Dr Devkota is an MBBS graduate from Gandaki Medical College, Pokhara, and Dr Neupane an MBBS graduate from Patan Academy of Health Sciences, Lalitpur. Both of them are currently working on various projects of Health Foundation Nepal.
Our ability to enjoy life and live well is based on our physical and mental health. As a result, scheduling a health screening is critical.
“I lost 10 kilograms in two months and had a bloody stool which I assumed was associated with piles," said a patient who had been having these symptoms for the past five years. She neglected to see a doctor all these years because of the incorrect self-diagnosis, but little did she know that a cancerous cell (colon cancer) was growing inside her body. This is a story of many Nepalis who put their lives at risk by dismissing cancerous symptoms. Had she been aware of the signs and what they signified, the treatment would have been a lot easier. Having said that, can we expect the common people to relate their symptoms to a disease? Absolutely not. Therefore, she should have rather opted for a screening test, which is one of the most viable options for preventing disease but is least practiced in Nepal.
So, what is a screening test?
A screening test is a medical test that is performed on an apparently healthy individual who is at an increased risk of developing a disease or disorder. It is a way of finding out an illness at an early stage, that is, before the body begins to show any symptoms. In other words, a screening test is done among symptom-free individuals. The goal of screening is to reduce morbidity (disease) or mortality (death) by detecting the disease as early as possible to increase the treatment success.
For which diseases can screening tests be performed?
Screening can be performed for various diseases and disorders, but some of the most common and recommended ones will be discussed here.
Colorectal cancer is a common type of cancer that develops at the end part of the large intestine. Its screening should begin at the age of 45 and should be continued until the age of 75. It should be done every 10 years on average, but more frequently if a family history of similar cancer is present. Another common cancer is cervical cancer. The cervix is the lower end of the womb/uterus. Two tests can be used to detect cervical cancer early. The first is a pap smear, which involves inserting a small instrument into the vaginal canal and gently scraping the cells from the cervix, which is then examined for signs of potential cancerous growth. It is done every three years, beginning at the age of 21. A combination of tests that includes a human papillomavirus (HPV) test and a pap smear is another option. The HPV test determines whether or not a person has the HPV, which causes cervical cancer. This combined test is done at the age of 30 and repeated every five years until 65.
Similarly, breast cancer screening should begin at the age of 50 and should be stopped at 74 years. A mammogram, an x-ray examination of the breasts should be performed every two years for this.
Lung cancer screening should begin at the age of 50 and and should be continued until 80 years of age. A low dose Ct scan is done for its screening every year. People who have smoked at least one pack of cigarettes a day for the last 20 years or who are still smoking or who have quit smoking within 15 years are the candidates for screening.
In addition to cancer screening, other chronic diseases can be screened to diagnose the disease at an earlier age. People over the age of 18 should have their blood pressure checked every three to five years, while those above the age of 40 should get it checked once a year.
Another common condition in our society is lipid disorders (abnormal cholesterol and/or fats in the blood). For this reason, the Centers for Disease Control and Prevention (CDC) recommends all healthy adults have their cholesterol checked every four to six years. However, people with heart diseases, diabetes, or a family history of high cholesterol, should get their cholesterol levels checked more frequently. Children and adolescents should have their cholesterol checked at least once between nine and 11 years of age and repeated between 17 and 21.
Similarly, Type 2 Diabetes Mellitus (high blood sugar) is a common chronic condition in our community. CDC suggests screening by either fasting glucose, oral glucose tolerance test (OGTT), HbA1C testing (a test that looks at average blood glucose levels over three months), or random glucose testing. One of the screenings, as mentioned above, is done on individuals 45 years or older. It is also done for those with risk factors, such as overweight, families (siblings, parents, or offspring) with diabetes, history of diabetes during pregnancy, and those who follow a sedentary lifestyle.
Osteoporosis is another common condition that affects nearly one in every five women aged 50 and above and almost one in 20 men aged 50 and above. In this condition, bones become weak, where a fall or even minor stress like bending or coughing can result in fractures. Women aged 65 and older and those aged 50 to 64 with risk factors such as low body weight, smoking, and osteoporosis in family members should be screened for it. The screening is done using a type of low-level x-rays called dual-energy x-ray absorptiometry (DEXA). DEXA can also detect weaker bones than expected and is susceptible to osteoporosis.
Abdominal Aortic Aneurysm is a term that many of us have never heard of. It is a balloon-like swelling in the wall of the main blood vessel supplying blood to the abdomen. Many people have no symptoms and are unaware they have this condition until it ruptures, which can be quickly fatal. Screening with ultrasound is recommended to detect this condition in men aged 65 to75 who have ever smoked.
Our ability to enjoy life and live well is based on our physical and mental health. As a result, scheduling a health screening is critical. The most effective health screenings are those that are personalized to your specific needs, with tests recommended based on your doctor's assessment of your age, gender, lifestyle habits, pre-existing conditions, and existing symptoms. The screening will check your overall health and discover any disease or health problems before they occur. Visit your doctor today to know more about these tests and live a healthy life with your loved ones.
(Dr Devkota is an MBBS graduate from Gandaki Medical College, Pokhara, and Dr Neupane an MBBS graduate from Patan Academy of Health Sciences, Lalitpur. Both of them are currently working on various projects of Health Foundation Nepal.)