Screening Tests for Adults (50 and Up)

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, 14.3 million are 45-64 and 12.0 million are 65 years of age or older. 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 aged 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.

Another complication is hearing loss. It is twice as common in people with diabetes as it is in those who don’t have the disease. Among adults with prediabetes, the rate of hearing loss is 30% higher than in those with normal blood glucose levels, according to the American Diabetes Association (ADA).

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 other 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:

• Delivering a baby weighing more than 9 pounds or having had gestational diabetes
• Having polycystic ovary syndrome

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 ADA and the U.S. Preventive Services Task Force (USPSTF) recommend that:

• All people age 45 and older get screening for type 2 diabetes, even if they have no symptoms or risk factors other than age. If you have additional risk factors, screening is especially important.
• Even if initial screening results are normal, get repeat testing at least every 3 years, according to the ADA and USPSTF. If you have been 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.

Links
NIDDK: Preventing Type 2 Diabetes
National Diabetes Education Program
National Diabetes Information Clearinghouse: Diabetes Tests & Diagnosis
American Diabetes Association: Diabetes Basics

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.

Obesity is a serious, growing health problem in the U.S. Over the past 20 years, the rate of obesity has increased steadily throughout the U.S. in all age ranges. Currently, about 42% of adults in the U.S. are obese and about 9% have severe obesity, according to the Centers for Disease Control and Prevention (CDC).

Obesity is a complex condition with several contributing factors, such as behaviors, environment and community, underlying diseases, and medications. According to the CDC, genes also play a role in developing obesity.

Obesity is a serious health concern because it decreases overall quality of life and increases the risk of many conditions and diseases, such as:

• High blood pressure (hypertension)
• High cholesterol and/or high triglycerides
• Type 2 diabetes
• Cardiovascular disease
• Gallbladder disease
• Gout
• Sleep apnea and breathing problems
• Arthritis (e.g., osteoarthritis)
• Several types of cancers
• Serious illness with COVID-19 exposure
• Mental health issues, such as depression and anxiety

Calculating your body mass index (BMI) can be a useful screening tool for assessing your weight status.

For adults, the following formula and classifications are used:

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

Thyroid diseases are primarily conditions that affect the amount of thyroid hormones being produced and thyroid cancer, which usually does not affect the level of thyroid hormones. It is estimated that 20 million Americans have some form of thyroid disease, and approximately 60% of those do not know it. Women are more likely than men to have thyroid problems, with 1 in 8 developing thyroid dysfunction during her life.

Examples of thyroid dysfunction include hypothyroidism, in which too little thyroid hormone is produced, and hyperthyroidism, in which too much is produced. Although people may experience symptoms, these can be so vague – like fatigue and weight changes – that many of those affected do not realize that they have an underactive or overactive thyroid. If left untreated, thyroid disorders can lead to other health problems, including heart disease.

Recommendations

Opinions vary on who can benefit from screening and at what age to begin.

• The U.S. Preventive Services Task Force reviewed the evidence for and against screening in 2004 and announced it could not determine the balance of benefits and harms of screening asymptomatic adults for thyroid disease.

The American Thyroid Association and the American Association of Clinical Endocrinologists released clinical practice guidelines in 2012 that recommend the following:

• Screening for hypothyroidism should be considered in patients over the age of 60.

On the other hand, if you have symptoms that might or might not be due to thyroid dysfunction, no matter what your age or sex, a number of organizations recommend testing to rule out thyroid dysfunction as a cause. Talk to your healthcare practitioner about whether getting tested would be appropriate. As you age and experience what seem to be natural signs of aging, particularly if you are a woman, be alert to the possibility of thyroid problems.

Links
American Thyroid Association
The Hormone Health Network: Thyroid Disorders Resources
MayoClinic.com: Hypothyroidism: Risk factors
MayoClinic.com: Hyperthyroidism: Risk factors

Sources Used in Current Review

Clinical Practice Guidelines for Hypothyroidism in Adults: Co-sponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. The American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults. Available online at http://online.liebertpub.com/doi/pdfplus/10.1089/thy.2012.0205. Accessed November 2012.

Prevalence of Thyroid Cancer Rises Sharply. Medical News Today. Article date 24 December 2009. Available online at http://www.medicalnewstoday.com/articles/174787.php. Accessed November 2012.

Osteoporosis is a growing concern for Americans. According to the National Osteoporosis Foundation, 10 million Americans have this disease and 43 million are at risk. It is also estimated that half of all women over age 50 will break a bone because of osteoporosis and so will 1 in 4 men.

