Want to understand the health status of your parents, detect diseases early for early intervention, but at the same time do not want to undergo excessive examinations and treatments that bring physical and mental burden to your parents, how to achieve a “win-win” situation? What are the key checks when taking your parents for a health checkup for the first time?
First, it should be stated that the appearance of physical discomfort symptoms is likely to be the body’s “distress signal”.Especially for the elderly, when physical discomfort occurs, it is best to visit the corresponding specialty for assessment to clarify the cause. If there is no special discomfort in normal times, or if chronic diseases are well controlled, one can choose to have a health checkup to understand the health status of their parents, detect diseases early, and achieve early intervention.
Adult health check-ups, screening mainly includes two aspects, chronic disease screening and cancer screening. The characteristics of health check-ups for the elderly are: (1) the incidence of chronic diseases and cancer is higher than that of young and middle-aged populations; (2) more prone to complications related to chronic diseases; (3) in cancer screening, after a certain age, weigh the pros and cons, and choose selective screening or discontinue cancer screening.
Therefore, the following introduces the key check-up items for the first time taking parents for a health check-up from basic check-up items, chronic disease items, and cancer items.
Basic Check-up Items
Basic check-up items refer to any age group is recommended to do,can preliminarily, quickly, and at a low cost determine whether there are significant diseases in the cardiovascular, respiratory, digestive, urinary, and blood systems of the basic check-up items.
Basic check-up items include: physical examination, vital signs(blood pressure, heart rate, respiratory rate)
, weight, waist circumference, blood routine, urine routine, stool routine, liver function, kidney function, electrocardiogram, abdominal ultrasound.
Chronic Disease and Complication Screening Items
There are many types of chronic diseases,it is not recommended to screen for all chronic diseases, it is recommended to screen for some common chronic diseases.For rare or uncommon chronic diseases, routine screening is not recommended, but selective examination can be chosen based on high-risk factors such as: past medical history, lifestyle, genetic background, etc., or personal preference.
Not all chronic diseases are suitable for universal screening
For example:
Rheumatoid arthritis is not recommended for universal screening.
The reasons are:
1. Low incidence rate, low screening efficiency.
2. The current examination methods have low sensitivity and specificity(in simple terms, the accuracy of the examination results is not high), abnormal test results alone cannot be used as a basis for diagnosis, and diagnosis depends on clinical manifestations.
3. False positive test results may lead to psychological burden.
It is recommended to screen for common chronic diseases
Chronic diseases that middle-aged and elderly people are recommended to screen for include:
hypertension, diabetes, hyperlipidemia, chronic obstructive pulmonary disease, chronic kidney disease, osteoporosis.
The reasons are:
1. The above chronic diseases have a high incidence rate and high screening efficiency.
2. Examination and detection methods have high sensitivity and specificity, and are easily accessible.
3. Before the occurrence of related symptoms, universal screening can detect early, and there are clear effective intervention measures to prevent disease progression, thereby improving prognosis, and the screened population truly benefits from the screening.
Hypertension and Complication Screening
Hypertension common complications include, ventricular hypertrophy, heart failure, ischemic heart disease, stroke, hypertensive nephropathy, etc. Hypertension complication screening includes:
1. Urine Creatinine and Urine Albumin Ratio
A sensitive indicator for assessing kidney function and early kidney damage, the best predictive indicator for the progression of kidney disease.
2. Carotid Ultrasound
To check for carotid atherosclerosis, plaque formation, stenosis, carotid aneurysm, etc. Carotid ultrasound examination can indicate the state of the whole body’s arteries and is of great value for the early diagnosis and prognosis judgment of atherosclerotic diseases.
3. Echocardiography
To check for cardiac structural abnormalities such as ventricular hypertrophy, valvular regurgitation, valvular insufficiency, cardiac ejection fraction measurement, and whether the ventricular wall movement is coordinated, etc.
Diabetes and Complications
Diabetes screening is recommended to check fasting blood sugar and glycated hemoglobin: to detect blood sugar levels, among which glycated hemoglobin can indicate the average blood sugar level in the past 3 months.
