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Family Health Magazine - growing older

Screening Tests
Another way to protect your health

It is time for your periodic health examination. Your doctor listens to your history, asks questions about your health, pokes and taps, and carefully evaluates the results. Nothing seems to be wrong.You feel great. However, your doctor still orders a whole battery of medical tests! Why are all of these tests necessary?

Screening tests are often used to check for health problems that even the most careful physical exam can miss. Tests ordered when you do not have symptoms are called screening tests. Some, such as the fecal occult blood (poop) test, are based on age-specific health recommendations. Others are ordered based on what you tell your doctor about your health or health issues in your family.

Screening, in medicine, is a strategy used in a population to identify the possible presence of an as-yet-undiagnosed disease in individuals who do not have signs or symptoms. This can include people with a disease before symptoms show or before symptoms are recognized. As such, screening tests are somewhat unique in that they are done on people who are apparently in good health.

The Canadian Task Force on Preventive Health Care (CTFPHC) has been established by the Public Health Agency of Canada (PHAC). Their role is to develop clinical practice guidelines that support primary care providers in delivering preventive health care. Guideline development is based on systematic analysis of scientific evidence. There are a number of guideline developers, including provincial organizations and specialty groups, in addition to the CTFPHC. Not all groups agree on the CTFPHC guidelines.

Screening tests can be a bit inconvenient in terms of time, since results are often normal. However, they may be very useful in helping diagnose problems that would otherwise be missed.

To many people, screening instinctively seems like an appropriate thing to do, because catching something earlier seems better. However, no screening test is perfect. Screening can certainly improve outcomes. As such, the CTFPHC is constantly evaluating the usefulness of any screening test. Some of the new recommendations are quite different compared to what was previously recommended. In fact, the CTFPHC provides knowledge tools that make it easier to understand the harms and benefits of screening. CTFPHC recommendations are made for specific age categories. For more information, you can go to the CTFPHC site (

Fecal occult blood

Stool, or feces, is formed mostly from undigested food. It offers important clues about problems in the digestive system. Blood in the stool suggests that there has been bleeding somewhere along the digestive system. Such bleeding can be caused by many problems including ulcers, inflammatory bowel diseases, and colorectal cancer. If blood is present, it will not be evenly distributed throughout the stool but deposited in small amounts here and there. The words fecal occult blood means blood hidden in the stool.

The CTFPHC recommendations apply to adults aged 50 years of age and older who are not at high risk for colorectal cancer (CRC). They do not apply to people with previous CRC or polyps, inflammatory bowel disease, signs or symptoms of CRC, or a history of CRC in one or more first-degree relatives. They also do not apply to adults with hereditary syndromes that place them at risk for CRC (such as familial adenomatous polyposis or Lynch Syndrome).

The screening test is commonly referred to as a ‘poop test.’ One test is the FIT, and it requires one sample. It is fast replacing the gFOBT, which commonly needs three samples. The CTFPHC recommends CRC screening for adults:

  • aged 60 to 74 with FOBT (either gFOBT or FIT) every two years or flexible sigmoidoscopy every 10 years.
  • aged 50 to 59 with FOBT (either gFOBT or FIT) every two years or flexible sigmoidoscopy every 10 years.

Pap smear

The cervix, or opening into the uterus, is at the end of the vagina (birth canal). Cancer of the cervix kills 8,000 women in North America each year.

The Pap smear, invented by Dr. Papanicolaou, checks the cervix for suspicious cells that indicate cancer. A small swab takes cells from the cervix. These samples are placed on slides and looked at under a microscope. The CTFPHC recommends the following for screening women for cancer of the cervix:

  • younger than 20 years – not routinely screened.
  • aged 20 to 24 – not routinely screened.
  • aged 25 to 29 – routine screening every three years.
  • aged 30 to 69 – routine screening every three years.
  • aged 70 and older:
    • for women who have been adequately screened (this means three negative Pap tests in a row in the last 10 years) – routine screening may cease.
    • - for women who have not been adequately screened – continued screening until three negative test results have been obtained.

Pelvic examination

The CTFPHC has adopted the American College of Physicians (ACP) 2014 recommendation on the use of pelvic examinations to screen for cancer (other than cancer of the cervix), pelvic inflammatory disease, and other gynecologic (reproductive system) conditions.

The recommendation applies to screening pelvic examinations for adult women who do not have symptoms and are not pregnant. However, it should be noted that a pelvic examination is appropriate in other clinical situations, such as diagnosing gynecological conditions when a woman has symptoms, or in following up a previously diagnosed condition.