With aging comes an increased risk of fractures as well as a reduced ability to recover from such injuries. Fracturing the hip, spine, or wrist can cause pain, disability, and deformity for an older person. Being immobilized in this way often means losing independence and needing long-term care.

Because osteoporosis often is “silent” until a fracture occurs, you may not notice you have this disease or realize you are at risk. Getting screened for low bone mass and osteoporosis and treating the problem can help reduce your risk of a fracture.

Risk Factors
The following factors increase a person’s risk of bone loss and osteoporosis:

• Being female (of those with osteoporosis, 80% are women)
• Older age
• Small, thin body size
• Being white or Asian in ethnicity
• Having a family history of osteoporosis or broken bones
• Having low levels of sex hormones (estrogen in women, testosterone in men), such as during menopause in women
• Having anorexia nervosa
• Deficiencies in calcium and vitamin D
• Lack of exercise
• Smoking cigarettes and drinking alcohol
• Use of certain medications

Recommendations
The bone mineral density (BMD) test is the primary test used to identify osteoporosis and low bone mass. One of the preferred and most accurate ways to measure BMD is Dexa-Scan (dual-energy X-ray absorptiometry or DXA). It uses a low energy X-ray to evaluate bone density in the hip and/or spine.

A number of organizations have published screening guidelines for osteoporosis.

The American College of Obstetricians and Gynecologists (ACOG) has guidelines for women and recommends:

• Bone mineral density screening for all women beginning at age 65.
• Postmenopausal women younger than 65 can be screened with DXA if they have significant risk factors for osteoporosis and/or bone fracture.
• In the absence of new risk factors, DXA screening should not be performed more frequently than every two years.
• Use of FRAX, a fracture risk assessment tool, to further predict someone’s risk of bone fracture in the next 10 years; can be done annually to monitor effect of age on fracture risk.

The U.S. Preventive Service Task Force (USPSTF) recommends:

• Osteoporosis screening for women 65 years of age or older and for younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors.
• For men, the Task Force says the current evidence is insufficient to assess whether screening for osteoporosis would be beneficial or harmful.

The National Osteoporosis Foundation recommends screening adults with bone mineral density testing as follows:

• Women 65 years of age and older as well as some younger postmenopausal women who have risk factors or who have had a fracture as an adult.
• Men age 70 and older as well as those age 50 to 69 who have risk factors or have had a fracture as an adult.

Osteoporosis screening guidelines for men published in May 2008 by the American College of Physicians point out that this condition is underdiagnosed in men.

• The guidelines recommend periodic risk assessment for osteoporosis in older men and DXA for men who are at increased risk and are candidates for drug therapy.

The Endocrine Society issued guidelines in 2012 for managing osteoporosis in men that recommend:

• Men at high risk for osteoporosis (e.g., those aged 70 and older; those aged 50-69 with risk factors like low body weight, smoking, and previous fracture) should be screened with DXA.

Link
NIH Osteoporosis and Related Bone Diseases National Resource Center

Article Sources

Sources Used in Current Review

ACOG. Osteoporosis Guidelines Issued. Bone Health Counseling Begins in Adolescence. August 21, 2012. Available online at https://www.guideline.gov/content.aspx?id=38413. Accessed June 2016.

Watts NB, Adler RA, Bilezikian JP, Drake MT, Eastell R, Orwoll ES, Finkelstein JS. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012 Jun;97(6):1802-22. Available online at https://www.guideline.gov/content.aspx?id=37827&search=osteoporosis. Accessed June 2016.

Cosman F, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. National Osteoporosis Foundation. Available online at http://link.springer.com/article/10.1007/s00198-014-2794-2. Accessed June 2016.

(January 2011) The U.S. Preventive Service Task Force. Osteoporosis: Screening. Available online at http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/osteoporosis-screening. Accessed June 2016.

Screening for Osteoporosis in Men: Recommendations from the American College of Physicians. Ann Intern Med. 2008;148:I-35. Available online at http://annals.org/article.aspx?articleid=740939. Accessed June 2016.

Breast cancer is the second most commonly diagnosed cancer in American women and a leading cause of cancer death. Almost 70% of breast cancers are found in women 55 or older. Regular screening can help to detect tumors at an early stage when they are most treatable. Mammography is an imaging test that can detect breast cancer before symptoms develop.

