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Screening Tests
for Persons at Risk

Screening tests are tools your health care provider uses for early detection of common and potentially deadly diseases.

Chlamydia and Gonorrhea

Chlamydia and gonorrhea are the most common bacterial sexually transmitted diseases (STDs) in the United States today, but most infected people have no symptoms. Heterosexual males are not routinely screened, although an infected male can spread these diseases and even re-infect a partner if he does not complete treatment. When diagnosed early, both diseases can be cured by antibiotics. Sexually active teens and young adults face the greatest risk of infection, but older adults in new or multiple sexual relationships also are at risk. Although fertility issues may not be a concern to older adults, the increased risk of becoming infected with other STDs remains a concern. Chlamydia and gonorrhea can infect the body through the genitals, anus, or mouth. Risk factors include the following: you are sexually active and less than 25 years old; you are sexually active and of African or Hispanic descent; you use drugs; you have a new male sex partner, have had 2 or more partners during the last year, or are a sex worker; you use barrier contraception inconsistently; or you have a history of STDs. Having one of these diseases increases your risk of becoming infected with human immunodeficiency virus (HIV). Many people have chlamydia and gonorrhea infections at the same time.

Older adults

The Association of Reproductive Health Professionals recommends that healthcare providers assess the risk of these diseases for their older adult patients. Older adults sometimes develop new sexual relationships, after a divorce, separation, or death of a long-term partner, for example.

Women

The U.S. Preventive Services Task Force recommends the following:

  • All sexually active females 25 years of age and younger should have a chlamydia test and gonorrhea test each year.
  • All other sexually active women who have no symptoms but are at increased risk for infection should be routinely screened.
  • If you are pregnant, more than 25 years old, and at increased risk, you should also be tested for chlamydia. If you are pregnant and at increased risk, you should be tested for gonorrhea.
  • The American Academy of Pediatrics recommends getting tested again after sex with any new partner.

The American College of Preventive Medicine suggests the following for females:

  • Have your healthcare provider review your risk factors at each routine care appointment so you know if you are presently at risk.
  • All adults, no matter what their weight or body mass, should be regularly counseled about the benefits of a healthful diet and physical activity.

Prostate Cancer

As many as 1 in 6 American men will develop prostate cancer during their lifetimes. Prostate cancer is the most frequently diagnosed cancer in males and the second leading cause of cancer death, after lung cancer. The strongest risk factor is age– it is rarely seen in men younger than forty while most cases are diagnosed in men 65 years of age or older. It is more common in African-American men and in those with a family history of prostate cancer.

Some prostate cancers progress quickly and cause death within months or a few years, but most grow slowly and never pose a serious threat. Prostate cancer screening tests are an important subject for men to discuss with their healthcare providers.

Expert panels have reached different conclusions about recommending universal screening for prostate cancer. Many complicated issues are involved:

  • Side effects of treatment (impotence and incontinence) can be more harmful than the cancer itself (about 1 in 4 cancers is slow-growing and may not cause any trouble).
  • Current technology cannot tell a slow-growing cancer from a fast one, and a man’s health or life expectancy may never be affected by the cancer.
  • Tests for prostate cancer do not detect all cases, and about one third of positive results do not prove to be cancer.
  • Some groups urge testing because the majority of evidence, though not conclusive, shows that early detection of prostate cancer saves lives. Since the introduction of blood tests for prostate-specific antigen (PSA tests) in 1990, more prostate cancers are being caught before they spread to other organs and become difficult to cure. However, the experts do not have enough information to conclude that this is a direct “cause and effect” relationship.
Informed decisions

The National Cancer Institute, U.S. Preventive Services Task Force, American College of Preventive Medicine, and American Academy of Family Physicians have refrained from recommending for or against routine prostate cancer screening for men at low risk. They are concerned about doing more harm than good. Through studies being conducted over the next 5 to 10 years, the medical community hopes to shed light on the issues so that firmer conclusions can be reached.

Most scientific and medical organizations agree that older and middle-aged men should receive balanced information about prostate cancer screening. This includes men with no known risk factors who have reached the age of 50 years and have a life expectancy greater than 10 years. They need to know the pros, cons, and limits of prostate cancer testing and treatment and should be helped to understand the risks and options. Both patients and healthcare providers are being advised to use “shared decision making” to determine if screening is appropriate for the individual.

