Screening tests for adults
Currently, national screening programmes for cervical and breast cancer in women and bowel cancer in both sexes are in place or being implemented. Other screening is on an ad hoc basis and relies on people visiting their family doctor. Family doctors will selectively screen adult patients for a variety of other conditions if they are at risk. This is how most asymptomatic cases of high blood pressure and diabetes are found.
Cancer Council Australia
National Heart Foundation
Australia has one of the highest rates of bowel cancer in the world. Around 1 in 23 Australians will develop bowel cancer during their lifetime. The National Bowel Cancer Screening Program (NBCSP) invites eligible people starting at age 50 and continuing to age 74 (without symptoms) to screen for bowel cancer using a free, simple test at home.
Screening is using faecal occult blood (FOB) testing at home with samples being mailed back.
NHMRC guidelines indicate that for persons of average risk, FOB testing is recommended at least every two years for all people over the age of 50. If eligible, participation in the National Bowel Cancer Screening Program is recommended.
Breast cancer is the most common cancer in women. In 2018, it is estimated that 1 in 8 women will develop breast cancer before age 85.
BreastScreen Australia provides free breast screening every two years for all well women without symptoms in Australia aged 50 to 74 years. Women aged 40 to 49, and those aged over 74 can also be screened free of charge, however, they are not sent invitation letters.
Many deaths from cervical cancer can be prevented through timely screening. Detection and treatment of precancerous lesions found during a cervical screening test (HPV test) can actually prevent cervical cancer, as well as find cervical cancer at an early stage when it is most curable.
From 1 December 2017, human papilloma virus screening has replaced the PAP smear in the National Cervical Screening Program. The following policy applies to women with no symptoms.
1. Routine cervical HPV screening should be carried out every five years for women aged 25 to 74 who have no or history suggestive of cervical pathology
2. All women who have ever been sexually active should start having cervical HPV screening after age 25, or two years after first having sexual intercourse, whichever is later. In some cases, it may be appropriate to start screening before 25 years of age
3. People aged 70 to 74 years will be invited to have a cervical screening test.
See the short video below for more on HPV testing and how it can help you avoid cervical cancer.
More information can be found at the National Cervical Screening Program.
Genital Chlamydia trachomatis is the commonest sexually transmitted disease (STD) in Australia. Infection is an important reproductive health problem as 10-30% of infected women develop pelvic inflammatory disease (PID). Around 9% of sexually active young women are likely to be infected and around 70% of infections are asymptomatic and so, are liable to remain undetected, putting women at risk of developing PID.
Screening for genital chlamydia infection may reduce pelvic inflammatory disease and ectopic pregnancy.
Screening can be done from a urine test (first catch urine not midstream) or a genital swab and is done by nucleic acid amplification which is where the laboratory uses a sensitive test to look for genetic material from the organism.
This difficult-to-manage disease is now occurring with alarming frequency, affecting Australians at a younger age and certain ethnic groups in particular. Half the people who have the common form called type 2 diabetes do not know it, and there is concern about the complications that can develop while it is untreated.
The National Health and Medical Research Council (NHMRC) has determined that there is no justification for general population screening for diabetes in Australia. There is evidence that screening high risk groups is beneficial and the NHMRC and RACGP (Royal Australian College of General Practitioners) recommend that people in these high risk groups be opportunistically screened using a stepped approach starting with a fasting blood glucose measurement. The high risk individuals to be screened are:
- People with impaired glucose tolerance or impaired fasting glucose.
- Aboriginal and Torres Strait Islanders aged 35 and over.
- Pacific Islanders, people from the Indian subcontinent and people of Chinese origin.
- People age 45 and over who are either obese (BMI greater than or equal to 30) or have high blood pressure.
- All people with prior cardiovascular disease i.e. heart attack, angina or stroke.
- Women with polycystic ovary syndrome who are obese.
Heart disease is the leading cause of death in Australia. The risk of heart attacks rises with age and men of 45 years of age and older and women of 55 years of age and older are often at an appreciable risk.