The medical community recognizes the value of breast cancer screening and mammography, but there are some differences in the advice on how often it should be done or when it should be started. Most organizations agree that women should work with their healthcare practitioner 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 for women with average risk:

Women with average risk have no personal or family history of breast cancer and no other risk factors for breast cancer.

Clinical Breast Exams

• The American College of Obstetricians and Gynecologists (ACOG) and the National Comprehensive Cancer Network (NCCN) say that, starting at age 40, women should be offered a clinical breast exam by a health professional yearly as part of their regular health exam.
• The U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) state that there is insufficient evidence or that they do not recommend clinical breast examinations for women at any age.

Breast self-awareness is important, according to ACOG. Women of all ages should discuss breast self-awareness with their healthcare provider and immediately report any change in their breasts’ normal appearance and feel. These changes could include pain, a mass, nipple discharge other than breast milk, or redness.

Mammograms

Ages 50 to 74

• ACOG recommends screening with a mammogram every 1 to 2 years.
• The American Medical Association (AMA) and NCCN recommend screening with a mammogram every year.
• ACS recommends women aged 45-54 have an annual mammogram; women aged 55 and older have the option to switch to mammograms every 2 years or continue with annual screening.
• USPSTF and the American College of Physicians (ACP) recommend that women ages 50 to 74 should have a routine screening mammogram every 2 years.

Age 75 and Older

• ACOG says that the decision to screen beyond age 75 should be made by a woman and her healthcare practitioner (shared decision) and should take into account her health and longevity.
• ACS and NCCN say that mammography screening should continue as long as a woman is in good health and she is expected to live for 10 years or longer.
• USPSTF and ACP have stated that current evidence is insufficient to determine whether there are additional benefits and harms from screening mammography in women 75 years or older and makes no specific recommendation for this age group.

Increased Risk

Family history and genetics can contribute to a high lifetime risk. Other risk factors for breast cancer include 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.

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

ACS 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.

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
American Cancer Society: Breast Cancer Risk and Prevention
National Cancer Institute: Breast Cancer Screening

Sources Used in Current Review (last reviewed 2/4/19)

(September 10, 2018) National Institutes of Health, National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Cancer stat facts: Female breast cancer. Available online at https://seer.cancer.gov/statfacts/html/breast.html. Accessed on January 2019.

(September 11, 2018) Centers for Disease Control and Prevention. Breast cancer: What is breast cancer screening? Available online at https://www.cdc.gov/cancer/breast/basic_info/screening.htm. Accessed January 2019.

(July, 2017) American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Available online at https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Breast-Cancer-Risk-Assessment-and-Screening-in-Average-Risk-Women. Accessed January 2019.

(January, 2016) U.S. Preventative Services Task Force. Breast cancer: Screening. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening1. Accessed on January 2019.

Oeffinger K.C., et al. American Cancer Society. Breast cancer screening for women at average risk: 2015 guideline update from he American Cancer Society. 2015;314:1599-614. Journal of the American Medical Association. Available online at http://dx.doi.org/10.1001/jama.2015.12783. Accessed on January 2019.

(October 9, 2017). American Cancer Society. Breast cancer early detection and diagnosis. Available online at https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html. Accessed January 2019.

(January, 2016) Facing Our Risk of Cancer Empowered. Comparison of breast cancer screening guidelines. Available online at http://www.facingourrisk.org/our-role-and-impact/advocacy/documents/breast-screening-comparison-chart.pdf. Accessed January 2019.

(May 18, 2018) National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology. Breast cancer screening and diagnosis. Available online at https://www.nccn.org/professionals/physician_gls/pdf/breast-screening.pdf. Accessed January 2019.

Cervical cancer is caused by the uncontrolled growth of cells in the cervix, the narrow bottom portion of a woman’s uterus. Cervical cancer is slow-growing and can take several years to develop. According to the American Cancer Society, cervical cancer is diagnosed most often in women between the ages of 35 and 44 years old. The average age at diagnosis is 50 years old. Cervical cancer is rarely diagnosed in women younger than age 20.

Almost all cervical cancers are caused by persistent infections with specific types of human papillomavirus (HPV). Two high-risk HPV types, 16 and 18, cause 80% of all cervical cancers. Cervical cancers caused by 9 high-risk types of HPV can be prevented with vaccination starting at age 11 to 12.

