This article waslast modified on June 25, 2018.

Screening tests are an important part of your preventive health care. The tests can be used for early detection of some of the more common and potentially deadly diseases, such as cancers, diabetes, and heart disease. These tests can find certain illnesses 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 take actions that can improve your health and even extend your healthy years. For example, a routine cholesterol test could reveal your risk for developing heart disease, allowing you to take preventive measures—like lifestyle changes—before you develop a serious condition.

The sections below provide information on the screening tests suggested for adults 50 years of age and older. They summarize 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 factors.

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
  • Hepatitis C

    More Americans today die from hepatitis C than from HIV, according to a 2012 study by the Centers for Disease Control and Prevention (CDC). Although many people with hepatitis C (HCV) have no symptoms for decades, if left undiagnosed and unmanaged, hepatitis C infection can progress to chronic liver damage.

    Over 2.7 million Americans are living with chronic HCV infection, which can cause long-term liver damage; without treatment, it is estimated that as many as half will develop cirrhosis and/or hepatocellular carcinoma, a type of liver cancer, both of which can be fatal. The CDC noted that the observed rise in deaths primarily affects those people born between 1945 and 1965, most of whom are unaware that they have even been infected by this slowly progressing disease.

    Risk

    Hepatitis C is spread by exposure to contaminated blood, for example, through sharing of needles during intravenous (IV) drug abuse. Though the risk is low, transmission can also occur through sexual activity and from an infected mother to her baby during 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. Health care workers who have been exposed to infected blood are also at risk.

    Recommendations

    • The CDC recommends one-time testing of all people born during the 1945-1965 time period, regardless of their risk factors for hepatitis C. Those who test positive should receive screening for alcohol use and intervention as needed, followed by referral to appropriate care for the hepatitis C infection and related conditions.
    • Likewise, the United States Preventive Services Task Force (USPSTF) recommends screening for all adults at high risk of hepatitis C and for anyone born between 1945 and 1965, since prevalence is highest in this group.

    Why get screening?

    Many people who may have contracted the virus several years ago are unaware of their condition. A one-time test for older adults could detect infections contracted long ago, allowing for timely treatment and prevention of complications.

    HCV-related disease and death is preventable if detected and treated. Before 2000, chronic HCV was curable in only 10% of cases. Now, treatments for HCV can cure over 90% of those detected before late complications occur.


    Link
    CDC: Hepatitis C FAQs for the Public


    Sources Used in Current Review

    U.S. Preventive Services Task Force. Hepatitis C: Screening. Release date: June 2013. Available online at http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/hepatitis-c-screening. Accessed December 2015.

    Ly K, et al. The Increasing Burden of Mortality From Viral Hepatitis in the United States Between 1999 and 2007. Ann Intern Med, February 21, 2012 vol. 156 no. 4 271-278. Available online http://www.annals.org/content/156/4/271.full. Accessed April 8, 2012.

    Rein D, et al. The Cost-Effectiveness of Birth-Cohort Screening for Hepatitis C Antibody in U.S. Primary Care Settings. Ann Intern Med, February 21, 2012, vol. 156 no. 4, 263-269. Available online at http://www.annals.org/content/156/4/263-270. Accessed April 8, 2012.

    Alter H.J, Liang T.J, Hepatitis C. The End of the Beginning and Possibly the Beginning of the End. Ann Intern Med, February 21, 2012, vol 156 no. 4, 317-318. Available online at http://www.annals.org/content/156/4/317. Accessed April 8, 2012.

    Centers for Disease Control and Prevention. Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945–1965. Prepared by Smith, Bryce D. et al. MMWR. August 17, 2012. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6104a1.htm?s_cid=rr6104a1_w. Accessed August 2012.

    MayoClinic.com. Hepatitis C risk factors. Available online at http://www.mayoclinic.com/health/hepatitis-c/DS00097/DSECTION=risk-factors. Accessed August 2012.

