Download HEALTH SCREENING PROCEDURES

HEALTH SCREENING PROCEDURES
Cholesterol
Cholesterol is naturally produced by the liver, and helps carry fat to parts of the body
that need it for energy and repairs. Cholesterol is a soft, waxy substance found among
the lipids (fats) in the bloodstream and in all the body's cells. It is normal to have
cholesterol. It's an important part of a healthy body because it is used to form cell
membranes, some hormones, and serve other needed bodily functions. But too high a
level of cholesterol in the blood is a major risk for coronary heart disease, which leads to
heart attack. It is also a risk factor for stroke.
When cholesterol rises above a desirable level, it may build up in the body and may put
a person at increased risk for heart disease or stroke. Hypercholesterolemia is the term
for high levels of blood cholesterol.
A person gets cholesterol in two ways. The body makes some of it, and the rest comes
from animal products that are eaten, such as meats, poultry, fish, eggs, butter, cheese,
and whole milk. Food from plants like fruits, vegetables, and cereals do not have
cholesterol.
Cholesterol and other fats can't dissolve in the blood. They have to be transported to
and from the cells by special carriers called lipoproteins. There are two kinds that a
person needs to be concerned with. Low-density lipoprotein, or LDL, is known as the
"bad" cholesterol. Too much LDL cholesterol can clog the arteries to the heart and
increase the risk of heart attack. High-density lipoprotein, or HDL, is known as the
"good" cholesterol. The body makes HDL cholesterol for its protection. It travels away
from the arteries. Studies suggest that high levels of HDL cholesterol reduce the risk of
heart attack.
High cholesterol is one of the main risk factors for coronary heart disease that a person
can control. Periodic screening for high blood cholesterol is recommended for all men
starting at age 35 and women starting at age 45. Some believe that all adults age 20
and over should have their cholesterol measured periodically.
Coronary heart disease is the leading cause of death in America today. Elevated levels
of cholesterol play a significant role in as many as 50% of those deaths. Although high
cholesterol is a serious risk factor for heart disease, it can be modified. There are
several drugs on the market today to assist in lowering cholesterol levels.
Prostate-Specific Antigen (PSA)
Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland.
The PSA blood test measures the level of PSA present in the blood. When the prostate
gland enlarges, PSA levels in the blood tend to rise. PSA levels can rise due to cancer
or benign (non-cancerous) conditions. Because PSA is produced by the body and can
be used to detect disease, it is sometimes called a biological marker.
The PSA test does not give physicians enough information to distinguish between a
benign or cancerous condition, but the physician will take the test as an indication of a
pending condition and then can order further testing.
The U.S. Food and Drug Administration (FDA) has approved the PSA test to be used in
addition to a digital rectal exam to help detect prostate cancer in men ages 50 and
older. It is also approved to monitor patients with a history of prostate cancer to check
for reoccurrence.
Benefits from screening for prostate cancer are still being studied. Testing is currently
being done by the National Cancer Institute (NCI) to determine if certain screening tests
reduce the number of deaths caused by prostate, lung, colorectal, and ovarian cancer.
Using the PSA test to screen men for prostate cancer is controversial because it is not
yet known if the process actually saves lives.
Recommendations for screening vary. Some encourage yearly screening for men ages
50 and over. Others recommend against routine screening, and still others counsel
men individually about the risks and benefits of screening and leave the decision to the
patient. These patients should be informed of the risk factors that increase a man’s
chances of developing prostate cancer.
The most common risk factor is age. More than 96% of prostate cancer cases occur in
men ages 55 and older. Other risk factors for prostate cancer include a family history
and race. Men who have a father or brother with prostate cancer have a greater chance
of developing prostate cancer. African American men have the highest rate of prostate
cancer, while Native American men have the lowest.
No screening test is without its limitations. Even though the PSA test can detect small
tumors, it does not necessarily reduce the chance of death from prostate cancer. The
PSA test indicates a tumor is present, but does not identify what kind of tumor, slow
growing or aggressive. False positive tests can occur when the PSA level is elevated
and no cancer is actually present. There can also be false negative tests when the PSA
range is normal, even though prostate cancer is present. This is why research
continues to improve the PSA test.
Mammograms
A screening mammogram is an x-ray of the breast used to detect changes in women
who have no signs or symptoms of breast cancer. It usually involves two x-rays of each
breast. With a mammogram, it is possible to detect microcalcifications (tiny deposits of
calcium in the breast, which sometimes are a clue to the presence of breast cancer) or
a tumor that cannot be felt.
