We asked Dr Neil Forrest from our Star Vista practice to breakdown Health Screenings and unpack who should be doing what at what age. And what we really don’t need to be doing!
“Annual health screenings are one of the most enjoyable aspects of my job. Getting to spend more time with someone allows me to find out more about their life, work, family and hopes for the future. It helps me to get to know my patients better and in turn, makes me more effective as a doctor to them. But why do we do medical screening in the first place? When should you start? How frequently should you do it? What tests should you do?
The answer is: there’s no simple screening that suits everyone at a given age. The screening tests I recommend for a patient do depend on their age but also their lifestyle, family genetics, gender, medical history and of course, budget.
The truth is that on a population level, there are actually very few screening tests that are ‘worth’ doing for everyone as, thankfully, most tests results are normal for most people. However, people’s ideas around whether a test is worthwhile for them and their family may differ from that of a government health system, and I enjoy discussing the pros and cons of the various tests with my patients. What we end up with is a health check that is tailored to the individual rather than an off the shelf package.
Below is an overview of the kinds of tests we should be thinking about in each decade of life.
20 – 30 yrs
Most people in this age group need relatively little in the way of formal medical screening. Cardiovascular disease and diabetes are rare in this group but I check blood pressure and blood sugar as these are easy to do and it is best to pick up early warning signs. Women should start cervical screening (PAP) smear in their 20’s (I recommend from age 25) and physical checks for skin cancer and for men, testicular cancer are also relevant. Sexual health screening is often required in this age group.
30 – 40 yrs
In addition to the checks noted above, I would consider checking cholesterol levels and thyroid function in this age group, depending on family history and other factors. Breast examination in women is important as well as the skin and testicular checks noted previously.
40 – 50 yrs
This is when your medical screenings really should be done on a regular basis. In addition to the blood glucose and cholesterol levels, a more complete blood panel screening liver and kidney function is often performed. In most women some form of breast imaging, in addition to physical examination would be relevant. Although colorectal cancer and heart disease are rare in this age group, we may be able to detect early warning signs, so I usually undertake some additional cardiovascular screening (scans, treadmill tests) and recommend a first colonoscopy around age 45. In certain men I may also start screening for prostate cancer from the late 40s. Many people in this age group ask about running hormone tests – generally I do these to investigate someone’s symptoms rather than as a general screening test.
50 years onwards
Beyond 50 years old, I run regular blood tests with a complete screening panel. Colonoscopy and scans to asses risk for heart attack and stroke are done at least every five years. A bone scan to screen for osteoporosis is often recommended. Regular mammogram screening for women and prostate tests for men are also undertaken.
Also to note…
Cervical cancer – PAP smear tests should now include testing for HPV, the virus responsible for causing cervical cancer (for which there is also a vaccine!). If HPV testing is done then the PAP test only needs to be taken every 5 years, and this is normally done up to age 70.
Skin cancer – skin cancer is an ongoing risk at all ages, especially in countries with high levels of UV like Singapore. As well as an annual check with the doctor, it’s important to check your own skin for any changes on a regular basis.
Mental health – whilst this guide focuses on physical health screening, it’s important to discuss mental health and mood during your annual check-up, and I find that these consultations offer a good opportunity for people who may be hesitant to come to the doctor for mental health reasons. I often see people who have been booked for an annual physical by their partner, who is actually worried about their mental, rather than physical wellbeing.
In some cases, patients don’t have the time, budget or inclination do all the recommended tests on a given visit, so I help them prioritise what is most important and plan for the future. There are some tests like colonoscopy that are more readily available or cost effective in Singapore than in Europe or the USA, so many patients with future plans to relocate will take advantage of this opportunity.
At Osler, the process will always involve a discussion with a doctor first. This way we can ensure a personalised approach, giving you the tests you need, when you need them. Then you can relax knowing that you are doing all you can to maintain your health and wellbeing, and forget about all this until next year”! For more see here.
Dr Neil Forrest is a British GP based at Osler Health Star Vista practice. He is known for his calm, kind and measured approach to health. Tel: 6339 2727
This article was first published in Home/Life magazine by Lottie Lifestyle