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. Should be measured at every clinic visit, and at least once a year.
Abdominal Aortic Aneurysm :
Recommended one-time screening for abdominal aortic aneurysm with ultrasound for men aged 65 to 75 years, who have ever smoked.(grade B). Dependent on other risk factors, in men who have never smoked. (grade C) Recommendations against screening in women for this disease.
Lipid profile screening :
The American Heart Association recommends all adults aged 20 years and older, should have their cholesterol checked every 4 to 6 years. (together with assessment of other risk factors). Amount of screening may very at a higher age, depending on other risk factors for coronary heart disease.
Ankle-Brachial Index (ABI)
Insufficient evidence to assess the balance of benefits and harms of screening for peripheral artery disease and cardiovascular disease in asymptomatic adults.
Screening for Diabetes Mellitus :
USPSTF recommends screening for abnormal blood glucose in adults age 40 to 70 years who are overweight or obese.
Hepatitis B Virus :
Strongly recommended in pregnant women. Also recommended for asymptomatic adolescents and adults at high risk of hepatitis B virus infection.
Remember that in Thailand there is a high incidence of Hepatitis B amongst the general population.
HIV :
Recommended for all pregnant persons. Recommended for adolescents and adults aged 15 to 65 years. Younger and older adults depending on increased risk of infection. At this moment not clearly defined how often to repeat HIV screening, but reasonable to do so when there is increased risk of HIV infection.
Prostate cancer :
In men aged 55 to 69, the pros and contras for PSA-based screening warrant explanation of the potential benefits and harms with a qualified physician. In any case, USPSTF states that clinicians should not screen men who do not express a preference for screening.
(grade C recommendation)
USPSTF recommends against screening this way for men 70 years and older. (D)
Breast cancer : (grade B)
Screening mammography, every 2 years for women aged 50 to 74, is recommended. From age 40 to age 49 (which in a previous version was explicitly recommended) there is the risk of more false positives, and overdiagnosis.
However, some patients at higher risk (like family history of breast cancer) may benefit. Evidence at present is not sufficient to prove more benefits than harms from performing additional ultrasonography. (grade C)
Cervical cancer :
For women aged 30 to 65 years, USPSTF recommends screening for cervical cancer with cervical cytology every 3 years, and every 5 years for high-risk human papillomavirus. Or cotesting both every 5 years. (grade A)
Women aged 21 to 29, are recommended screening with cervical cytology alone every 3 years.
Screening in older women is recommended against, provided they had prior screening and are not at high risk for cervical cancer.
Colorectal cancer :
It is recommended to screen men and women 50 sto 75 years of age for colorectal cancer. Various screening methods may be effective.(grade A)
Decision to screen older patients depends on their overall health and prior screening history. (grade C)
Recommendation by American Cancer Society :
No specific test for screening is clearly recommended ('talk to your healthcare provider'), but the age of 45 is mentioned as the starting point.
We checked an older review we made quite a few years ago. At that time there were the following recommendations :
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). In Thailand liver cancer is very prevalent. Not sure if expatriates are also likely to get it, there may be an increased risk if people go completely local (our own interpretation), have the same diets etc.
Osteoporosis :
Women aged 65 and older, should be screened for osteoporosis (bone density tests). Also at a younger age, if risk of osteoporosis is judged to be increased. (grade B) Not recommended for men.
Screening for Coronary Heart Disease :
Do not screen with resting or exercise ECG, in adults at low risk of cardiovascular disease events (grade D).
No recommendation in adults at intermediate or high risk of cardiovascular disease events (grade I, insufficient evidence).
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. 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.
5) The recommendation for HIV testing by USPSTF is striking, and one could suggest they are also applicable to Thailand. We did not find any health screening program we reviewed, where HIV screening is included or suggested as an option.
6) Having an EKG by itself if you are not having symptoms, may not be too revealing, and is not promoted by the above mentioned guidelines. However, it is a minor exam, and can be useful to compare later with subsequent EKGs.
Grading USPSTF :
Grade A : high certainty net benefit is substantial
Grade B : high certainty that the net benefit is moderate or there is a moderate certainty that the net benefit is moderate or substantial.
Grade C : selective recommendation ; moderate certainty that the net benefit is small.
Grade D : recommends against.
Grade I : insufficient evidence.