A diagnostic mammogram is an x-ray of the breast that is used to diagnose unusual
breast changes, such as a lump, pain, thickening, nipple discharge, or a change in
breast size or shape. A diagnostic mammogram is also used to evaluate changes
detected on a screening mammogram. A diagnostic mammogram takes longer
because it involves more x-rays to obtain more views.
The National Cancer Institute (NCI) recommends that women have a screening
mammogram every 1 to 2 years when they are in their 40s and older. Women who are
at higher than average risk of breast cancer should talk to their health care providers
about whether to have mammograms before age 40 and how often to have them. The
risk of developing breast cancer is not the same for all women.
Research has shown that several factors increase a woman’s chance of developing
breast cancer. Some of these factors include personal history of breast cancer; family
history; certain breast changes on biopsy; genetic alterations; reproductive and
menstrual history; breast density; radiation therapy; diet, and lifestyle factors. Refer to
the National Cancer Institute web site for more information.
Age is the most important risk factor for breast cancer. The older a woman is, the
greater her chance of developing breast cancer. Most breast cancers occur in women
over the age of 50; the number of cases is especially high for women over age 60 and is
relatively uncommon in women under the age of 40.
Even though several studies have shown that screening mammograms have reduced
the number of deaths from breast cancer, every woman should perform self-breast
exams on a routine basis. Breast self-exams (BSE) alone reduce the numbers of
deaths from breast cancer every year. BSE should not take the place of a clinical
breast exam by a health care provider and a mammogram. Mammograms can detect
breast cancer that cannot be felt.
Even though mammography can detect tumors that cannot be felt, finding a small tumor
does not always mean that a woman’s life will be saved. Mammography may not help a
woman with a fast-growing or aggressive tumor that may have spread to other parts of
her body before being detected. There are also false positive and false negative
reports. Overall, mammograms miss up to 20 percent of all breast cancers that are
present at the time of screening.
Pap Test
The Pap test (sometimes called a Pap smear) is a way to examine cells collected from
the cervix, which is the lower, narrow end of the uterus. This test can show the
presence of infection, inflammation, abnormal cells, or cancer. The Pap test is
performed during a pelvic exam. During a pelvic exam, an instrument called a
speculum is used to widen the vagina so the cervix can be seen. Another instrument is
used to obtain the sample of cells from in and around the cervix. The specimen (or
smear) is placed on a glass slide, treated with a fixative, and sent to a laboratory for
examination.
A Pap test and pelvic exam are important parts of a woman’s routine health care. They
can detect abnormalities that may lead to invasive cancer. These abnormalities can be
treated before the cancer develops. Most invasive cancers of the cervix can be
prevented if women have Pap tests and pelvic exams regularly. Women are
encouraged to visit their physician or other specially trained health care professional,
such as physician assistants, nurse midwife or nurse practitioner, who may perform Pap
tests and pelvic exams.
Current guidelines recommend that women who are or have been sexually active, or
have reached age 18, should have Pap tests and pelvic exams regularly. There is no
known age at which Pap tests cease to be effective. Yearly Pap tests and pelvic exams
are recommended. A woman should have the Pap test when she is not menstruating.
The best time is between 10 and 20 days after the first day of the last menstrual period.
About 50 million Pap tests are performed each year in the U.S. Five to seven percent of
these are reported as abnormal. An abnormal result may mean that the cells on the
surface of the cervix appear abnormal but are not necessarily cancerous. Some
abnormal conditions may lead to cancer but many do not. There are several
classifications of abnormal findings. These describe abnormal changes to cells on the
surface of the cervix.
As with any screening test, there can be false positive and false negative results. False
positive and false negative results do not occur very often, but they can cause anxiety
and can affect a woman’s health. Regular screening helps to compensate for the false
negative results. In 1996, the National Institute of Health (NIH) concluded that about
half of the false negative Pap tests were due to inadequate specimen collection. The
other half were caused by a failure to identify or interpret the specimens correctly. As a
result of these conclusions, new methods of collecting and reading cervical cells have
been developed.
Colorectal Cancer Screening
Colorectal cancer is a disease in which cells in the colon or rectum become abnormal
and divide without control or order, forming a tumor. Cancer cells invade and destroy
the tissue around them. They also break away from the tumor and spread to form new
tumors in other parts of the body.
Colorectal cancer is the fourth most common type of cancer and the second leading
cause of cancer death in the U.S. Although the numbers are decreasing, 135,000 new
cases are diagnosed and more than 56,000 people die from colorectal cancer each
year.