The CTFPHC recommends not performing a screening pelvic examination to screen for non-cervical cancer, pelvic inflammatory disease, or other gynecological conditions in asymptomatic women.

Lung cancer

These recommendations apply to adults aged 18 years and older who are not suspected of having lung cancer. They do not apply to people who have a history of lung cancer, or suspected lung cancer.

The CTFPHC based the recommendations on the overall balance between the possible benefits and harms of screening for lung cancer. They weighed the potential benefits of early disease detection against the harms of over-diagnosis and invasive follow up testing.

*Pack year =

Average number of cigarette packs smoked daily


Number of years smoking

  • Low dose computed tomography (LDCT)
  • For adults aged 55 to 74 years with at least a 30 pack-year* smoking history, who currently smoke or quit less than 15 years ago – the recommendation is annual screening with LDCT up to three consecutive times.
  • Screening should only be carried out in health care settings that have expertise in early diagnosis and treatment of lung cancer. Many settings do not have the expertise needed. The main issue with LDCT scanning is the rate of false positives.
  • For all other adults, regardless of age, smoking history or other risk factors – the recommendation is not screening for lung cancer with LDCT.
  • Chest x-ray (CXR)
    • It is recommended that a chest x-ray not be used to screen for lung cancer. This applies whether or not a test has been done to look for abnormal cells in the sputum under a microscope. (This is called sputum cytology.)


A mammogram is used to screen women for breast cancer. Each breast is squeezed between two plates, and low-dose x-rays are used to take a picture. These x-ray pictures help doctors identify changes within the breast that may or may not be cancer. Mammograms can find extremely small lumps that are too tiny to be felt during a physical exam.

Recommendations are presented for the use of mammography, magnetic resonance imaging, breast self-exam and clinical breast exam to screen for breast cancer. These recommendations apply only to women at average risk of breast cancer aged 40 to 74 years. They do not apply to women at higher risk due to personal history of breast cancer, history of breast cancer in a first degree relative, known BRCA1/BRCA2 gene mutation, or prior chest wall radiation. No recommendations are made for women aged 75 and older, given the lack of data. For screening women with mammography, the recommendations are:

  • at ages 40 to 49 – not routinely screened.
  • at ages 50 to 69 years – routinely screened every two to three years.
  • at ages 70 to 74 – routinely screened every two to three years.

Bone densitometry

The medical term for a bone scan is dual energy x-ray absorptiometry, or DEXA. This test uses low-dose x-rays to determine the density of bones. Bones that are less dense are also weaker.

If your bones are weak and more likely to fracture than normal, you have osteoporosis. If your scan detects weak bones, your doctor can help you include exercise and a healthy diet into your lifestyle. A variety of useful medications can build stronger bones.

The Executive Committee of the Osteoporosis Canada Scientific Advisory Council has developed the following recommendations:

  • All men and women over age 65 should have a DEXA bone scan. Those at risk of osteoporosis should have it done earlier. This includes women who have gone through menopause and people with a family history of osteoporosis. Asian and European women with small body frames are also more likely to have weaker bones as they age.

Prostate specific antigen

Prostate specific antigen, or PSA, is a substance produced by a man's prostate gland (located just below the bladder). PSA is released into the bloodstream, so a blood test can measure the concentration of PSA. An elevated level can be normal, but is also associated with prostatitis (inflammation of the prostate gland) or prostate cancer.

There is some controversy about PSA testing. Many men will develop prostate cancer. However, most die of another disease before the cancer ever becomes fatal. This clinical practice guideline applies to all men not previously diagnosed with prostate cancer. This includes men with lower urinary tract symptoms (needing to wake in the night and pass urine, urgency, frequency, and poor stream) or with benign prostatic hyperplasia (BPH).

That being said, the Canadian Cancer Society recommends that all men over age 50 should at least discuss the PSA test with their family doctor. African men and men who have a family history of prostate cancer should consider the test even earlier.

  • For men aged less than 55 years, they recommend not screening for prostate cancer with the prostate-specific antigen test.
  • For men aged 55 to 69 years, they recommend not screening for prostate cancer with the prostate-specific antigen test.
  • For men 70 years of age and older, they recommend not screening for prostate cancer with the prostate-specific antigen test.

Diabetes screening

A proven and dependable method must be used to assess level of risk of diabetes. The recommendations are for diabetes screening for adults:

  • at low to moderate risk of diabetes – not routinely screening for type 2 diabetes.
  • at high risk of diabetes – routinely screening every three to five years with A1C.
  • at very high risk of diabetes – routine screening annually with A1C.

The A1C is a blood test that provides information about a person’s average levels of blood glucose over the previous three months.