Common chronic complications of diabetes include: diabetic peripheral neuropathy, vascular disease(such as coronary heart disease), nephropathy, diabetic retinopathy, etc. Diabetes complication screening includes:
1. Urine Creatinine and Urine Albumin Ratio
A sensitive indicator for assessing kidney function and early kidney damage, the best predictive indicator for the progression of kidney disease.
2. Vision and Fundus Photography
Patients with diabetes are at increased risk of vision loss, and it is recommended to regularly check vision and fundus photography during physical examinations.
3. Foot Examination
Visual inspection of the feet to check for skin damage and other skin lesions, nail hygiene issues, pressure injuries caused by ill-fitting shoes, fungal infections, and callus formation, etc.
4. Carotid Ultrasound
To check for carotid atherosclerosis, plaque formation, stenosis, carotid aneurysm, etc. Carotid ultrasound examination can indicate the state of the whole body’s arteries and is of great value for the early diagnosis and prognosis judgment of atherosclerotic diseases.
Hyperlipidemia Screening
Hyperlipidemia is one of the independent risk factors for atherosclerotic heart disease. The main reference indicators for the diagnosis of hyperlipidemia include:total cholesterol, high-density lipoprotein, low-density lipoprotein, triglyceride detection.
Hyperlipidemia complication screening is recommended to undergocarotid ultrasound, to check for carotid atherosclerosis, plaque formation, stenosis, carotid aneurysm, etc. Carotid ultrasound examination can indicate the state of the whole body’s arteries and is of great value for the early diagnosis and prognosis judgment of atherosclerotic diseases.
Chronic Obstructive Pulmonary Disease (COPD) Screening
The 2022 U.S. Preventive Services Task Force’s latest evidence does not support screening for COPD in asymptomatic adults.
However, given the heavy burden of COPD disease, this recommendation should not be seen as a signal to stop COPD screening.The elderly are a high-incidence group for COPD, with low disease awareness, serious underdiagnosis issues, and clinical symptoms lack specificity, often combined with other chronic diseases, so general practitioners need to consider comprehensively when receiving the elderly.
When elderly visitors have any of the following: shortness of breath after activity, chronic cough or phlegm, repeated lower respiratory tract infections, long-term smoking, occupational exposure history,all should suspect COPD and arrange related examinations.
Pulmonary function test is the main examination method for COPD.
Chronic Kidney Disease Screening
Chronic kidney disease has a concealed onset and no obvious symptoms in the early stage. Middle-aged and elderly people need to undergo chronic kidney disease screening every year. The urine routine and kidney function(serum creatinine, urea, uric acid)in the basic examination items are chronic kidney disease screening items. In addition, middle-aged and elderly people are recommended to complete the following two items.
1. Urine Creatinine and Urine Albumin Ratio
A sensitive indicator for assessing kidney function and early kidney damage, the best predictive indicator for the progression of kidney disease.
2. Double Renal Ureter Ultrasound Examination
To assess whether there are renal parenchyma changes, renal tumors, kidney stones, ureteral stones, etc.
Osteoporosis Screening
The high-risk factors for osteoporosis include: age, gender, low body mass index, smoking, drinking, hormone therapy, rheumatoid arthritis, personal history of fractures, parental history of hip fractures, etc.
All people over 50 years old should assess the risk factors for osteoporosis.Young postmenopausal women and men aged 50-69, if there is at least one major or two minor osteoporosis risk factors, should undergo osteoporosis screening.It is recommended to conduct bone density tests for women over 65 years old and men over 70 years old.
Bone density examination is the main examination method for osteoporosis.
Cancer Screening
Cancer screening is an important part of the physical examination, but not all cancers are suitable for screening.
Not all cancers are suitable for screening
For example, pancreatic cancer is not recommended for routine screening because: the incidence rate is low, the specificity and sensitivity of examination methods are insufficient, the tumor progresses rapidly, and current research shows that screening does not reduce mortality or improve prognosis.