The exact causes of colorectal cancer are unknown. However, studies show that there
are certain factors that increase a person’s chance of developing this cancer. One
factor is age; colorectal cancer is more likely to occur as people get older. Other factors
are the presence of polyps (benign growths); personal history of colorectal cancer or
other cancers; family history of colorectal cancer; ulcerative or Crohn’s colitis; and diet.
This cancer may be associated with a diet high in fat and low in fiber.
Screening for colorectal cancer involves checking for health problems before they cause
symptoms. Several procedures are used in screening for colorectal cancer. A fecal
occult blood test (FOBT) checks for hidden blood in the stool. Studies have proven that
the FOBT, when performed every 1 to 2 years in people ages 50 and over, can reduce
the number of deaths from colorectal cancer.
Another screening method is a sigmoidoscopy, which is an examination of the rectum
and lower colon using a lighted instrument called a sigmoidoscope. A colonoscopy is
an examination of the rectum and entire colon using a colonoscope. Both of these
examinations can find precancerous or cancerous growths in the scoped area. The
colonoscopy has increased risks of bleeding and puncturing the lining of the colon.
Studies suggest that regular screening with sigmoidoscopy after age 50 can reduce the
numbers of deaths from colorectal cancer.
The American Cancer Society and the U.S. Preventative Services Task Force have
developed guidelines for colorectal screening. Although their recommendations vary for
which screening tests to use and how often to screen, all of the organizations support
screening for colorectal cancer. People should talk with their health care provider about
when and how to screen. Decisions will be made according to the risk factors present.
Skin Cancer Screening
Skin cancer is the most common cancer in the United States. It affects one million
Americans each year. Skin cancer accounts for about 2% of all cancer deaths. Nearly
all skin cancers occur in fair-skinned individuals who have been exposed to the sun, xrays, or ultraviolet light for extended periods.
There are three main types of skin cancer: basal cell, the most common; squamous cell;
and malignant melanoma. Basal and squamous cell cancers have an excellent
prognosis, but individuals with nonmelanoma skin cancer are at a higher risk for
developing additional skin cancers.
Skin cancers are easily detected clinically and are often cured by excisional biopsy.
That does not mean that they should be neglected, because when neglected, they can
be very deforming and may cause death. Melanoma, the least common and most
deadly, is responsible for about 75% of all deaths from skin cancer. Most research and
studies are based on the melanoma cancers.
Fair-skinned persons exposed to the sun are at a higher risk for skin cancer. The
incidence of melanoma rises rapidly in Caucasians after age 20. The best defense is
protection from ultraviolet light. Incidence increased 126% between 1973 and 1995 in
the U.S., while mortality rates of melanoma increased by 1.7% annually between 1973
and 1990. In the 90s the incidence rates stabilized and the mortality rates decreased
slightly, possibly due to the trend of prevention and early detection.
In 2002, about 53,600 individuals are expected to develop melanoma and almost 7,400
to die. Screening is the key to early detection. Over 90% of melanomas that arise in
the skin can be recognized with the naked eye. Very often there is a prolonged
horizontal growth phase where the tumor expands beneath the epidermis but does not
invade the dermis. Melanoma is 100% curable if treated prior to the onset of the vertical
growth phase with its metastatic potential.
People are asked to observe their skin and note any changes. A visit to the
dermatologist for a full screening provides a good baseline. This is an individual
decision based on skin type, personal history, and family history. Use of sunscreens in
prevention of melanoma has been challenged in several studies. The best prevention is
limited exposure to the sun and ultraviolet light.
Screening for Vision
Problems
Snellen Charts
 Come in a variety of types
 Some contain pictures for
small children
 Some have E in various
positions (Pt. points in
direction of E) for non-English speaking people or
non-readers
 Some contain letters of the alphabet
 Characters (letters or pictures) on the chart come in
specific heights - smallest at bottom of chart.
NORMAL VISION = 20/20
 When standing 20 feet from the chart, a
person should be able to see characters 20
mm high
 The top number represents the distance from
the chart.
Snellen charts test only for myopia.
 To test for hyperopia, a printing book or cards are
used.
 Color blindness is usually tested using the Ishihara
method
Vision Screening Terms and
Abbreviations
O.D.
Right Eye
O.S.
Left Eye
O.U.
Both Eyes
Myopia Nearsighted, defect in distance
vision
Hyperopia
Farsighted, defect in close
vision
Ophthalmoscope
examining the eye
Instrument for
Tonometer Instrument to measure
intraocular pressure
--sign of
glaucoma