With the nationwide crisis in primary care and the pandemic-spurred changes in the virtual and in person availability of family doctors to their patients, healthcare has shifted further to reactive rather than proactive care.
Screening tests are the procedures and other investigations recommended to detect health problems — including diabetes, cancer and high blood pressure — early enough to improve patients’ outcomes with these conditions. They are regularly revised according to the best medical evidence and based on gender and age.
It's not unusual for a patient not to have seen their family physician since the start of the pandemic — now over four years ago! The unfortunate reality is that most of your healthcare encounters are reactive rather than proactive and preventive.
You usually make an appointment to your primary care provider when you have a problem such as a respiratory infection or bothersome symptoms such as fatigue, chest pain or weight changes.
If you're lucky enough to have a family doctor, get an appointment and the doctor is not in a rush, he or she will take the time to review your chart and in addition to addressing your presenting concerns, remind you if you are due for any screening tests, such as a blood pressure check, pap smear, mammogram or screen for diabetes.
But in the majority of your medical visits, this doesn't happen, and you may have no way of knowing what screening tests you need and when.
Here's a quick quiz to test your knowledge of screening tests.
- When should you check for high blood pressure?
High blood pressure (over 140/90 in a medical setting or over 135/85 at home) is a silent and usually asymptomatic risk factor that can increase your risk for arterial disease including strokes, kidney failure and heart disease (angina, heart attacks and heart failure).
Adults 18 and over should check their blood pressure by a doctor or nurse at least annually.
- When does a woman need a pap smear?
The pap test is a sampling of cells from the cervix to detect cancer at an early stage while it is treatable. This test starts at age 25 and if normal, repeated every 3 years. When a woman is 70 and has had three successive normal paps over the prior 10 years, she can stop screening.
- Do you need a test for diabetes?
People with diabetes have impaired glucose tolerance. It is a metabolic condition that if untreated can increased your risk for kidney disease, blindness, nerve damage and vascular disease.
Those at high risk based on the FINDRISC or CANRISK calculators (available online) should have a fasting glucose or Hb a1c blood test every 3 to 5 years. Those at very high risk require an annual blood test.
- When are screening mammograms recommended?
Breast cancers are more easily treated and often curable when detected by mammograms before a woman can even feel a lump. The current recommendation is to start at age 50 and continue every two years until the age of 69. However, women between 40 and 49 and over age 70, should discuss the risks and benefits of screening with their physician. If my 72-year-old patient is in good health and has a long life expectancy, I will recommend continued screening mammograms because the risk of breast cancer increases with age.
- How do we screen for colon cancer?
Colon cancer usually starts with a polyp in the large bowel that may bleed, and that blood may not be visible in your stools. The screening test in BC is the FIT (fecal immunochemical test) requiring a tiny amount of stool. It is recommended for all adults over age 50 every two to three years until the age of 70. In other provinces and countries, colonoscopies are publicly funded as screening tests every 10 years.
- When should a man start screening for prostate cancer?
As men age, testosterone stimulates the growth of the prostate gland that sits at the neck of the bladder. With benign enlargement of the prostate, most men will notice a gradual reduction of the urine stream, incomplete bladder emptying and dribbling after they think they're done.
If peeing from a dock were an Olympic sport, the world record for an 80-year-old would not be more than a few inches.
Men over 50 should have a discussion with their family physician about their prostate health and ask about a digital rectal exam. Don't expect a high-tech noninvasive scan. Digital refers to your doctor’s lubed gloved finger. Don't ask for a second opinion, or your doctor may use two fingers. The PSA blood test is not covered by MSP as a screening test. However, this approximately $40 lab test may detect prostate cancer before it can be felt by a digital rectal exam. Men should discuss the value of this test with their personal physicians.
All screening tests are intended for individuals who have no symptoms and are at average risk for these conditions.
A family history of breast, prostate or colon cancer can put you at a higher risk, and screening is recommended at earlier ages than for the general population.
If a woman has breast pain or feels a lump, she should see her physician immediately as an expedited diagnostic mammogram may be the more appropriate investigation after a physical examination.
If you see blood in your stool, consistent changes in the shape of your stools or persistent changes in your pattern of bowel movements, you should see your physician for a physical examination and possibly an expedited colonoscopy.
Dr. Davidicus Wong is a Burnaby family physician and has written for the NOW since 1991.
If you’re not sure if a new symptom warrants a visit to the doctor or you don’t know which screening tests you or your loved ones need, on Thursday, February 29th, 2024, Dr. Wong be giving a free online talk from 7 to 8:30 pm.
The topic: making sense of symptoms and screening tests.
Dr. Wong will review the screening tests recommended based on gender and age and how to determine which symptoms are normal and when you should see your doctor.
It’s part of the Burnaby Division of Family Practice’s Empowering Patients health education program.
To register, you can email Leona at [email protected], call 604-259-4450 or visit the event's Zoom link.