Age recommendations

For men who decide that screening is right for them, the American Cancer Society and American Urological Association offer the most rigorous screening guideline:

  • Average risk: If you are of average risk, you can start getting tested at 50 years old. If you have risk factors, consider getting screened in your 40s. Citing evidence from various sources, the National Comprehensive Cancer Network suggests being more aggressive: men who want prostate cancer screening should consider getting a baseline PSA test at age 40.
  • Increased risk: If you are of African descent or have a father or brother who was diagnosed at an early age, go for testing at 45 years (40, according to the National Comprehensive Cancer Network and the American Urological Association).
  • High risk: If more than one relative was affected at an early age, you could begin testing at 40 years; then, depending on the results, get tested again at age 45 or earlier as results warrant.
  • The American Urological Association, National Comprehensive Cancer Network, and American Cancer Society advise using the digital rectal exam (DRE) and the PSA test, in combination, for the broadest detection of cancer in its early stages.

The American Cancer Society recommends that men 50 years of age and older who have a life expectancy of at least 10 years be offered both a PSA test and digital rectal exam each year. The U.S. Preventive Services Task Force says that testing once every other year may be as good as testing each year. However, the task force also, for the first time, published guidelines in 2008 recommending that such screening with PSA and DRE stop at age 75, citing concerns that the potential harms associated with screening outweigh the benefits of detecting prostate cancer early for those who are 75 and older or who have a chronic medical condition or a life expectancy of less than 10 years.

A healthcare provider can help you weigh the pros and cons based on your age, life expectancy, family history, race, and previous test results.

Tuberculosis

According to the Centers for Disease Control and prevention (CDC), there were 13,293 reported cases of tuberculosis in 2007, a decline by 4.2% compared to 2006. Overall, the TB incidence rate has decreased from 7.3%, as seen in the 1990s, to.8% during the first seven years of this decade. However, this rate of decline appears to be slowing, and the ultimate goal of eliminating TB in the US is still elusive. Slightly more than one per cent (1.1%) of those patients with TB has multidrug-resistant tuberculosis (MDR TB). In 2008, the World Health Organization (WHO) reported that MDR TB was at the highest rate ever.

While tuberculosis is still relatively rare in this country, it is a large health issue among at-risk groups. The rate is almost ten times higher in foreign-born persons living in the US as opposed to US-born individuals. Among those TB-positive patients in 2007 who were also tested for HIV, 11.3% were HIV-positive. HIV is now recognized as a key risk factor in the progression from latent to full TB infection; thus the CDC has recommended HIV testing for all TB patients. Current guidelines call for targeted screening among such groups. Adults who are part of or have been exposed to those who fall into high risk groups should also be considered for screening.

The infection may be detected via a tuberculin skin test and/or a blood test. The CDC notes that more data are needed on the blood test’s effectiveness in children and those with HIV or acquired immunodeficiency syndrome (AIDS). Although the CDC discourages routine screening of low-risk populations, students are often required to be tested before the first day of school, most healthcare workers are routinely tested for possible exposure, persons who have had contact with an individual who has suspected or confirmed TB, and persons with or at risk for HIV infection are the CDC’s highest screening priority.

If an adult has been exposed to a high-risk adult, he or she should be tested. The American Academy of Family Physicians’ high-risk category includes the following:

  • Those with close contact to a person with known or suspected TB
  • Healthcare workers
  • Immigrants from countries with a high rate of this disease (generally, less industrialized, developing nations)
  • People with HIV
  • Alcoholics
  • Users of injection drugs or other illicit substances
  • Residents of long-term care facilities (such as nursing homes, mental health facilities, prisons, AIDS care facilities, and homeless shelters)
  • Those considered medically underserved from a low-income environment

Others vulnerable to infection:

  • The elderly and individuals whose immune systems are impaired, including persons whose medical conditions or therapies put them at greater risk.
  • Persons who live in unclean or crowded places and those without healthy food.
  • Infants, children, and adolescents: if they are exposed to high-risk adults, they should be tested.
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