  • 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. 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: Ages 50 to 74 without known risk factors

    • The American College of Obstetricians and Gynecologists (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, says ACOG; women should report any changes they feel in their breasts to their healthcare provider.
    • ACOG and the American Medical Association (AMA) recommend annual screening with a mammogram.
    • The American Cancer Society (ACS) recommends women aged 45-54 have an annual mammogram; women aged 55 and older have the option to switch to mammograms every two years or continue with annual screening.
    • The U.S. Preventive Services Task Force (USPSTF) and the American College of Physicians (ACP) recommend that women ages 50 to 74 should have a routine screening mammogram every two years.

    Recommendations: Over Age 74 without known risk factors

    • According to ACOG, women in this age group may choose to continue having breast exams by health professionals, performing breast self-exams, and/or having mammograms yearly.
    • ACS says 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.
    • The USPSTF has 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.
    • ACP recommends against screening women 75 years and older.

    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

    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. 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 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.

    (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.

    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 gynecological 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 is a slow-growing cancer that can take several years to develop and most often is seen in women 40 years of age or older. 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 ever starts.

    Recommendations: Ages 50 to 65 | Over age 65

    The American College of Obstetricians and Gynecologists (ACOG), the U.S. Preventive Services Task Force (USPSTF), and the American Cancer Society (ACS) recommend that women ages 50 to 65 have a Pap test and an HPV test every 5 years, although a Pap test alone every 3 years is also acceptable.

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

    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.

    Recommendations: Over age 65 | Ages 50 to 65 

    ACOG, USPSTF and ACS recommend against screening for cervical cancer for women over the age of 65 who have had negative results on adequate prior screening. Guidelines define adequate prior screening as 3 consecutive negative Pap tests or 2 consecutive negative HPV tests in the prior 10 years, with the most recent within 5 years.

    Risk Factors

    How often you should be tested depends on your risk factors. Risk factors include persistent infection with a high-risk strain of HPV, 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 these risk factors, you may be tested more frequently. Ask your healthcare provider for a recommendation on frequency and if this test is still appropriate for you. 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.

  • Colorectal Cancer

    Colorectal cancer (cancer of the colon and/or rectum) 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. Colorectal cancer 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. Because these are found most often in people 50 years of age and older, experts recommend universal screening of average risk people in this age group. However, if you have one or more risk factors for colon cancer as described below, you should talk to your healthcare provider about more rigorous or more frequent screening options.

    Risk

    The exact causes of colon and rectal cancer are not known, but greater risk of occurrence appears to be associated with genetic, dietary, and lifestyle factors. According to the Centers for Disease Control and Prevention (CDC), factors that may contribute to increased risk for colon cancer include lack of regular physical activity, low fruit and vegetable intake, a low-fiber and high-fat diet, obesity, excessive alcohol consumption, and smoking. African Americans have the highest incidence of colorectal cancer and Ashkenazi Jews have the highest risk of developing colorectal cancer.

    More frequent screening is appropriate if you have risk factors. If you began screening before age 50 due to one or more of these risk factors, it is important that you continue screening at the interval recommended by your healthcare provider.

    • Average risk: This includes people over 50 with no other known risk factors.
    • Increased risk:
      • A family history of colorectal cancer or adenomatous polyps, a specific type of polyp associated with higher risk of colorectal cancer, increases your risk for colorectal cancer. Most of these cancers occur in people without a family history of colorectal cancer. However, 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 any first-degree relatives (parents, siblings or children) who had colorectal cancer or adenomatous polyps before age 60, or two or more first-degree relatives who had either finding at any age, you are in this risk category. The risk is about doubled in those with one affected first-degree relative. It is even higher if the first-degree relative was diagnosed at a young age or if multiple first-degree relatives were 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.
    • 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.

    Screening Tests and Recommendations: Ages 50 to 75   | Over age 75

    Several health organizations, including the American Cancer Society (ACS), U.S. Multi-Society Task Force on Colorectal Cancer, the American College of Radiology, U.S. Preventive Services Task Force (USPSTF), and the American College of Gastroenterology (ACG), have colon cancer screening recommendations. While there are minor differences, they each emphasize and support screening for colon cancer.

