To Do OR Not To Do: Are Screening Tests Required Post-50?

By definition, a screening test is done to detect potential health disorders or diseases in people who do not have any symptoms of the disease. Taking from this definition, there is a divide in the way people, including healthcare professionals, perceive the ‘need’ for screening tests. While some doctors and health professional refute the belief that screening tests post 50 are necessary until there is a sign or symptom shown by the individual, some believe these tests are like a map that sheds more light on the health of an individual.

For a healthy adult, routine screening tests need not be done unless they are symptomatic. However, as we ascend the ladder of age and reach the half-century of our life, it is better to tread cautiously and get some examinations done so that we are better prepared for any curveball that our body may throw at us, thereby eliminating unpleasant surprises. So, after 50 yrs of age, certain tests become vital and must be done annually.

Screening for Cancer

Starting with the most morose and life-threatening disease may be unpleasant but these tests must be carried out every year after the age of fifty for early detection and overall eradication of the condition at an early stage. Some commonly done cancer screening tests include–

PAP SMEAR: Imperative to carry out every year after the age of 50 to nip cervical cancer in the bud.
MAMMOGRAM: After the physical examination of the breasts is carried out, any lump felt in the breast must not be kept under observation without a mammogram. If there exists a family history of breast cancer, then it may even be carried out an earlier age.
PSA: Prostate Specific Antigen(PSA) levels are checked to make sure the prostate is not producing proteins above the ordinary level and if the results show a PSA level greater than 4.0 the physician may ask for a biopsy as well. However, whether this test should be performed or not is quite controversial. Doctors need to weigh the benefits of the PSA test against the short-term and long-term harmful effects of this screening method, including complications that can arise from biopsies and treatment, and the risk of overdiagnosis and overtreatment.
Colorectal Cancer Screening: Due to problems of indigestion being a usual event in the life of the elderly, a routine examination for colon cancer is advised as it will prevent a delayed detection and subsequent complications of colon cancer. Men aged 50 to 75 years should be tested using one of these three methods: Fecal occult blood test (annually), flexible sigmoidoscopy once every 5 years and colonoscopy every 10 years.

Tests for Cholesterol Level

Another pertinent test one must carry out is to check the level of cholesterol in the body. Although some amount of cholesterol, preferably HDLs, are necessary to carry out routine body functions, an increase in the levels of LDL or overall cholesterol levels may necessitate or indicate a switch to a healthier lifestyle. Via early detection, one can decrease the risk of a heart attack and also take measures to improve their health beforehand, without resorting to chronic intake of medications.

Blood Sugar Monitoring

As doctors, we are well aware that high blood sugar levels act as silent killers in our body and can deactivate all our systems, without much of a hint to us. This makes it very important that people suffering from diabetes do a fasting and postprandial blood sugar test at least once in 3 months while those who are asymptomatic may perform the test once a year. With regular exercise and diet modifications, a mild increase in blood sugar levels can be kept under check and maintained for life.

Individuals with no history of high blood sugar levels must get their blood sugar tested atleast once every 3 years according to the American Diabetes Association. It recommends testing for prediabetes and future diabetic risk for all individuals above the age of 45 years.

Abdominal Aortic Aneurysm

Men between 65-75 years who have smoked in their life need to get a one-time screening done by ultrasonography for an abdominal aortic aneurysm.

Thyroid Screening Tests

The thyroid gland has control over many physiological functions occurring in the body– right from hair growth, hormones, metabolism and weight management to body temperature! An optimum level of TSH is needed to keep the body’s clock running smoothly. So, getting a simple blood test for TSH levels is sufficient to know if there is a hitch in the smooth functioning of these hormones. While you may advise your patients to get a TSH done, but when was the last time you got your TSH levels checked?

How Necessary is an Electrocardiogram (ECG)?

Though non-specific and non-sensitive, this test gives physicians an indication about any disturbance, if present, in the functioning of the heart; and on detection of the slightest problem he/she may urge the patient to perform other investigations. A test that may seem undiagnostic in nature actually helps reduce the risk of heart attacks and prevents medical emergencies in the long run.

Is a Routine Blood pressure Check Important Post 50?

Measuring blood pressure when patients visit a physician is highly recommended, especially if they are above the age of 50, irrespective of whether they have any history of blood pressure problems or not.

How About a Weight check?

Standing on the weighing scale once a month is not only restricted to the health and figure conscious individuals but also to all geriatric patients so as to know if there is any drastic rise or fall in their weight, which could be due to an underlying pathology. A harmless, non-invasive test that can be a part of the routine tests performed by a physician.

Bone density

Once women are past menopause, it is extremely significant to check bone density as osteoporosis is a very common finding in this age group. If performed routinely, it can help take measures to prevent further weakening of bones before any mishaps occur.

Eye examination

The lens in our eyes tends to harden once we cross 50 yrs of age hence making day to day tasks such as driving or reading a problematic affair.

If one already has an eye problem or vision impairment they must get regular check-ups done to keep a tab on their extent.

As people cross the 50-year mark in their lives, they tend to develop more health problems than they had when they were in their 20s and 30s. Screening tests, therefore, become more important than ever post 50 as they help visualise early issues, assess risks associated with various disorders, encourage a healthy lifestyle and also keeps the individual prepared for any unplanned emergencies. Precautions are always blamed until proven useful in which case they are then labelled as unnecessary. All in all, one must always adapt to a life that keeps them happy, functional and satisfied while taking cautious measures to ensure the same. Are screening tests essential post 50? Well, there can’t be a single word correct answer in the form of the words YES or NO. In fact, there are some tests that are important and must be done in every individual post 50.

References

Schröder F, Hugosson J, Roobol M, Tammela T, Zappa M, Nelen V et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. The Lancet. 2014;384(9959):2027-2035. https://www.bmj.com/content/362/bmj.k3519
Routine Screening Tests for Men, Harvard Health Publishing, Available from https://www.health.harvard.edu/mens-health/routine-screening-tests-for-men
Heart Health Screenings, Available from https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/heart-health-screenings