HPV is a very common sexually transmitted disease. Many HPV infections resolve without treatment—the body is able to clear the infection—but infections with high-risk HPV types that do not go away can lead to cervical cancer. It can take many years for an HPV infection to develop into cancer. A persistent infection with high-risk HPV can cause infected cells to grow uncontrollably. Usually the immune system recognizes these cells and limits their growth, but sometimes the cells remain and become precancerous.

Most deaths from cervical cancer can be avoided by having regular checkups and cervical cancer screens. Routine screening can help identify cervical cancer early on, at a time when it is highly curable. Screening even finds precancerous lesions so they can be removed before cancer starts to develop.

Recommendations: Ages 50 to 65

Cervical cancer screening tests include:

• Pap smear (Pap test)—this test screens for precancerous or cancerous changes in cervical cells. A sample of cervical cells is place on a slide and examined using a microscope.
• HPV test—this test detects the genetic material (DNA or messenger RNA) of high-risk HPV (hrHPV) in a sample of cervical cells.

Recommendations from the U.S. Preventive Services Task Force (USPSTF) for cervical cancer screening have been endorsed by the Society of Gynecologic Oncology and the American Society for Colposcopy and Cervical Pathology (ASCCP) and are largely in line with current guidelines from the American College of Obstetricians and Gynecologists (ACOG), ASCCP, the American Cancer Society, and the American Society for Clinical Pathology (ASCP).

These health organizations recommend that women ages 30 to 65 choose one of the following screening strategies. Talk to your healthcare provider about the pros and cons of all three screening strategies so you can decide which approach is best for you:

• Co-testing with a Pap smear and high-risk HPV (hrHPV) test every 5 years, or
• Pap smear alone every 3 years, or
• hrHPV tests alone every 5 years (considered an alternative screening strategy)

You should still undergo regular cervical cancer screening even if you have been vaccinated against HPV.

More frequent screening is advised for women with risk factors, such as:

• Being exposed to a drug called DES (a drug given to some women between 1940 and 1971 to prevent miscarriage) before birth. In this case, a Pap smear is required for screening.
• A previous abnormal cervical cancer screening or diagnosis of cervical cancer
• Family history of cervical cancer
• History of chlamydia infections
• A compromised immune system (e.g. HIV infection)

(See the section on Risk Factors in the Cervical Cancer article.)

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

Recommendations: Over age 65

ACOG, USPSTF, and ACS recommend against screening for cervical cancer for women over the age of 65 who have had adequate screening and are not at high risk for cervical cancer. This means you have no history of abnormal cervical changes and either of the following:

• Three consecutive negative Pap smears or
• Two consecutive negative co-tests (Pap plus hrHPV tests) in a row within the past 10 years, with the most recent co-test performed within the past five years

For women with hysterectomies
If you have had a total hysterectomy (surgical removal of the uterus and cervix) and you have no history of cervical cancer or cervical changes, guidelines suggest that you may discontinue cervical cancer screenings. However, if you have a history of cervical cancer or severe to moderate cervical changes, then it is recommended that you continue to be screened for cervical cancer for 20 years after your surgery. If you had a partial hysterectomy (removal of the uterus but not the cervix), then you should continue to have regular cervical cancer screenings as recommended above.

Link
National Cancer Institute: Cervical Cancer Screening (PDQ®)–Patient Version

Sources Used in Current Review (last reviewed 6/22/2020)

(Reaffirmed November 8, 2019) American College of Obstetricians and Gynecologists. Practice advisory: Cervical cancer screening (update). Available online at https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-Cervical-Cancer-Screening-Update. Accessed June 2020.

(November 20, 2016) American Cancer Society. The American Cancer Society guidelines for the prevention and early detection of cervical cancer. Available online at https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/cervical-cancer-screening-guidelines.html. Accessed June 2020.

(September 2017) American College of Obstetricians and Gynecologists. Frequently asked questions (FAQ 085): Cervical cancer screening. Available online at https://www.acog.org/patient-resources/faqs/special-procedures/cervical-cancer-screening. Accessed June 2020.

(August 2019) U.S. Centers for Disease Control and Prevention. HPV vaccine information for clinicians. Available online at https://www.cdc.gov/hpv/hcp/schedules-recommendations.html. Accessed June 2020.

(August 21, 2018) U.S. Preventive Services Task Force. Cervical Cancer Screening. Available online at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening. Accessed June 2020.

May 13, 2020. National Cancer Institute. Cancer Screening (PDQ®)-Health Professional Version. Available online at https://www.cancer.gov/types/cervical/hp/cervical-screening-pdq. Accessed June 2020.

