Prioritize, Prevent, Protect: The importance of preventive health screenings for adults

Nearly 25 million US adults and 7% of US children and adolescents have high cholesterol [4]. But it’s important to recognize that cholesterol isn’t necessarily bad. In fact, it’s necessary for making hormones, supporting healthy metabolic function, and building cell membranes. Too much cholesterol can build up in your blood vessels, causing inflammation and contributing to cardiovascular disease. Therefore, the key is to optimize your cholesterol levels.

Cholesterol screening is often performed alongside blood pressure checks and measurements of height and weight to assess overall cardiovascular risk.

A standard cholesterol test is a simple, small blood draw that measures low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, and total cholesterol. However, this only tells us part of the story.

It’s important for your doctor to measure not just the weight of your cholesterol but also the number and size of your cholesterol particles, which can better determine your risk for heart disease [5]. Furthermore, getting tested for lipoprotein (a) - an atherogenic protein that is largely genetic - at least once can help provide a better understanding of one’s cholesterol profile. In addition, Apolipoprotein B (ApoB) is a more direct reflection of atherogenic risk than LDL cholesterol, which is typically estimated and not measured directly.

If you have a family history or other risk factors (e.g. sedentary lifestyle; smoking), you should get your cholesterol checked annually. Maintaining a healthy weight, monitoring your body mass index, and engaging in regular physical activity are important for heart health and can help prevent obesity and excessive weight gain. The first cholesterol screening should happen between ages 9-11 and again between ages 17-21, then every 4-6 years for healthy individuals [6].

Your doctor may recommend other screening tests as part of a comprehensive cardiovascular risk assessment.

Glucose isn’t the only thing that a doctor should be evaluating when it comes to a person’s metabolic health and diabetes risk. Along with measuring glucose, a blood test should also evaluate your insulin and hemoglobin A1C (which is an indication of your average blood sugar level over the past three months). It’s important to note that if you’re on a keto diet, you may have higher glucose and insulin levels when doing a fasting glucose tolerance test (in which you need to drink a glucose solution beforehand) due to increased sensitivity to glucose [7]. Certain health conditions and medical conditions, such as a family history of diabetes among close relatives, can put individuals at increased risk for developing diabetes.

Most doctors will perform a comprehensive metabolic panel with your annual blood work; however, new ADA guidelines recommend that all adults should get screened for diabetes every three years beginning at age 35 [8]. Understanding your risks for diabetes and related complications can help guide screening frequency and preventive strategies.

Of the 20 million Americans with thyroid problems, 60 percent are unaware [9]. Thyroid dysfunction can cause fatigue, sleep disturbances, appetite changes, changes in weight, hair loss, and even negative changes in mood. Thyroid dysfunction can also contribute to a range of health problems, making early detection important. Other factors, such as age and family history, may influence the need for thyroid screening. If you are experiencing these symptoms, it’s important to have your thyroid checked. It’s also important that your doctor is measuring the right things. Most standard thyroid tests only check thyroid-stimulating hormone (TSH) levels. However, you also want to make sure your doctor is measuring:

• Free T3 (triiodothyronine): the active form of the thyroid hormone

• Free T4 (thyroxine): an inactive form that is converted into T3

• Reverse T3: a metabolically inactive form of thyroid hormone that is also a marker for inflammation

• Thyroid antibodies: includes thyroid peroxidase antibodies and thyroglobulin antibodies

Oftentimes all other measurements can be normal but thyroid antibodies can be elevated, which is a sign of autoimmune thyroid problems like Hashimoto’s disease [10].

While your doctor should check your thyroid hormone during your annual blood work, it’s recommended that all individuals test starting at age 35 and get screened every five years [11].

Colorectal cancer is the third most common cancer diagnosed and, while it is slightly more common in men, it is the third leading cause of cancer-related deaths in both men and women in the US [12]. A colonoscopy is still considered the “gold standard” for detecting colorectal cancer [13]; however, research suggests that newer options, like the stool DNA test (Cologuard), are almost as sensitive (92% vs 95%) at detecting cancer as a colonoscopy [14]. Other screening tests may be available depending on individual risk factors and should be discussed with your healthcare provider.

