Principles

of Health
Screening
Content
• Definition
• Principle
• Suitable criteria for screening
• Tools for screening in primary care
Definition
• The presumptive identification of unrecognized
disease in an apparently healthy, asymptomatic
population by means of tests, examinations or other
procedures that can be applied rapidly and easily to the
target population.

• Screening is a process – one that begins with invitation

to participate and ends with treatment for
appropriately identified individuals.
Principles of health screening

1. Screening for asymptomatic conditions such as hypertension, diabetes,

hypercholesterolaemia and colon cancer.
2. Screening for symptomatic conditions that are under-reported by patients such
as depression.
3. Assessing health risk behaviours such as smoking and nutritional status.

• The final aim of health screening is to reduce morbidity and mortality associated
with the disease screened.
• Health care providers need to inform patients on:

1. The test procedures

2. The aim of the test, i.e., benefit of screening and treatment
following screening
3. The screening process including the steps after the test
results
4. Harms from the screening and diagnostic procedures, and
from treatment resulting from positive diagnosis upon
confirmation of screening tests.
5. Patient’s personal goals for undertaking the screening
 Tools for Screening in Primary Care
Screening Tool

Cardiovascular Framingham risk score

Cervical cancer Conventional Pap smear, liquid-based cervical technology

Colorectal carcinoma Faecal tests, i.e., guaiac-based faecal occult blood test (gFOBT), immunochemical
faecal occult bleeding test (iFOBT), and stool DNA test (sDNA), which are primarily
effective in identifying CRC.

Secondly, the partial or full structural examinations, i.e., flexible sigmoidoscopy,

colonoscopy, double-contrast barium enema (DCBE), and computed tomography
colonography (CT colonography), which are effective at detecting cancer and
premalignant adenomatous polyps.

Tobacco The 5A strategy (Ask, Advise, Assess, Assist, and Arrange)

Alcohol abuse Alcohol Use Disorders Identification Test (AUDIT)

HIV Antibody rapid test

Condition not recommended for health
screening
1. Thyroid dysfunction
2. Osteoporosis in male
3. Chronic obstructive pulmonary disease
4. Prostate cancer
5. Hearing problem in older age group
6. Visual impairment in older age group
7. Dementia in older age group
8. Urinary incontinence in older age group
References
• 1. Screening Guidelines for Primary Care 2005 by MOH
• 2.
https://www.who.int/cancer/prevention/diagnosis-screening/screeni
ng/en/
Cardiovascular
Disease Screening
 Introduction

• Cardiovascular disease (CVD) is a group of disorders of

the heart and blood vessels.
• CVD refers to coronary heart disease, cerebrovascular
disease and peripheral artery disease where
atherosclerosis is the main cause.
• CVD is a leading cause of mortality worldwide.
• In Malaysia, 24.4% of deaths in government hospitals
were attributed to CVD.
• Treating major CVD risk factors has been proven to
reduce cardiovascular mortality.
• Hence, screening is done on high risk individuals in order
to properly manage the risk factors as well as treat CVD,
if it arises.
Cardiovascular
Disease (CVD)
Screening
Why? To identify risk factors and eliminate CVD risk

Who? ≥ 30 with prior known CVRFs and ≥ 40

without prior known CVRFs

How? Opportunistically using various screening tools

and methods
Recognized CVD Risk Factors
 Screening Tools and Tests
Framingham Risk Scoring
• Risk prediction for a CVD event over a 10-year period
• Age, gender, smoking, diabetes, systolic blood pressure, use of anti-
hypertensives, total cholesterol, HDL level and BMI
• Screening age:
≥ 30 - with prior known CVRFs
≥ 40 - without prior known CVRFs
• Low (< 10%)
Intermediate (10 - 20%)
High (> 20%)
Framingham Risk
Scoring
Framingham Risk
Scoring
Cardiovascular Risk Factor
Obesity:
BMI ≥ 27.5 kg/m²
WC ≥ 90 / ≥ 80
Overweight:
BMI 23 – 27.5 kg/m²
Hypertension
BP ≥ 140/90 mmHg
Smoking
Physical inactivity
Screening Tools Interval
Age
≥ 18 BMI Normal (with no CVRF)
Waist circumference - Every 2 years
Normal (with CVRF)
- Annually
Overweight or Obesity
- 6 monthly
≥ 18 Mercury column sphygmomanometer SBP 130-139, DBP 85-89
Aneroid sphygmomanometer - Every 3-6 months
Certified electronic devices
Automated ambulatory BP devices SBP <130, DBP <85
- Annually
≥ 18 Ask and document their smoking Opportunistically
status on a regular basis
≥ 18 Ask if they participate in any physical Low risk
activity (level, intensity, duration) - Every 2 years
High risk
- Every visit
Cardiovascular Risk Factor Screening Tools Interval
Age
Unhealthy diet ≥ 18 Screen for adherence to the Low risk
Malaysian Dietary Guidelines for - Every 2 years
healthy eating High risk
- Every 6 months
Family history of ≥ 18 Ask for family history of premature 1st presentation
premature CVD CVD (men < 55y/o; women < 65y/o)
Screen for FH if there is
Dyslipidemia ≥ 18 Complete fatty lipid profile Annually
CVRF (TC, LDL, HDL, TG)

≥ 40
No CVRF
Diabetes mellitus ≥ 18 Random blood glucose, Fasting blood No DM risk factors
FBG ≥ 7.0 mmol/L DM RF glucose, Oral glucose tolerance test, - Every 1-3 years
RBG ≥ 11.1 mmol/L HbA1c
2-H OGTT ≥ 11.1 mmol/L ≥ 30 With DM risk factors
No DM RF - More frequent
 Screening
Cardiovascular Risk Factor Tools Interval
Age
Familial ≥ 18 Assess probability of having FH using 1st presentation
hypercholesterolemia With RF modified UK Simon Broome criteria
(FH)
No need for genetic testing in screening
 Risk Factor
Screening
Risk Factor Screening Age Screening Tools / Tests Intervals
Diabetes Mellitus ≥ 18, with known Random blood glucose 1 – 3 years if no
diabetes risk Fasting blood glucose diabetes RF
FBG ≥ 7.0 mmol/L factors OGTT More frequent if
RBG ≥ 11.1 mmol/L ≥ 30, without HbA1c diabetes RF
2-hour OGTT ≥ 11.0 diabetes risk
mmol/L factors

Familial All adults ≥ 18 Assess using modified UK At first presentation

hypercholesterolemia Simon Broome criteria
(FH)