(February 18, 2014) American Cancer Society. DES Exposure: Questions and Answers. Available online at https://www.cancer.org/cancer/cancer-causes/medical-treatments/des-exposure.html. Accessed June 2020.

Prostate cancer is the second most frequently diagnosed cancer in men, after skin cancer. It is also 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 major 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 significantly affect a man’s health or life expectancy.
• Screening tests for prostate-specific antigen (PSA) do not detect all cases, and some elevated PSA results do not prove to be cancer.
• Diagnosis through biopsy (with a small risk of infection and bleeding) and side effects of treatment (which could cause erectile dysfunction and incontinence) can potentially be harmful. 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 has 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 when deciding whether to undergo screening 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 age 65
• High risk: Men with more than one relative who was affected at an early age

Tests

If you choose to be tested, the following tests may be recommended:

• Prostate specific antigen (PSA)—blood test that measures the level of PSA in the blood
• Digital rectal exam (DRE)—part of a physical exam that the health practitioner performs to manually examine the prostate gland

Recommendations: Ages 50 to 70
Most organizations recommend prostate cancer screening only after men discuss the advantages and disadvantages of PSA-based screening for prostate cancer with their healthcare practitioners and make informed decisions. You should consider your own tolerances for risk and uncertainty and how you will use the test results.

• The U.S. Preventive Services Task Force (USPSTF) advises men ages 55 to 69 to make an individual decision about PSA screening with their healthcare practitioner. The decision is based on the harm that can come from false-positive PSA test results which then may lead to surgical or radiation treatment that ultimately will provide little benefit.
• The American Cancer Society (ACS) recommends screening for men 50 years of age and older, with average risk and a life expectancy of at least 10 years who choose to be screened. ACS recommends testing at a younger age for higher-risk groups. If you are in one of these groups, you may want to consider ongoing testing or starting it now. 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 (AUA) recommends men at average risk wait to have a baseline PSA and DRE until age 55, and regular screening from age 55 to 69 for men who wish to be screened. For men younger than age 55 who are at increased or high risk, AUA advises that decisions regarding prostate cancer screening be individualized based on patient preferences and an informed discussion about benefits and harms. AUA recommends regular PSA and DRE testing regardless of whether your PSA was high or low or if the DRE was abnormal.
• The American College of Physicians (ACP) advises men 50 to 69 years old who are in good health to discuss the benefits and harms of screening with their healthcare practitioners and to get screened if they decide to do so. A PSA blood test may be done every 2 to 4 years.
• The National Comprehensive Cancer Network (NCCN) recommends a baseline test at age 45 for men who want screening, which then will determine when and how often to have future tests—and if you haven’t yet had a baseline test, consider getting tested now. NCCN advises using the DRE and the PSA test in combination for the broadest detection of cancer in its early stages. If the PSA test result is greater than 1.0 ng/mL, or the man is at higher risk, NCCN recommends DRE and PSA tests at one- to two-year intervals.

Recommendations: Over age 70 

• USPSTF recommends against screening men older than 70. It found that potential harms from prostate screening outweigh the benefits for men at an age where prostate cancer is not likely to cause death.
• ACS and AUA emphasize that overall health, not just age, is an important consideration for older men when deciding to be screened. They recommend that men with a life expectancy less than 10 years not be screened. AUA notes that some men who are otherwise in excellent health and over the age of 70 could benefit from screening and urges those men to talk with their doctors about it.
• ACP advises against screening men over age 69.
• NCCN emphasizes that men over 70 should receive individual consideration for their overall health, previous PSA results, family history, and risk factors before deciding to screen and how frequently they should get screened for prostate cancer. For men over 75, NCCN recommends that testing should be done only in very healthy men to detect rare, but aggressive prostate cancers.

Link

Articles: Making Informed Decisions for Better Health

Sources Used in Current Review (Latest review 6/25/2018)

(March 11, 2016) American Cancer Society. About Prostate Cancer. Available online at https://www.cancer.org/content/dam/CRC/PDF/Public/8793.00.pdf. Accessed on June 22, 2018.

(March 11, 2016) American Cancer Society. Prostate Cancer Risk Factors. Available online at https://www.cancer.org/cancer/prostate-cancer/causes-risks-prevention/risk-factors.html. Accessed on June 22, 2018.

