,000-4,000 people die every year in the U.S. from HBV-related liver disease.

    The vast majority of those with chronic infections will have no symptoms. A test for hepatitis B surface antigen (HBsAg) may be used for screening asymptomatic people who fall into one of the high-risk categories for chronic HBV. Effective vaccines against HBV are available; however, those who have not been vaccinated or who are at high risk and were vaccinated before being screened for HBV infection may want to consider getting tested.

    Risk
    According to the USPSTF, in the U.S., people considered at high risk for HBV infection include those from countries with a high prevalence of HBV infection, those who are HIV-positive, injection drug users, household contacts of those with HBV infection, and men who have sex with men. Since the prevalence of HBV infection is low in the general U.S. population and most of those infected do not develop complications, HBV screening is not recommended for those who are not at increased risk.

    Recommendations
    In 2008, the CDC revised its guidelines to recommend that the following groups be screened for HBV:

    • Healthcare and public safety workers
    • People born in areas of the world that have a greater than 2% prevalence of HBV (for example, much of Asia and Africa)
    • People born in the U.S. but who were not vaccinated and whose parents are from an area with greater than 8% prevalence of HBV
    • Men who have sex with men
    • People who have elevated liver enzymes (ALT and AST) with no known cause
    • People with certain medical conditions that require that their immune system be suppressed, such as organ transplant recipients
    • Pregnant women
    • People who are in close contact with someone infected with HBV
    • Those infected with HIV

    In 2014, the USPSTF updated its statement to recommend screening for HBV among asymptomatic, non-pregnant adolescents and adults in certain high-risk groups, bringing their recommendations into line with those of the CDC. The USPSTF had previously published the recommendation for HBV screening during pregnancy.

    Why get tested?
    People with chronic HBV can unwittingly spread the infection to others and remain at risk for serious complications of the infection.


    Link
    CDC: Hepatitis B Information for the Public 


    Sources Used in Current Review

    USPSTF Urges HBV Screening for High-Risk People. By Michael Smith. MedPage Today. Published May 27, 2014. Available online through http://www.medpagetoday.com. Accessed June 2014.

    USPSTF Recommends Hepatitis B Screening for High-Risk Groups. By Amy Orciari Herman. May 27, 2014. Journal Watch. Available online at http://www.jwatch.org/fw108870/2014/05/27/uspstf-recommends-hepatitis-b-screening-high-risk-groups?query=pfw through http://www.jwatch.org. Accessed June 2014.

    Screening for Hepatitis B Virus Infection in Nonpregnant Adolescents and Adults: U.S. Preventive Services Task Force Recommendation Statement. Michael L. LeFevre, MD, MSPH, on behalf of the U.S. Preventive Services Task Force. Annals of Internal Medicine. Article published online 27 May 2014. Available online at http://annals.org/article.aspx?articleid=1874740 through http://annals.org. Accessed June 2014.

    Centers for Disease Control and Prevention. Hepatitis B FAQs for the Public. Available online at http://www.cdc.gov/hepatitis/b/bFAQ.htm#statistics through http://www.cdc.gov. Accessed June 2014.

    Centers for Disease Control and Prevention. Hepatitis B Information for the Public. Available online at http://www.cdc.gov/hepatitis/B/index.htm through http://www.cdc.gov. Accessed June 2014.

    Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection. Recommendations and Reports. September 19, 2008 / 57(RR08);1-20. Morbidity and Mortality Weekly Report. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm through http://www.cdc.gov. Accessed June 2014.

View Sources

Centers for Disease Control and Prevention. CDC Prevention Checklist. Available online at https://www.cdc.gov/prevention/. Accessed Oct 2016.

MedlinePlus Medical Encyclopedia. Physical exam frequency. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/002125.htm. Accessed Oct 2016.

U.S. Preventive Services Task Force. Published Recomendations. Available online at https://www.uspreventiveservicestaskforce.org/BrowseRec/Index. Accessed Oct 2016.