U.S. Preventive Services Task Force (USPSTF) Health Screening Recommendations.


Below are Preventative Screening Recommendations as presented by the U.S. Preventive Services Task Force (USPSTF). The USPSTF is charged with assessing the merits of various preventive health screening measures. Most recommendations are for the 18-65 years age group. Recommendations by other (mostly U.S.-based) authoritative organizations may also by included (and mentioned).

At bottom : How does this apply to screening procedures, as performed in Bangkok?

Blood Pressure :

One for the most important screenings! Possibly more important than a bunch of the other listed tests below all together.

Lipid profile screening :

USPSTF recommends screening men aged 35 years and older and women age 45 years and older. Screening should include total cholesterol and high-density lipoprotein cholesterol (HDL-cholesterol). Routine triglyceride measurements are not really warranted.
American Heart Association recommends lipid profile screening every five years, starting from age 20 (and more frequent of course if abnormal, and with increasing age).

Screening for Diabetes Mellitus :

Screening for type 2 Diabetes is recommended in adults with high blood pressure or hyperlipidemia (an abnormal lipid profile). This relates to the Fasting Blood Sugar, as a preliminary screening test. Insufficient evidence to screen general asymptomatic population.
American Heart Association recommends blood glucose level screening at least every three years, starting from age 45.

Hepatitis B Virus :

Strongly recommended in pregnant women. Not recommended for the general asymptomatic population (in U.S.A.). This rule likely does not apply to Thailand, where there is a high incidence of Hepatitis B amongst the general population.

HIV :

Necessity of screening dependent on patient history and symptoms.

Prostate cancer :

USPSTF states that evidence is insufficient for routine prostate cancer screening by Prostate Specific Antigen (PSA).

Breast cancer :

Screening mammography (with or without breast examination), every 1 to 2 years for women aged 40 and older, is recommended.

Cervical cancer :

Screening for cervical cancer is women who have been sexually active (and have a cervix), is recommended. This relates to the Pap smear test.
After age 65, this recommendation is amended and depends on previous results and risk. [It may not be necessary anymore at that age]

Colorectal cancer :

It is recommended to screen men and women 50 years of age and older for colorectal cancer. Various screening methods may be effective.

Recommendation by American Cancer Society :
Beginning at age 50 (for people with 'average' risk) : Fecal occult blood test and fecal immunochemical test (FIT), every year. Also a stool DNA test (sDNA) is mentioned as a recommendation.

Colonoscopy is recommended every 10 years. Other possibilities (alternative choices) are : double-contrast barium enema every 5 years, or CT colonography (virtual colonoscopy) every 5 years.

Tumor Markers :

CEA (CarcinoEmbryonic Antigen) :
Can be used as screening for certain types of cancer. It may be elevated due to a variety of different cancers. Often this marker is used (and more useful) to follow up its levels after treatment.

AFP (Alpha-Fetoprotein) :
Can be used to help diagnose and follow treatment of hepatocellular carcinoma (liver cancer). Levels are subject to interpretation (can be elevated due to other conditions than cancer).

Osteoporosis :

Women aged 65 and older, should be screened for osteoporosis (bone density tests).

Screening for Coronary Heart Disease :

Routine screening with electrocardiogram (EKG, ECG), exercise testing, computer tomography, scanning for coronary calcium, is not recommended. This advise by U.S. Preventive Services Task Force (USPSTF) states that potential harms of routine screening for coronary heart disease (CHD) exceed the potential benefits (for asymptomatic adults at low risk).

USPSTF also found insufficient evidence to recommend for or against (=maybe?) screening in adults at increased risk for CHD.

Just in July 2012 the Task forces issued the following striking statement regarding screening with a standard electrocardiogram (ECG).

Quote :

1.The Task Force recommends against screening with resting or exercise
electrocardiography (ECG) for the prediction of coronary heart disease (CHD) events in asymptomatic adults at low risk for CHD events.

2 The Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening with resting or exercise ECG for the prediction of CHD events in asymptomatic adults at intermediate or high risk for CHD events.
(reasons for not recommending relate to 'doing more harm than good' by doing the test)

Screening procedures in Bangkok, how do they differ, and some suggestions :

1) Blood tests in Bangkok cover the basics. It is not clear whether having the tumor markers evaluated, is of benefit. Contrary to the above recommendations, we would think tests for hepatitis B are useful in Thailand, in view of the high incidence of hepatitis B in the general population (leading to an increased risk of liver cancer in the country).

2) Tests for breast cancer and cervical cancer are clearly recommended. While PAP smear tests are included in almost all packages, a mammography is only present when you use the more extensive screening packages. Since these exams have to be performed regularly, we suggest you may request them separately on occasion, to avoid having to pay an expensive complete package.

3) Faecal occult blood tests are recommended certainly above age 50 years. There seems to be consensus that sigmoidoscopy and/or coloscopy needs also be performed from that age. These tests are not included in the packages offered by various hospitals in Bangkok. They are of course quite invasive and unpleasant procedures.

4) Most more extensive packages (for males) include tests for coronary heart disease (CHD). It is not clear that stress exercise tests and echocardiograms are recommended to be performed in customers without symptoms and at low-risk for heart disease.
In addition, if you are at high risk for heart disease (but yet without symptoms), recommendations on what you have to do to reduce your risk, will likely not substantially change whether you perform a lot of tests or not. If you are overweigth, smoking, have a high cholesterol or high blood pressure, don't exercise much, well you need to get a program to get all these risk factors under control.
Note : If you want to engage in strenuous exercise activities, while unaccostomed to it, you should have your cardiac condition evaluated, and above mentioned tests may have to be included.