Screening tests for adults: 50 and over
The need for regular health checks is more important in your older years. Height, weight, and blood pressure should be monitored, and the need to update immunisation should be reviewed. Flu vaccine is currently offered to all people aged over 65 years. Vision and hearing should also be tested in the elderly.
A National Bowel Cancer Screening Programme is being implemented for men and women. For women, the National Screening programmes for Cervical and Breast Cancer are currently in place.
Cancer Council Australia
National Health and Medical Research Council
National Heart Foundation
NSW Health, Centre for Genetics Education: Haemochromatosis
Healthdirect Australia: Osteoporosis
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 will use 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 years. 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 ge 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 with 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.
- Routine cervical HPV screening should be carried out every five years for women aged 25 to 74 years who have no or history suggestive of cervical pathology
- All women who have ever been sexually active should start having cervical HPV screening after age 25, or one 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
- 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.
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 the 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
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.
Osteoporosis is a common disease in Australia with 1.2 million people estimated to have osteoporosis and further 6.3 million with low bone density. 1 in 2 women and 1 in 3 men over 60 years will have an osteoporotic fracture in Australia.
Population screening for osteoporosis is not recommended in Australia. Investigation of individuals may be considered on the basis of their profile of risk factors. Risk factors for osteoporosis include:
- being postmenopausal
- a family history of osteoporosis
- having chronic illness or malabsorption syndrome
- being on certain medications such as corticosteroids
- having a sedentary lifestyle
- excessive alcohol use
It seems that the more risk factors, the greater the risk. Screening using bone densitometry attracts a Medicare benefit for women aged 70 or more.
Currently in Australia there is no organised screening programme for prostate cancer. The Australian Cancer Society and the Australian Health Ministers' Advisory Council have together stated that the harm associated with screening for prostate using the PSA test outweigh the benefits.
Currently the decision to screen for prostate cancer should be made by the individual after discussion of the issues with the 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 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, immigrants and healthcare workers.
Typically, infected people do 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 done through the TB health services.