The following recommendations apply for adults.
Weight. Weight should be recorded at least every few years. Obesity is a major reversible health risk for adults, contributing to many diseases (e.g. heart disease, diabetes, arthritis). Body mass index (BMI) should ideally be between 20 and 25.
Abdominal obesity is a major risk factor for adults. The waist:hip circumference ratio is regarded as a useful predictor of cardiac disease. Recommended waist:hip ratios are:
Blood pressure. Blood pressure should be recorded at least every 1–2 years on all people 16 years and over. There is no dispute that control of blood pressure results in reduced mortality from cerebrovascular accidents and, to a lesser extent, heart disease, kidney failure and retinopathy.
Cholesterol. All adults aged 45 and over should have a 5-yearly estimation of serum cholesterol. Total cholesterol is adequate for screening purposes. HDL levels give additional information. The National Heart Foundation recommends keeping cholesterol levels below 4.0 mmol/L. For most, dietary modification is sufficient to achieve these levels; some may require drug treatment.
Fasting blood glucose. Screen every 3 years for all patients >40 years of age.
Cervical cancer. From age 25 (to age 74), women who have ever been sexually active should commence cervical screening with a HPV test 2 years after their last Pap test. If negative, this can be performed every 5 years. If positive, cervical cytology will be checked with the sample and follow-up is determined according to the national guidelines. Women aged 70–74 should be offered a final ‘exit test’ and can cease screening if negative.
Breast cancer. Mammography should be performed at least every 2 years on women aged 50–74 years. It is not useful for screening prior to age 40 years due to difficulty in discriminating malignant lesions from dense tissue. Women aged 40–49 years may also choose to have a mammogram.14 Mammography must not be used alone to exclude cancer if a lump is palpable. Such lesions require a complete appraisal since, even in the best hands, mammography still has a false-negative rate of at least 10%. Genetic testing should be considered in those at risk.
Colorectal cancer (CRC). A history should be taken, with specific enquiry as to family history of adenomas or colorectal cancer, past history of inflammatory bowel disease and rectal bleeding. Rectal examination should be performed as part of an examination. Faecal occult blood testing (FOBT) every 2 years is now recommended for screening for people over 50 years without symptoms and with average or slightly above average risk.
Should a positive history be elicited, then the following are recommended:
past history of large bowel cancer or colonic adenomas—colonoscopy
past or present history of ulcerative colitis—colonoscopy with biopsies
familial polyposis, Gardner syndrome—sigmoidoscopy or colonoscopy
Prophylactic colectomy needs consideration in some individuals.
Apart from FOBT screening, the National Health and Medical Research Council (NHMRC) currently recommends 2-yearly colonoscopy for people from 25–30 years of age if there is a family history on the same side of the family of:
three or more first or second degree relatives with CRC at any age
two or more first or second degree relatives diagnosed as CRC <50 years of age
a family member where genetic studies identify a high risk
Refer to the RACGP Guidelines for Preventive Activities in General Practice14 for further information. Genetic testing should be considered in those at risk.
Prostate cancer. Screening is controversial. The RACGP guidelines do not recommend routine screening with DRE, PSA or transabdominal ultrasound. Patients should make their own decision after being fully informed of the potential benefits, risks and uncertainties of testing. Doctors should also use their clinical judgment for their individual male patients.
Skin cancer. All patients should be informed regularly about the need for protection of the skin and eyes from ultraviolet (UV) radiation, using hats, clothing, sunglasses and sunscreens, and avoiding exposure during peak UV periods (10 am to 3 pm).
Skin cancer, which is increasing in incidence, is common in Australia, particularly in more northern areas. Squamous cell carcinoma, and melanoma in particular, may be lethal. Detection and treatment of early lesions prevents mortality and morbidity. Prevention of skin cancer by reduction of sun exposure should be taught to all patients.
Oral hygiene/cancer. Patients should be counselled about cessation of smoking and alcohol consumption, and dental hygiene should be taught. The oral cavity should be inspected annually in patients over the age of 40 years.
Although oral cancer has a relatively low incidence, premalignant lesions may be detected by inspection of the oral cavity. Its incidence is highest in elderly people with a history of heavy smoking or drinking. Poor dental hygiene may result in poor nutrition, particularly among the elderly.
Cancer screening in summary14
Screen for breast, cervical and colorectal cancer.
Routine population-based screening is at this stage of evidence not recommended for lung, melanoma, ovarian, prostate and testicular cancers.