    Recommendations for average-risk individuals include laboratory tests performed on stool samples that mainly detect existing cancers and imaging tests that examine the inside of the colon to detect pre-cancerous polyps as well as existing cancers. Your healthcare provider can help you assess your individual risk factors and which test(s) to use. No single test is preferred for all individuals. As the CDC notes, any of the recommended tests is better than no test.

    The following tables summarize screening options for individuals with average risk for colon cancer:

    Imaging Tests

    These tests visualize the colon and can detect both pre-cancerous polyps and existing cancers.

    Test Description Recommended Screening Interval Starting at Age 50 for People at Average Risk Pros Cons
    Sigmoidoscopy Examination of the rectum and lower colon with a rigid or flexible lighted instrument Every 5 years Minimal preparation ahead of time; does not usually need sedation; fairly quick and safe Only examines about 30% of colon; can't remove all polyps; small risk of bleeding, infection or bowel tear; may need to have colonoscopy if abnormal result found
    Colonoscopy Examination of the rectum and entire colon with a lighted instrument Every 10 years Can examine the entire colon; can remove polyps and take biopsies for pathological testing Extensive full bowel preparation ahead of time; sedation needed to perform; takes at least one day for prep and recovery; risk of bleeding, infection or bowel tears
    Double contrast barium enema Series of x-rays of the colon and rectum; patient is given an enema with a white, chalky solution that outlines the colon and rectum on the X-rays; tube inserted in rectum, bowel is inflated with air Every 5 years Does not require sedation; can view entire colon; relatively safe; minimal risk of tear to colon Same full bowel preparation needed as for colonoscopy; cannot remove polyps; may need to have colonoscopy if suspicious results found
    Virtual colonoscopy (CTC, or Computed Tomographic Colonography) Examination of the rectum and entire colon to the small intestine using X-rays and computers; tube inserted in rectum and bowel is inflated with air Every 5 years No sedation required; can view entire colon; relatively safe; minimal risk of tear to colon Full bowel preparation required; cannot remove polyps; may need colonoscopy if abnormal results; effectiveness as a screening tool is not fully accepted

    Laboratory Tests

    These tests are performed on stool samples and detect mainly existing cancers.

    Stool Tests Description Recommended Screening Interval Starting at Age 50 for People at Average Risk Pros Cons
    Guaiac-based fecal occult blood test (gFOBT) Test to detect hidden blood in stool sample Annually No bowel preparation; no direct risk to bowel; sample can be collected at home Dietary restriction before testing; cannot detect precancerous changes; detects any blood in colon, not just from cancers but from food or dental procedures
    Fecal Immuno-chemical test (FIT or iFOBT) Test to detect hidden blood in stool sample; different collection technique than gFOBT Annually No dietary or drug restrictions; no bowel preparation; no direct risk to bowel; sample can be collected at home Cannot detect precancerous changes; may miss some cancers; one time testing not effective
    DNA test Detects mutations in specific genes associated with colon cancer in DNA isolated from a stool sample Every three years, according to the American Cancer Society No bowel preparation or dietary restrictions; sample can be collected at home; no risk of bowel tear Cannot detect precancerous changes; adequate stool sample must be obtained; special handling needed

    Guidelines urge the use of a screening test such as colonoscopy or sigmoidoscopy that is good at finding pre-cancerous polyps because these procedures can help prevent cancer rather than only detect it after it has developed. These procedures are considered invasive yet are recommended and should be discussed with your healthcare provider. Stool sample testing and sigmoidoscopy are easier than colonoscopy but not as accurate. They are best used in conjunction with each other.