On the other hand, according to the 2017 U.S. Preventive Services Task Force’s recommendation statement,it is not recommended to routinely screen for thyroid cancer in asymptomatic adults.
Conversely, studies have shown that colonoscopy can identify early colorectal cancer, thereby improving disease prognosis. Compared with discovering colorectal cancer after the onset of symptoms, early colorectal cancer is easier to treat and has a lower mortality rate. In addition, colorectal cancer screening can detect and remove precancerous polyps before they progress to colorectal cancer, thus preventing colorectal cancer.
For the elderly population, it is also important to note that the occurrence and development of tumors require a certain amount of time and conditions, some tumors grow slowly, and whether the elderly will benefit from tumor screening, the current evidence-based evidence is not sufficient.
Decisions on tumor screening need to be comprehensively analyzed in combination with past examination results, life expectancy, and personal preference.
According to the latest data from the National Cancer Center of China based on tumor registration and follow-up, the malignant tumors with higher incidence in China in 2022 include lung cancer, colorectal cancer, thyroid cancer, liver cancer, stomach cancer, breast cancer, esophageal cancer, cervical cancer, prostate cancer, etc.Cancer screening guidelines provide strong evidence-based evidence for screening high-risk factors, screening age, and screening methods.
With the continuous update of medical technology, the means of tumor screening are also increasing. The “tumor markers” that are often heard are very “tempting” new screening technologies, but not all tumor markers have screening significance. For more information, you can refer to the Distinct Health tumor marker-related popular science 👇.
Is it necessary to screen for tumor markers in physical examinations?
Lung Cancer Screening
1. Preferred Screening Method
Low-dose lung CT.
2. Screening Age
If there are high-risk factors, 50 to 80 years old, the screening should be done once every 1-2 years. For people over 75 years old, opportunistic screening can be considered(imaging examination when there are symptoms or suspicious signs).
3. Risk Factors
(1) Smoking history: smoking ≥ 20 packs*years(the number of cigarettes smoked per day × the number of years smoked)or passive smoking ≥ 20 years, if you have quit smoking now, the time since quitting does not exceed 15 years.
(2) A history of long-term occupational exposure to carcinogens: long-term exposure to radon, arsenic, beryllium, chromium and its compounds, asbestos, chloromethyl ether, silica, as well as coke oven emissions and coal smoke, etc. lung cancer carcinogens.
(3) First and second-degree relatives with lung cancer, while smoking ≥ 15 packs/year or passive smoking ≥ 15 years.
(4) If there are other important lung cancer risk factors in some high-incidence areas, they can also be used as conditions for screening high-risk groups.
(5) A history of lung tumors and underlying lung diseases(COPD or pulmonary fibrosis).
Colorectal Cancer Screening
1. Preferred Examination Method
Colonoscopy.
2. Screening Age
If there are no high-risk factors, start checking every 10 years from the age of 45 with a colonoscopy.
If there are high-risk factors, start colorectal cancer screening 10 years earlier than the age when a relative was diagnosed.
For those over 75, based on personal preference and life expectancy, consider opportunistic screening or discontinuation of screening if the life expectancy is less than 10 years.
3. High-Risk Factors
(1) A history of colorectal cancer in first-degree relatives.
(2) First-degree relatives with adenomatous colonic polyps, familial adenomatous polyposis.
(3) Personal history of intestinal adenomas or first-degree relatives with adenomatous colonic polyps, familial adenomatous polyposis.
(4) Personal history of long-term(8-10 years)
untreated inflammatory bowel disease.
(5) Personal history of repeated unexplained fecal occult blood positivity.
Liver Cancer Screening
1. Preferred Screening Method
Abdominal ultrasound + alpha-fetoprotein testing.
2. Screening Age
If there are high-risk factors, Asian men over 40 years old and Asian women over 50 years old, screen every 6 months.
3. High-Risk Factors
(1) Active hepatitis(elevated serum transaminases and/or high viral load).
