Screening & diagnostics

1.4.3 Clinical health screening

For adults, screening and diagnostics are to detect and manage the risk factors for chronic diseases and some communicable diseases. Screening recommendations vary by country, and region. For the purposes of this report, we have relied on the US Preventive Task Force (USPTF) and UK National Screening Committee (NSI) recommendations.

 

Cardiometabolic Health

Screening recommendations for cardiovascular and metabolic disease have moved away from focusing on single risk factors to a more comprehensive aggregate risk assessment, for example the QRISK score in the UK and the ASCVD Risk in the US to calculate a patient’s 10-year risk of a CVD event (such as a heart attack or stroke). These calculators combine multiple factors, including age, sex, smoking status, blood pressure, cholesterol levels, and family history, to provide a more accurate and personalized risk score. The primary benefit of this approach is its ability to identify individuals who may have normal levels of a single risk factor but whose overall risk is high due to the combination of other factors. For example, the National Institute for Health and Care Excellence (NICE) guidelines recommend offering statin therapy to individuals with a QRISK score of 10% or greater for a 10-year CVD risk (NICE, 2023).

While specific guidelines vary slightly between organizations, the general approach to cardiometabolic disease screening in adults is consistently centred around the following risk factors:

Lipids (Cholesterol)

• In adults ages 40–75 to identify dyslipidemia and calculate a 10-year cardiovascular disease (CVD) risk. For adults ages 20–39, screening is recommended if they have other CVD risk factors (USPSTF, 2020).
• Adding Lp(a) and ApoB to a standard lipid panel can significantly improve risk assessment for CVD events, especially in individuals with “normal” cholesterol. This is discussed in the innovation in screening and diagnostics chapter.

Blood Pressure

• Annual screening is recommended for those aged 40 and older, and younger adults with risk factors in the US, it is measured every 5 years in the UK from age 45, or more frequently for those with risk factors.

Glucose (Prediabetes/Diabetes)

• Screening for abnormal blood glucose in adults ages 40–70 is recommended for those who are overweight or obese as part of a CVD risk assessment.

Abdominal Aortic Aneurysm (AAA)

• A one-time screening with ultrasonography is recommended for men aged 65–75, especially if they are smokers.

 

Cancer Screening

Cancer screening has a significant impact on public health by detecting tumours or precancerous lesions at an early, more treatable stage which has led to a reduction in cause-specific mortality for several cancers, particularly colorectal, cervical, and breast cancer. The introduction of cytology-based cervical cancer screening (Pap tests) led to a dramatic decline in cervical cancer incidence and death rates by 50-80% in developed nations (Cancer Research UK, 2024). A 10% increase in screening uptake can reduce colorectal cancer deaths by 21% and cervical cancer deaths by 40% (Knudsen et al., 2023). However, screening is only recommended for cancers where the benefits of early detection are proven to outweigh these harms through high-quality evidence from randomized controlled trials (USPTF, UK National Screening Committee, Cochrane collaboration).

Breast Cancer

Women aged 40–74 years get screened for breast cancer with mammography every two years in the US, and aged 50-71 every 3 years in the UK. For women with risk factors, e.g. a positive family history, screening recommendations begin at an earlier age.

Colorectal (Bowel) Cancer

There are varied approaches to screening for colorectal cancer. In the US and other countries, screening for colorectal cancer is routinely recommended for ages 45 -75, and on individual health and screening history for ages 76–85. Screening options include:

• Annual fecal immunochemical test (FIT) or high-sensitivity guaiac fecal occult blood test (gFOBT).
• Every 3 years a stool DNA test.
• Every 5 years a flexible sigmoidoscopy or CT colonography.
• Every 10 years a colonoscopy.

The UK has a bi-phase approach with an initial at home FIT test for people aged 50–74, every 2 years, followed by colonoscopy only if there is a positive FIT test. People over 75 years are not routinely offered screening.

Cervical Cancer

US recommendations are for screening with a Pap test from age 21, and co-testing (Pap and HPV) every 5 years for those ages 30-65. The UK recommends screening every three years for ages 25–49 and every five years for ages 50–64, with a bi-phase approach, initial testing only for high-risk HPV, and only if HPV is detected is a cytology test performed (American Cancer Society).

Lung Cancer

Screening for lung cancer is currently only for those at high risk, ie those aged 50–80 who are currently or were previously heavy smokers (at least 20 pack-years), who are offered low dose CT scans. The UK are rolling out a similar Targeted Lung Health Check program.

Prostate Cancer

Recommendations are debated, but men ages 55-69 should discuss the pros and cons of prostate-specific antigen (PSA) screening with their doctor.

 

Hormonal Health

Currently there are no recommendations for routine hormonal testing for men or women.

Female Hormonal Health

For women aged 40 and above, screening for menopause and peri-menopause is based on age, symptoms and menstrual cycle changes.

• Age 45+: For women aged 45 or older with typical menopausal symptoms (like hot flashes, irregular periods, or night sweats), no hormonal tests are needed to confirm the diagnosis. The diagnosis is made based on the woman’s self-reported symptoms and changes in her menstrual cycle. Hormonal levels, particularly follicle-stimulating hormone (FSH) and estrogen, fluctuate significantly during perimenopause and are not reliable indicators.
• Under Age 45: For women between 40 and 45 with menopausal symptoms, a hormonal test may be considered together with symptoms of perimenopause.
• Under Age 40: Hormonal testing is recommended for women under age 40 who are experiencing menopausal symptoms or an unexplained cessation of their menstrual cycle. A blood test for FSH, along with other hormones, can help diagnose premature ovarian insufficiency, which can lead to a higher risk of heart disease and osteoporosis.
• Other Hormones: There is no evidence to support the use of other hormones, such as anti-Müllerian hormone (AMH) or inhibin B, for the diagnosis of menopause or perimenopause. Salivary hormone testing is also not recommended as it lacks clinical validity for this purpose.

Male Hormonal Health

The decision to screen for hormonal imbalances, such as low testosterone, should be based on a man’s clinical signs and symptoms including such as decreased libido, erectile dysfunction, unexplained fatigue, depressed mood, or loss of muscle mass.

Initial screening is for a blood test for morning total testosterone.

 

Bone Health

Screening recommendations for bone health, aimed at preventing fractures caused by osteoporosis, are primarily based on age, sex, and individual risk factors.

US recommendations are for screening for osteoporosis with dual-energy X-ray absorptiometry (DXA) in all women 65 years or older, and of postmenopausal women younger than 65 at increased risk of fracture on clinical risk assessment tools.

The UK relies on clinical risk based assessment only. The Canadian Task Force on Preventive Health Care estimates the 10-year fracture risk for women 65 years and older, using the FRAX score (Kanis et al., 2009).

 

Infectious Diseases

National and international public health bodies prioritize screening for infectious diseases that are common, can be asymptomatic, and have serious health consequences if left untreated.

• HIV: Universal, one-time screening for all adults aged 15-65 is recommended in the US, and more frequent testing for those at higher risk.
• Hepatitis: A one-time screen for Hepatitis B (all adults) and Hepatitis C (all adults 18-79) is advised, with periodic testing for high-risk individuals (e.g., those who inject drugs).
• STIs (Chlamydia & Gonorrhea): Annual screening is recommended for sexually active women under 25 and for older women at increased risk. Syphilis screening is also targeted at high-risk individuals and pregnant women.
• Tuberculosis (TB): There is no universal screening for TB. Instead, targeted screening is advised for at-risk groups, such as those who have recently travelled to high-prevalence areas, live in congregate settings, or have a weakened immune system.