    Other recommendations:

    • People whose first-degree relatives had colorectal adenomas or cancer at 60 years or older can be screened as those with average risk; those whose first-degree relative was diagnosed before the age of 60 may wish to consider screening at an earlier age than 50 years.
    • If you have increased or high risk for colorectal cancer due to a personal history of polyps or colon cancer, family history, hereditary syndromes such as hereditary non-polyposis colorectal cancer (HNPCC), you should talk to your healthcare provider about more aggressive and frequent screening.
    • A colonoscopy is usually recommended for people who are at increased or high risk of colon cancer 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 or every 5 years compared to every 10 years.
    • Both men and women of African descent should begin testing at age 45.
    • While the incidence of colorectal cancer is greater in men, women are cautioned to not delay screening and should also begin at age 50.
    • Those who are heavy cigarette smokers or who are obese may also be candidates for early screening procedures and some suggest the age of 45 years.

    Recommendations: Over age 75 | Ages 50 to 75 

    The U.S. Preventive Services Task Force (USPSTF) revised its guidelines in October 2008 to recommend against routine screening in people aged 76 to 85 who have had consistently negative screening results since they were age 50 and against screening for anyone over the age of 85 years.

    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

    Colon Cancer Alliance. Guaiac Fecal Occult Blood Test (FOBT). Available online at http://www.ccalliance.org/screening/fecal-occult-blood-test.html. Accessed February 2015.

    Colorectal Cancer Screening Guidelines. Centers for Disease Control and Prevention. Available online at http://www.cdc.gov/cancer/colorectal/basic_info/screening/guidelines.htm. Accessed February 2015.

    (October 15, 2014) American Cancer Society. Colorectal cancer screening tests. Available online through http://www.cancer.org. 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. Accessed February 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. 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, 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:

    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.

  • 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.

  • 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.

  • 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 diseases, 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.

  • Osteoporosis

    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.

  • Thyroid Dysfunction

    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 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 doctor 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. 

  • 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 areas, such as the throat and rectum. Left untreated, these diseases can cause health complications. However, both diseases can be cured with antibiotics.

    While rates of chlamydia and gonorrhea are highest in young people, any sexually active older adult can get a chlamydia or gonorrhea infection.

    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 and gonorrhea screening for all sexually active older women who have risk factors, such as a new or multiple sex partners. The CDC specifically recommends annual screening.

    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 man can spread these diseases and even re-infect a partner if he does not complete treatment. For sexually active men who have sex with men, the CDC recommends chlamydia and gonorrhea screening at least annually.

    Risk

    Examples of risk factors include:

    • Previous chlamydia or gonorrhea infections, even if you were successfully treated
    • Having other STDs, especially HIV
    • Having new or multiple sex partners
    • Using condoms inconsistently
    • Exchanging sex for money or drugs
    • Using illegal drugs
    • Living in a detention facility

    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: Get Tested, Find Free, Fast, and Confidential Testing Near You


    Sources Used in Current Review (last reviewed 12/5/2017)

    (2016 October 17, Updated). Chlamydia - CDC Fact Sheet (Detailed). Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm. Accessed on October 2017.

    (2016 October 28, Updated). Gonorrhea – CDC Fact Sheet (Detailed Version). Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea-detailed.htm. Accessed on October 2017.

    (2016 December). Chlamydia, Gonorrhea, and Syphilis FAQ. American Congress of Obstetricians and Gynecologists. Available online at https://www.acog.org/Patients/FAQs/Chlamydia-Gonorrhea-and-Syphilis. Accessed on October 2017.

    Fisher, M. and Schlaberg, R. (2017 July, Updated). Sexually Transmitted Infections. ARUP Consult. Available online at https://arupconsult.com/content/sexually-transmitted-infections/?tab=tab_item-1. Accessed on October 2017

    (December 1, 2016) Centers for Disease Control and Prevention, STD Risk and Oral Sex - CDC Fact Sheet. Available online at https://www.cdc.gov/std/healthcomm/stdfact-stdriskandoralsex.htm. Accessed on October 2017.

    (September 2014) US Preventive Services Task Force, Final Recommendation Statement Chlamydia and Gonorrhea: Screening. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/chlamydia-and-gonorrhea-screening. Accessed on October 2017.

  • Prostate Cancer

    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:

    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.

  • 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. 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. 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. 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. 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. 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.