(April 14, 2016) American Cancer Society. If Prostate Cancer Screening Test Results Aren’t Normal. Available online at https://www.cancer.org/cancer/prostate-cancer/early-detection/if-test-results-not-normal.html. Accessed on June 22, 2018.

(April 14, 2016). American Cancer Society. Recommendations for Prostate Cancer Early Detection. Available online at https://www.cancer.org/cancer/prostate-cancer/early-detection/acs-recommendations.html. Accessed on June 22, 2018.

(April 5, 2018) National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Prostate Cancer Early Detection. Available online at https://www.nccn.org/professionals/physician_gls/pdf/prostate_detection.pdf. Accessed on June 22, 2018.

(May 8, 2018) U.S. Preventive Services Task Force Bulletin. USPSTF Issues Final Recommendation on Screening for Prostate Cancer. Available online at https://www.uspreventiveservicestaskforce.org/Home/GetFile/6/250/prostate-cancer-final-rec-statement-bulletin/PDF. Accessed on June 22, 2018.

(May 2018) U.S. Preventive Services Task Force. Final Recommendation Statement: Prostate Cancer: Screening. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prostate-cancer-screening1. Accessed on June 22, 2018.

(May 5, 2018) American Urological Association. Press release: AUA Responds to USPSTF Final Recommendations on Screening for Prostate Cancer. Available online at http://auanet.mediaroom.com/2018-05-08-AUA-Responds-to-USPSTF-Final-Recommendations-on-Screening-for-Prostate-Cancer. Accessed on June 22, 2018.

(2015) American Urological Association. Clinical Guidelines: Early Detection of Prostate Cancer. Available online at http://www.auanet.org/guidelines/early-detection-of-prostate-cancer-(2013-reviewed-and-validity-confirmed-2015). Accessed on June 22, 2018.

(19 May 2015) American College of Physicians. Screening for Cancer, Summary for Patients. Available online at http://annals.org/aim/fullarticle/2293232/screening-cancer. Accessed June 2018.

Colon cancer (cancer of the colon and/or rectum) is the uncontrolled growth of abnormal cells within the layers of tissue that line the colon. It is the third most common non-skin cancer in adults and the third leading cause of cancer deaths in men and women in the United States. The lifetime risk of developing colon cancer is about 1 in 21 (or 4.7%) for men and 1 in 23 (4.4%) for women, according to the American Cancer Society (ACS).

Over the last several years, the number of deaths from colon cancer has dropped significantly. Improved screening has led to removal of more pre-cancerous polyps, preventing the development of cancer. Likewise, better screening has detected more cancers in the earlier stages, when they are most treatable.

But while the incidence of colon cancer has decreased over the last several years in people age 55 and older due in part to effective screening, there has been a 51% increase in colon cancer among people younger than age 50 since 1994. In 2018, the ACS lowered their recommended starting age for colon cancer screening to age 45 for people with an average risk of colon cancer. If you haven’t already begun screening, you may consider it now.

Furthermore, if you have one or more risk factors for colon cancer you should talk to your healthcare practitioner who can help you assess your individual risk factors and determine if you should get screened more frequently. As the Centers for Disease Control and Prevention (CDC) notes, any of the recommended tests is better than no test.

Screening Recommendations

Several health organizations have colon cancer screening recommendations. In 2017, screening guidelines for the early detection of pre-cancerous polyps and colon cancer were released by the US Multi-Society Task Force (MSTF) on Colorectal Cancer. The US Preventive Services Task Force released updated similar recommendations in 2016 and the American Cancer Society (ACS) updated their guidelines in 2018. While these groups may differ on which tests to use and how often, they each support screening for colon cancer. Recommendations are based on your age and level of risk.

Increased and High Risk: 
Risk of colon cancer increases with age, being overweight or obese, and with the occurrence of cancers in other parts of the body. Examples of other risk factors include:

• Family history—having one or more family members with colon cancer or multiple polyps, especially if they were younger than age 60 at diagnosis
• Diet—high fat and meat diets are risk factors, especially combined with not eating enough fruits, vegetables, and/or high-fiber foods
• Lifestyle—these risk factors include cigarette smoking, drinking excessive amounts of alcohol, and lack of regular exercise
• Having ulcerative colitis, a form of inflammatory bowel disease
• Having type 2 diabetes
• Racial or ethnic background—African Americans and Ashkenazi Jews have higher risk and rates of colon cancer compared to others.
• Having a personal history of colon cancer and/or high risk precancerous polyps
• Having a rare inherited disease called familial adenomatous polyposis (FAP)—this causes benign polyps to develop early in life and causes cancer in almost all affected persons unless the colon is removed. (See the Genetics Home Reference article on FAP)
• Having a genetic syndrome called Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC) (See the Genetics Home Reference article on Lynch syndrome.)

