Screening Tests for Adults

 Current expert opinion in the UK suggests that general testing of the population detects only a few cases of overt thyroid disease and is therefore unjustified even in high risk groups such as women over 60 and those with a strong family history of thyroid disease. (Guidelines on the Diagnosis and Treatment of Hypothyroidism - British Medical Journal vol 313 pp 539-544 1996.
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.

Genital Chlamydia trachomatis is the commonest Sexually Transmited Disease (STD) in England. 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 PID and ectopic pregnancy.
A National screening programme to screen for Chlamydia is currently being developed.

Bowel cancer is also known as colon, rectal or colorectal cancer. The lining of the bowel is made of cells that are constantly being renewed. Sometimes these cells grow too quickly, forming a clump of cells known as a bowel polyp (sometimes known as an adenoma). Polyps are not bowel cancers (they are usually benign), but they can change into a malignant cancer over a number of years. A malignant cancer is when cancer cells have the ability to spread beyond the original site and into other parts of the body. Bowel cancer is the third most common cancer in the UK, and the second leading cause of cancer deaths, with over 16,000 people dying from it each year.

The UK National Screening Committee (NSC) reviewed the evidence for bowel cancer screening, and found that population screening of people over the age of 50 for non-visible (occult) blood in faeces can reduce the mortality rate for bowel cancer. In 2006, the NHS Bowel Cancer Screening Programme began and offers screening every two years to all men and women aged 60 to 74 in England. The Screening Programme is also open to individuals opting-in to be screened from age 75 and above. People within the age range are automatically sent an invitation, then their screening kit, so they can perform the test at home. After the first screening test, individuals are sent an invitation and screening kit every two years. For further information about the NHS Bowel Cancer Screening Programme. Separate screening programmes are offered in Wales, Scotland, Northern Ireland and the Republic of Ireland.

Guidelines for bowel cancer screening in higher risk groups, for example, those with a significant family history, have been produced by The British Society of Gastroenterology.

From 2013, some 55 year olds across England were invited to attend Bowel scope screening which involved the self-administration of an enema followed by visualisation of the colon by flexible-sigmoidoscopy. Following a review by the UK NSC, this part of the Screening Programme was discontinued in 2020.

In 2020, the UK National Screening Committee agreed that the Bowel Cancer Screening Programme should start from the age of 50. From April 2021, age-extension will begin across the programme. This will take place gradually over the next few years until all men and women in England age 50-74 are invited to participate every two years. Scotland already invites men and women age 50-74 and there are proposals for Wales and Northern Ireland screening programmes to do the same.

This difficult-to-manage disease is now occurring with alarming frequency, affecting Britons at a younger age and certain ethnic groups in particular. Many are unaware that they have the disease, and there is concern about the complications that can develop. The current view from the UK National Screening Committee is that there is no justification for population screening for diabetes in the United Kingdom. However, there is some support for screening and commencing intense treatment in population sub-groups in whom undiagnosed diabetes and coronary heart disease are especially prevalent. In individuals opportunistically identified as being at high risk of heart disease, additional testing for hyperglycaemia may be of benefit. Although the complications of diabetes are of public health importance, an appropriate strategy is to optimise management of blood pressure and hyperglycaemia in people with known diabetes and to ensure universal screening for eye disease and prompt treatment. It is unclear whether population screening for diabetes would significantly improve outcomes.
Obesity, hypertension, high cholesterol, inactivity, and a family history of diabetes are some of the factors that increase your risk of developing diabetes. Some ethnic groups, particularly South Asians and Afro-Caribbeans have a higher prevalence of the condition.
For further information see the Diabetes UK website.

The most common genetic disease in North European populations, with a gene frequency as high as 1 in 8, hereditary hemochromatosis, or iron overload disease, 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. The National Screening Committee’s most recent review of the evidence for screening for haemochromatosis (to be reviewed in 2005) concluded that screening should not be recommended.

Currently in the UK there is no organised screening programme for prostate cancer but an informed choice programme "Prostate Cancer Risk Management" has been introduced. Its aim is to ensure that men who are concerned about the risk of prostate cancer receive clear and balanced information about the advantages and disadvantages of the PSA test and treatment for prostate cancer. This will help men decide whether they want to have the test. General Practitioners have received advice about counselling and supplies of patient information sheets. For further information see the NHS Cancer Screening Website.

While not recommended as a general screen, screening for tuberculosis is usually recommended based on known risk factors.
In the UK, the number of TB cases is rising. Alcoholics, HIV-positive individuals, some recent immigrants and healthcare workers are at increased risk. The disease is most commonly found in places such as hostels for the homeless, prisons, and centres for immigrants arriving from areas with high rates of HIV infection or inadequate health provision.

Typically, you may not feel ill or have symptoms. If you are at risk of infection, for example you have come into contact with a person infected with tuberculosis, are HIV-positive or receiving immunosuppressive therapy, you may be given a tuberculin (Mantoux) skin test, a chest X-ray and sample of sputum or phlegm may be taken for laboratory examination.

It is recommended by the Health Protection Agency that individuals working as healthcare workers who are previously unvaccinated, and who are negative or grade 1 on tuberculin testing, should receive BCG vaccination.

For more information visit the Health Protection Agency and NHS Choices websites.