(2) Family history of liver cancer.
(3) Liver cirrhosis.
Stomach Cancer Screening
1. Preferred Screening Method
Gastroscopy.
2. Screening Age
If there are risk factors, 40 to 75 years old, once every 3 years. For those over 75, based on personalpreference and life expectancy, consider opportunistic screening or discontinuation of screening if the life expectancy is less than 5 years.
3. High-Risk Factors
(1) Population in high-incidence areas of stomach cancer(e.g., Linqu County, Shandong Province, Zhuanghe County, Liaoning Province, Changle County, Fujian Province, and some areas of Gansu, Qinghai, Ningxia, Jilin, Jiangsu, Shanghai, etc.)
; or high-incidence countries (Japan, South Korea, Venezuela, and Chile).
(2) Helicobacter pylori infection.
(3) Past history of chronic atrophic gastritis, gastric ulcer, gastric polyps, postoperative residual stomach, hypertrophic gastritis, pernicious anemia, and other precancerous diseases of the stomach.
(4) First-degree relatives of stomach cancer patients.
(5) Other high-risk factors for stomach cancer(high salt, pickled diet, smoking, heavy drinking, etc.).
Breast Cancer Screening
1. Breast Cancer Screening Methods
Mammography or breast ultrasound examination.
2. Screening Age
If there are no high-risk factors, 40 to 69 years old, check once a year. If there are high-risk factors for breast cancer: it is recommended to visit a doctor, based on risk factors, combined with personalpreference, and make decisions on screening and follow-up plans with a doctor. People over 70 can consider opportunistic screening(imaging examination when there are symptoms or suspicious signs).
3. High-Risk Factors
(1) Carrying breast cancer susceptibility genes.
(2) Having a first-degree relative(parents, children, and siblings) with a family history of breast cancer.
(3) Women with a history of breast cancer.
(4) A history of chest radiation therapy.
(5) Diagnosed with atypical hyperplasia of mammary ductal epithelium, atypical lobular hyperplasia, or lobular carcinoma in situ before the age of 40.
Esophageal Cancer Screening
1. Preferred Screening Method
Gastroscopy.
2. Screening Age
If there are risk factors, 45 to 75 years old, once every 3 years. For those over 75, based on personalpreference and life expectancy, consider opportunistic screening or discontinuation of screening if the life expectancy is less than 5 years.
3. High-Risk Factors
(1) Specific dietary factors: hot soup diet, pickled diet, spicy diet, fried diet, high-salt diet, moldy diet, rapid eating, etc.
(2) Family history of esophageal cancer.
(3) Alcohol consumption.
(4) Smoking.
Cervical Cancer Screening
1. Screening Methods
HPV nucleic acid testing, cervical cytology examination.
2. Screening Age
If there are no high-risk factors, 25 to 64 years old, use HPV nucleic acid testing alone every 5 years, or HPV nucleic acid testing combined with cervical cytology examination; or cytology examination every 3 years. For those over 65 with sufficient negative screening records in the past, screening can be discontinued. If there are high-risk factors, it is recommended to start screening within 1 year of starting sexual activity and appropriately shorten the screening interval, and it is recommended to visit a doctor for comprehensive assessment.
3. High-Risk Factors
(1) History of multiple sexual partners.
(2) Early sexual history.
(3) Human Immunodeficiency Virus(HIV)infection.
(4) Smoking.
Prostate Cancer Screening
1. Preferred Screening Method
Prostate-specific antigen.
2. Screening Age
If there are no high-risk factors, start checking every 2 years from the age of 50. If there are high-risk factors, start checking every 2 years from the age of 40. Prostate cancer progresses slowly, if over 60, with a PSA level less than 1mcg/L, the patient’s意愿 and life expectancy should be comprehensively assessed whether to continue screening.
3. High-Risk Factors
(1) PSA level greater than 1mcg/L.
(2) Carrying the BRCA2 gene population.
(3) Family history of prostate cancer.
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