People with increased or high risk of colon cancer may be advised to start screening at a younger age (e.g. age 40). A colonoscopy is usually recommended because it is the most accurate and thorough. Also, the recommended screening interval for high-risk individuals is shorter than for people with average risk (such as every 1-2 years compared to every 10 years).

Additionally, people who have been screened and found to have colon cancer or high risk pre-cancerous polyps also need more frequent re-testing, usually at least every 3 years. (This is called surveillance.) For example, the MSTF guidelines advise enhanced surveillance for people with 3-10 small tubular adenomas as well as those with 1 or more high-risk polyps (i.e., villous features, larger than 10 mm diameter tubular adenoma or serrated sessile polyp, or any polyp that has very atypical features, called high grade dysplasia). On the other hand, those with 1-2 small (less than 10 mm) tubular adenomas in the colon can be re-screened at normal intervals (i.e., every 10 years). Another common polyp, termed a hyperplastic polyp, is not felt to increase risk of colon cancer.

For more information on these types of polyps, read the American Cancer Society’s webpage Understanding Your Pathology Report: Colon Polyps

Average Risk

Ages 50 to 75:
This includes people with no known risk factors other than age. The ACS recommends that all average-risk people begin screening at age 45. Both the MSTF and the USPSTF recommend that people with average risk for colon cancer begin screening at age 50. MSTF recommends that African-Americans begin at age 45.

In 2016, the Canadian Task Force on Preventive Health Care (CTFPHC) issued colon cancer screening recommendations that differ in part from U.S. groups. It recommends that adults aged 50 to 74 years be screened with guaiac-based fecal occult blood test (gFOBT) or FIT every 2 years or flexible sigmoidoscopy every 10 years and recommends against using colonoscopy for primary screening.

Ages 76 to 85: 
The MSTF and USPSTF have similar guidelines recommending that the decision to screen for colon cancer in people aged 76 to 85 should be an individual one based the overall health of the individual and prior screening history. Screening would be most beneficial for those who have never had screening. It is also most appropriate for people healthy enough to undergo treatment if necessary and for those who do not have other underlying conditions that would affect their life expectancy.

The Canadian Task Force on Preventive Health Care recommends against screening people age 75 and older.

Screening Tests
The following table summarizes the screening tests that are options for people with average risk. Tier 1 tests are the tests of choice, according to the MSTF, while tier 2 tests have some disadvantages compared to tier 1 tests. The ACS guidelines do not prioritize a particular screening test and instead says patients and their healthcare practitioners should choose from among several tests based on the patient’s preference.

In addition to screening tests, a healthcare practitioner may perform a digital rectal examination (DRE) to feel for a rectal mass with a gloved finger. The DRE is primarily performed to examine the prostate gland, but also allows for the examination of the lower rectum, pelvis, and belly. Most colon cancers, however, are beyond the detection range of a DRE.

If a test other than colonoscopy gives a result suggestive of polyps or cancer, a colonoscopy is often done to examine the full colon and remove polyps or potentially cancerous areas.

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
Tests: Fecal Occult Blood Test and Fecal Immunochemical Test

Condtions: Colon Cancer

Sources Used in Current Review (September 17, 2018)

(2016 June). Colorectal Cancer: Screening. US Preventive Services Task Force. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening2?ds=1&s=colon. Accessed on September 2018.

Rex DK, Boland CR, Dominitz JA, et al. Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2017; 112(7):1016–1030. Available online at http://www.nature.com/articles/ajg2017174. Accessed on 9/12/2018.

Canadian Task Force on Preventive Health Care. Recommendations on screening for colorectal cancer in primary care. Canadian Med Assoc J. 2016 Mar 15; 188(5): 340–348. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786388/. Accessed 9/12/2018.

Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018; 68(4):250-281. First published: 30 May 2018. Available online at https://doi.org/10.3322/caac.21457 https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21457. Last accessed 9/12/2018.

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.

The number of new cases of hepatitis C has increased dramatically since 2010, particularly in young adults, and most have been linked to injection drug use, according to the Centers for Disease Control and Prevention (CDC). For some people, infection with the hepatitis C virus (HCV) is a short-term illness, usually with few, mild symptoms or no symptoms, and the virus is cleared from the body without specific treatment. This is called acute hepatitis C.