Standard guidelines recommend that a colonoscopy be performed every 10 years starting at age 45 in low-risk individuals. Screening guidelines and screening recommendations from expert organizations help determine the appropriate timing and frequency of colorectal cancer screening. Those with risk factors should consider getting screened by 40 (or 10 years before the age when their family member was diagnosed) and keep up with screenings every five years [15].

Osteoporosis, or bone loss that occurs with age, affects 1 in 5 women and 1 in 20 men aged 50 or over [16]. Unfortunately, most people don’t know they have it. Certain medical conditions and health conditions, such as rheumatoid arthritis or long-term steroid use, can put individuals at increased risk for osteoporosis. A bone density screening can be incredibly beneficial, especially for women who have gone through menopause, as estrogen is the hormone that regulates bone mineral density. The Bone Health and Osteoporosis Foundation (BHOF) recommends bone density scans as early as age 50 for women and men who are at risk for fractures [17].

Besides being postmenopausal, individuals who aren’t at high risk for osteoporosis (such as family history or a sedentary lifestyle), should start getting screened at age 65 for women and age 70 for men. Talk to your doctor about risk factors for osteoporosis and whether you could benefit from early screening. Experts also recommend getting this test every two years [18].

This vaginal pap test, which detects abnormal cervical cell growth, human papillomavirus (HPV), and cervical cancer, is recommended for women starting at age 21. The HPV test is another important screening tool used to detect the human papillomavirus, which is a sexually transmitted infection that can lead to cervical cancer. The HPV vaccine is also recommended as a preventive measure to reduce the risk of HPV-related cancers. A Pap test should be done every 3 years until age 30, then every 5 years until age 65. If you have had an abnormal Pap test result, you may need to have more frequent screenings [19]. Screening guidelines and screening recommendations may vary based on individual risk factors, and women at increased risk should consult their healthcare provider for personalized advice.

The American Institute for Cancer Research estimates that at least 33% of US breast cancer could be prevented through lifestyle [20]. Of course, along with leading a healthy lifestyle, it’s important that all women get regular mammograms to check for breast cancer.

Screening guidelines and screening recommendations for mammograms are based on age, family history, and other factors. A new recommendation by the US Preventive Services Task Force states that women should start getting mammograms at age 40 and continue to get mammograms every two years until age 74 [21]. Women at high risk for breast cancer should begin screenings at age 30 [22]. Women with dense breast tissue may also need to undergo an ultrasound or MRI. Since dense breast tissue is associated with a higher risk for breast cancer (but also incredibly common), you may need to be screened annually [23]. Women with close relatives who have had breast cancer or who are at increased risk should discuss personalized screening plans with their healthcare provider.

Although there has been controversy surrounding the utility of this test, delving into the details of this screening can help you determine if it’s right for you. The standard PSA test doesn’t detect cancer directly, but rather, it measures the amount of prostate-specific antigen (PSA), a protein normally produced by the prostate, in your bloodstream. This offers insight into the size of your prostate.

Why is the size of your prostate important? The prostate tends to become larger with age. Usually, this is caused by a harmless growth known as benign prostatic hyperplasia (BPH), but sometimes this growth can be due to prostate cancer. Regardless, an enlarged prostate tends to “leak” higher PSA levels into the bloodstream. An elevated PSA reading can indicate an enlarged prostate due to BPH or prostate cancer, and follow-up testing is needed to determine the cause [24].

Men at average risk should start getting this test at age 50 every 2-4 years. Those with a family history or other risk factors may want to start by age 45 [25]. Screening guidelines and screening recommendations for prostate cancer may vary based on age, family history, increased risk, and other factors. Men with close relatives who have had prostate cancer or who are at increased risk should discuss screening options with their healthcare provider or care provider.

Though not a cancer-detection standard (yet!), those with high PSA might consider getting a 4Kscore® or prostate health index (PHI) test, which analyzes total, free, and intact PSA, differentiating low from high risk. A low-risk 4k score indicates a 99% non-cancer likelihood in 10 years [26].