The National Vascular Disease Prevention Alliance recommended in 2012 that priority be given to identifying people at increased risk of heart disease so that they can be given advice and treatment to reduce the risk of initial or recurrent heart attacks. The Consensus Statement recommends that people aged 45 years and over be targeted although it recognises that some people may be at high risk below the age of 45. Such people include those with multiple risk factors and people of aboriginal or Torres Strait islander ethnicity. The risk factors are shown in the table below.
||Biological risk factors
||Lifestyle risk factors
|Existing heart disease
||High blood pressure
||Protein in urine
||Overweight / obese
||Poor living circumstances
||Excessive alcohol consumption
Widespread population screening is not currently recommended in Australia. The Australian Guidelines recommend targeting those most at risk, i.e. those most likely to benefit from intervention. This is determined by the presence of known risk factors, such as smoking, high blood pressure, diabetes, chronic kidney disease, familial hypercholesterolaemia, obesity/overweight, a family history of early heart disease, aboriginal or Torres Strait islander ethnicity, high blood cholesterol (high total and high LDL), or low HDL cholesterol.
Assessment is best done by a lipid profile, a blood test conducted after a 9- to 12-hour fast, which determines your total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels.
While not recommended as a general screen, screening for iron overload disease is recommended based on known risk factors.
Hereditary haemochromatosis or iron overload disease, is the most common genetic disease in populations of North European origin, with a gene frequency as high as 1 in 8. Haemochromatosis causes the iron from a person's diet to accumulate in the body's organs. Over a lifetime and without treatment, serious and even fatal health effects can result.
General population screening is not recommended in Australia but screening of first-degree relatives of affected persons may be considered.
The need to inform Australian men about prostate cancer is increasingly important. Each year almost 3300 Australian men die from prostate cancer and more than 21,000 new cases are diagnosed.
Unlike cancers of the bowel, breast and cervix, there is insufficient evidence to support the benefits of population-based screening for prostate cancer using the prostate specific antigen (PSA) test. Current evidence indicates that the PSA test is not suitable for population screening, as the harms (see below) outweigh the benefits. Men who are concerned about prostate cancer should discuss it with their doctor.
Skin cancer is the most common cancer in Australia and accounts for about 80% of all new cancers diagnosed each year. Approximately 2 in 3 Australians will be diagnosed with skin cancer by the time they are 70. Non-melanoma skin cancer is more common in men, with almost double the incidence compared to women. In 2015, 2162 people died from skin cancer in Australia, 1520 from melanoma and 642 from non-melanoma skin cancers.
Both the Federal Government and the State Governments and Cancer Councils are active in skin cancer
prevention programmes. However the Cancer Council of Australia and the Australasian College of Dermatologists do not recommend population-based screening for any type of skin cancer. They do recommend that individuals carry out self-monitoring for skin cancer.
See the Healthdirect Australia: skin cancer pages for more information.
Current expert opinion suggests that general testing of the population detects only a few cases of overt thyroid disease and screening is therefore unjustified even in high risk groups such as women over 60 and those with a strong family history of thyroid disease. (US Preventative Services Task Force)
Testing is recommended in those patients who are at high risk of iatrogenic hypothyroidism because of previous thyroid surgery or treatment with radioiodine and those prescribed lithium or amiodarone.
While not recommended as a general screen, screening for tuberculosis (TB) is recommended based on known risk factors. In Australia the number of TB cases remains constant, about 1,000 new cases are diagnosed each year. Those individuals at risk for developing tuberculosis include HIV, being immunosuppressed (e.g. cancer, chronic kidney disease), migrants from high tuberculosis prevalence countries. Infected people may not feel ill or have symptoms but can reactivate and develop disease if treated with immunosuppressive medication or chemotherapy.
A tuberculin (Mantoux) skin test may be recommended if you are at risk of infection, have come in contact with a person infected with tuberculosis, in HIV-positive individuals and in some individuals receiving immunosuppressive therapy. A blood test is also available called an interferon gamma release assay or Quantiferon and has the advantage of not cross reacting in people who have had the BCG TB vaccine.
The skin or blood tests are mainly done to diagnose latent tuberculosis or for selecting people for the treatment of latent tuberculosis, and this is generally done through the TB health services.