However, more than half of people with acute hepatitis C go on to develop chronic hepatitis C. Without treatment, chronic hepatitis C can lead to serious, long-term health problems like cirrhosis and liver cancer, and may be fatal. Chronic hepatitis C progresses slowly over time, so infected individuals may not be aware they have the condition until it causes enough liver damage to affect liver function.

According to the CDC, there are over 2.4 million Americans living with chronic HCV infection and many of these people don’t know it.

Risk

You may be at risk of HCV infection if there’s a chance you are exposed to the virus. Hepatitis C is spread most often by exposure to contaminated blood through sharing of needles, syringes or similar equipment used during intravenous (IV) drug abuse. Less commonly, transmission can also occur through sexual activity, sharing personal items like razors or toothbrushes, and from an infected mother to her baby during pregnancy and childbirth. Prior to 1992, when HCV screening of donated blood became routine, it was also possible to become infected with HCV through blood transfusion or organ transplant. Healthcare workers who have been exposed to infected blood (e.g., needlestick injuries) are also at risk.

Screening Recommendations

Health organizations including the CDC, Infectious Diseases Society of America, and the American Association for the Study of Liver Diseases recommend:

• One-time testing of all people age 18 years and older, regardless of their risk factors for hepatitis C
• One-time testing of people regardless of age who:
  • Have ever injected illegal drugs
  • Received a blood transfusion or organ transplant prior to July 1992 (before blood and organs were tested for HCV)
  • Have received clotting factor concentrates produced before 1987
  • Were ever on long-term dialysis
  • Are children born to HCV-positive mothers
  • Have been exposed to the blood of someone with hepatitis C
  • Are healthcare, emergency medicine, or public safety workers who had exposure to HCV-positive blood
  • Have evidence of chronic liver disease
  • Have HIV
• Periodic testing for those with ongoing risk factors, such as injection drug use

The CDC also recommends:

• Screening of all pregnant women during each pregnancy
• Screening for any person who requests it

The United States Preventive Services Task Force (USPSTF) similarly recommends:

• One-time testing for all adults between the ages of 18 and 79 years
• Regular screening for people at high risk, regardless of age
• Screening of pregnant women, regardless of age

HCV tests

• The initial screening test is an HCV antibody test that detects the presence of antibodies to the virus in your blood. Your body produces these antibodies when you are exposed to the virus. This test cannot distinguish a past infection that has cleared and a current, active infection.
• If the antibody test is positive, a second test for the virus (HCV RNA) is performed to determine whether you have an active, current infection.

For more details, see the article on Hepatitis C Testing.

Why get screening?

Many people who may have contracted the virus, sometimes several years ago, have no noticeable symptoms and are unaware of their condition. A one-time test could detect these infections, allowing for treatment and prevention of complications.

Complications, such as cirrhosis, liver cancer and death, are preventable if chronic hepatitis C is detected and treated before the scarring in the liver is severe. Treatments for HCV can cure over 90% of cases before late complications occur.

Link
CDC: Hepatitis C Questions and Answers for the Public

Sources Used in Current Review (last reviewed July 2020)

(2020 April 29, Reviewed). Testing Recommendations for Hepatitis C Virus Infection. CDC Recommendations for Hepatitis C Screening Among Adults in the United States. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/hepatitis/hcv/guidelinesc.htm. Accessed on 05/23/2020.

(2020 March 2, Updated). Hepatitis C Virus Infection in Adolescents and Adults: Screening. US Preventive Services Task Force. Available online at https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/hepatitis-c-screening. Accessed on 05/23/2020.

(2020 April 9, Reviewed). Dramatic increases in hepatitis C, CDC now recommends hepatitis C testing for all adults. Centers for Disease Control and Prevention VitalSigns. Available online at https://www.cdc.gov/hepatitis/hcv/vitalsigns/index.html. Accessed on 05/23/2020.

(2020 May 27, Reviewed). Hepatitis C Questions and Answers for Health Professionals. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm. Accessed on 05/23/2020.

(2019 November 6, Updated). HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. AASLD and IDSA. Available online at https://www.hcvguidelines.org/. Accessed on 05/23/2020.

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:

• IGRA TB blood test (preferred): also known as Interferon gamma release assay, requires a blood sample to be drawn.
• 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.

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.