Screening Recommendations

Definition:

Screening recommendations provide guidelines for assessing the health of individuals at various ages to detect conditions early, reduce the risk of diseases, and ensure timely intervention. Screening aims to identify health issues before they become symptomatic, particularly in at-risk populations.

Aetiology/Causes:

Screening is essential for detecting conditions like hypertension, cardiovascular disease (CVD), diabetes, high cholesterol, osteoporosis, and skin cancers, which are often asymptomatic in their early stages. Early detection allows for prevention and management to reduce morbidity and mortality.

Pathophysiology:

• Hypertension (BP): Elevated blood pressure over time can lead to vascular damage, increasing the risk of heart disease, stroke, kidney damage, and other complications.

• Cardiovascular Disease (CVD): CVD encompasses heart disease, stroke, and peripheral artery disease, often caused by atherosclerosis, high blood pressure, and dyslipidaemia.

• Diabetes: Elevated blood sugar leads to complications such as kidney disease, neuropathy, cardiovascular complications, and poor wound healing.

• Lipid Disorders: High cholesterol and low HDL cholesterol contribute to atherosclerosis, leading to CVD.

• Fracture Risk: Bone loss, particularly in postmenopausal women and older adults, increases the risk of fractures.

• Skin Cancer: Regular skin screening helps in the early detection of melanoma and non-melanoma skin cancers.

Symptoms:

• Hypertension: Often asymptomatic, but can lead to headaches, dizziness, and blurred vision when severe.

• CVD: Symptoms may include chest pain, shortness of breath, dizziness, and fatigue.

• Diabetes: Thirst, frequent urination, fatigue, blurry vision, and slow-healing sores.

• High Lipids: Often asymptomatic; symptoms are typically seen in later stages with complications like heart disease.

• Osteoporosis: Pain, fractures with minimal trauma, and height loss in severe cases.

• Skin Cancer: Changes in skin lesions, new growths, or changes in existing moles.

Differential Diagnosis:

• Hypertension: Anxiety, stress, and endocrine disorders (e.g., pheochromocytoma).

• CVD: Anxiety, musculoskeletal pain, and gastrointestinal issues.

• Diabetes: Other causes of polyuria and polyphagia, like kidney disease or certain medications.

• Lipid Disorders: Other cardiovascular issues may present with similar symptoms (e.g., heart failure, peripheral artery disease).

• Fractures: Trauma or underlying metabolic bone diseases.

• Skin Conditions: Psoriasis, eczema, or benign skin growths may resemble skin cancer.

Investigations:

• Blood Pressure (BP): Measure annually for adults 18 and over; more frequently if elevated.

• AUSDRISK: Screening for diabetes risk at age 40 and over every 3 years, and for ATSI individuals over 18 years every 3 years. This includes waist circumference as a key measure.

• Cardiovascular Risk (CVD): Individuals aged 45 and over should be screened every 2 years for CVD. For ATSI individuals, screening starts at age 35 and should occur every 2 years. If the individual is at low risk, blood tests from the previous 5 years may be used.

• Lipid Profile: Screening for cholesterol levels at age 45 and over every 5 years. For ATSI individuals, start screening at age 35 and over, every 5 years.

• Fracture Risk: Fracture risk calculation should be performed for postmenopausal women over 45 years and men over 50 years using the Garvan fracture risk calculator. This is critical for individuals with a history of osteoporosis or those who are at risk of falls.

• Skin Screening: Opportunistic screening for skin cancer should be conducted for individuals over 40 years, particularly those with risk factors like fair skin or a history of significant sun exposure.

Management:

• Blood Pressure: If elevated, initiate lifestyle changes (e.g., diet, exercise) and consider antihypertensive medications for high readings.

• Diabetes: Lifestyle modification, weight management, and glucose-lowering medications, including insulin or oral agents.

• CVD: Lifestyle changes, statins for lipid control, antihypertensive medications, and antiplatelet therapy if indicated.

• Lipid Management: Statins or other lipid-lowering therapies depending on cardiovascular risk assessment.

• Osteoporosis: Encourage weight-bearing exercises, calcium and vitamin D supplements, and bisphosphonates or other bone-protective medications.

• Skin Cancer: Regular self-examination and professional skin checks. Treatment of detected skin cancers may include excision or referral to a specialist.

Screening Recommendations:

1. Blood Pressure (BP):

   • Screen for all individuals 18 years and older every 2 years.

2. AUSDRISK (Diabetes Risk):

   • Screen individuals aged 40 and over every 3 years; ATSI individuals over 18 years should be screened every 3 years. It involves waist circumference measurements as a key indicator.

3. Cardiovascular Disease (CVD):

   • Screen all individuals 45 years and over every 2 years. For ATSI individuals, start screening from age 35 years. If the risk is low, blood tests from the previous 5 years can be used.

4. Lipid Profile:

   • Screen individuals aged 45 and over every 5 years for cholesterol levels. For ATSI individuals, start screening at age 35 and over.

5. Fracture Risk:

   • Postmenopausal women aged 45 and over, and men aged 50 and over should undergo fracture risk calculation using the Garvan fracture risk calculator.

6. Skin Screening:

   • Opportunistic skin screening should be performed for individuals over 40 years, especially for those at higher risk of skin cancer.

Prognosis:

• Early Detection: Timely screening allows for early detection of chronic conditions, improving long-term health outcomes. For conditions like CVD, diabetes, and osteoporosis, appropriate management can significantly reduce complications and mortality.

• Skin Cancer: Early detection and treatment of skin cancers improve survival rates, particularly for melanoma.

NOTES:

• ATSI Populations: Regular screening is critical for ATSI individuals, with earlier initiation and more frequent screenings compared to the general population due to higher risks.

• Reassessment of Screening Intervals: Adjust screening intervals based on individual risk factors. For example, those with a family history of diabetes or CVD may need more frequent assessments.