Screening Tests for Adults (50 and Up)

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 cholesterol, HDL-cholesterol, LDL-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.

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.

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

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

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

Recommendations: Ages 50 to 75
In deciding which organizational guidelines you and your healthcare provider will follow, 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 against PSA screening in men of any age, concluding that screening does not improve survival rates for prostate cancer for healthy men. The decision is based on the harm that can come from diagnoses that lead to false-positive test results or harm from the treatment of cases that are slow-growing and non-lethal.

Several other organizations recommend screening only after men discuss the advantages and disadvantages of PSA-based screening for prostate cancer with their healthcare provider and make an informed decision.

• 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. The ACS recommends earlier testing for higher-risk groups. If you are in one of these groups, you may want to consider ongoing testing or starting it now.
  • If you are African American or have a father or brother who was diagnosed before they were 65, you should begin testing now if you didn't start at the recommended age of 45.
  • If more than one relative had prostate cancer at an early age, the ACS recommends testing begin at 40; then, depending on the results, retest at age 45 or earlier as results warrant.

  The ACS recommends rescreening 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 a baseline PSA and DRE between the ages of 55 and 69 for men who wish to be screened. For those at increased or high risk, the group advises that decisions regarding prostate cancer screening be individualized based on patient preferences and an informed discussion about benefits and harms. The 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 advises screening men 50-69 years old who request to be screened.
• The National Comprehensive Cancer Network (NCCN) recommends a baseline test at age 45 for men who want screening, which will determine when and how often to have future tests. If you haven't yet had a baseline test, you may consider getting tested now. The NCCN advises using the DRE and the PSA test, in combination, for the broadest detection of cancer in its early stages. If the result is greater than 1.0 ng/mL, or the man is higher risk, it recommends an annual DRE and PSA test.

Recommendations: Over age 75

• The USPSTF recommends against screening men of any age, including those older than 75. 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.
• The American Cancer Society and the American Urological Association emphasize that overall health, not just age, is an important consideration for older men when deciding to be tested. They recommend that men with a life expectancy less than 10 years not be tested, and the AUA does not recommend routine screening after age 70.
• The National Comprehensive Cancer Network 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 for prostate cancer and how frequently.

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

Sources Used in Current Review

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

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

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

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

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

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

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

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

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

Tuberculosis (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.

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.