Recommendations are presented for screening asymptomatic adults for type 2 diabetes. They do not apply to people with symptoms of diabetes or those at risk of type 1 diabetes.

Hypertension (high blood pressure)

  • The CTFPHC recommends that blood pressure measurement happen at all appropriate primary care visits. Appropriate visits may include new patient visits, periodic health exams, urgent office visits for neurological or cardiovascular related issues, medication renewal visits, and other visits where the primary care practitioner deems it an appropriate opportunity to monitor blood pressure. It is not necessary to measure blood pressure for every patient at every office visit if not clinically indicated.
  • They also recommend that blood pressure be measured according to the current techniques described in the Canadian Hypertension Education Program (CHEP) recommendations for office and out-of-office (ambulatory) blood pressure measurement.
  • The frequency and timing of blood pressure screening may vary between patients. The risk of high blood pressure and the risk of stroke or heart disease change over a person’s natural lifespan. It increases with age, and the presence of other disease conditions and other risk factors. Therefore, appropriate screening frequency may increase accordingly, especially in patients with more than one vascular risk factor. Adults identified as belonging to a high-risk ethnic group (South Asian, Aboriginal, African ancestry) may benefit from more frequent monitoring. Having recent, consistently normal blood pressure measurements may decrease the need for monitoring. A tendency toward high-normal blood pressure could indicate that more frequent monitoring is needed.

Other tests your doctor may do are not specifically screening tests, but rather a form of surveillance of your health, depending on what health concerns you may have.

Blood tests

Blood supplies all the cells in your body with nutrients and oxygen. At the same time, it removes waste products and carbon dioxide. Hundreds of different tests can be done on blood.

Normally, an annual blood test only screens you for the following common health problems.

  • CBC (complete blood count) – computers analyze and count each different part of your blood. This includes red blood cells, white blood cells, and the platelets (that help with blood clotting). A CBC can find conditions like anemia, leukemia, and blood clotting problems.
  • ALT (alanine aminotransferase) – ALT is one of many enzymes made by your liver. Elevated levels of any of the liver enzymes in your blood can signal a liver disease like hepatitis or gallbladder disease.
  • Serum creatinine – creatinine is a waste material produced by active muscles. Your kidneys clear it from the blood into the urine. An abnormally high serum creatinine level means that your kidneys are unable to remove creatinine from your body, as in kidney failure.
  • Lipids – lipid tests measure levels of triglycerides, bad LDL cholesterol, and good HDL cholesterol. High levels of triglycerides and LDL cholesterol, and low levels of HDL cholesterol, are associated with heart attack and stroke.
  • TSH (thyroid stimulating hormone) – TSH, a chemical in your body, stimulates your thyroid gland to make thyroid hormone. Abnormal TSH levels warn your doctor that your thyroid is not working properly.

Older adults

(age 50 years or older)

Younger adults

(50 years or younger)

These clinical risk factors for fracture apply to menopausal women and men between the ages of 50 and 64.

  • A fragility fracture after age 40*
  • Long use of glucocorticoid medication
  • Having a parent who has fractured a hip
  • Fracturing a vertebra in the spine
  • Osteopenia (lower bone mineral density than normal) identified on a radiograph
  • Current smoker
  • High alcohol intake
  • Rheumatoid arthritis
  • Low body weight (less than 60 kg)
    or major weight loss (losing more than
    10 percent of your body weight at age 25)

A fragility fracture after age 40*

  • Minimally functioning sex glands (hypogonadism) or premature menopause (at age 45 or younger)
  • Intestines that cannot adequately absorb certain nutrients (malabsorption syndrome)
  • primary hyperparathyroidism (results in increased calcium in the blood)
  • Long use of glucocorticoid medication

Urine studies

Urine is made by the kidneys. It is a mixture of water, electrolytes and other substances. From the kidneys, urine travels down small tubes, called ureters, into the bladder. It is stored there until released from the body via another small tube called the urethra.

Doctors can learn much about how your body is working by analyzing the contents of your urine. Red blood cells show that there has been bleeding somewhere along the urinary or genital systems. White blood cells suggest inflammation, such as a bladder infection. The presence of protein is used to monitor diabetes.

Book a full check-up with your family doctor, and faithfully get your screening tests done. This way, you and your doctor can work together to help you live a longer and healthier life.

FAMILY HEALTH is written with the assistance of:
College of Family Physicans of Canada
Alberta College of Family Physicians
FAMILY HEALTH is written with the assistance of:
College of Family Physicans of Canada
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2019, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1    [GO_FHab17]
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