This article was last reviewed on
This article waslast modified on 17 April 2018.

The need for regular health checks is more important in your older years. Height, weight, and blood pressure should be monitored, and the need to update immunisation should be reviewed. Flu vaccine is currently offered to all people aged 65 years and over. Vision and hearing should be tested in the elderly.

For men, while current evidence does not indicate that screening asymptomatic men for prostate cancer would reduce mortality, the Department of Health's Prostate Cancer Programme has developed the Prostate Cancer Risk Management Programme. For women, the National Screening programmes for Cervical and Breast cancer are currently in place.

In addition, the National Service Framework for Coronary Heart Disease requires General Practitioners to identify all people at significant risk of cardiovascular disease but who have not developed symptoms and offer them appropriate advice and treatment to reduce their risks. For more information on screening in adults, visit the UK National Screening Committee’s web site.

The NHS Bowel Cancer Screening Programme offers screening every two years to all men and women aged 60 to 69 in England. The age range is currently being extended to 60 to 74 and is open to individuals opting-in to be screened from age 75 and above. People within the age range are automatically sent an invitation, then their screening kit, so they can perform the test at home. After the first screening test, individuals are sent an invitation and screening kit every two years. For further information about the NHS Bowel Cancer Screening Programme see www.cancerscreening.nhs.uk/bowel/index.html.

Tests
  • Breast Cancer

    Currently all women in the UK aged 50 and over are provided with free breast screening every three years by the NHS Breast Screening Programme . Around two million women are now screened in the UK each year. Women aged between 50 and 70 years old, registered with a GP, are routinely invited for breast screening every three years. However, because the local screening units invite women from GP practices in turn on a rolling basis, not every woman would have received an invitation for screening by the age of 50. However, she should have received an invitation by her 53rd birthday. Once a woman has passed the age of 70 she is still eligible for free screening every 3 years however will not receive a routine invite. Therefore it is advised that women over 70 make their own appointments with their local mammogram unit.

    The screening programme is now extending the age range of women eligible for breast screening to those aged 47 to 73. This started in 2010 and is gradually being phased across the UK. It is expected to be complete by 2016. Currently, only a small group of women aged 47-49 and 71-73 from eligible areas are randomly being selected for screening. Eventually however all women in these age groups and in all areas will be invited.

  • Cervical Cancer

    Many deaths from cervical cancer can be prevented through screening. Detection and treatment of precancerous lesions found during a liquid based cytology (LBC) test can prevent cervical cancer, as well as detect cervical cancer at an early stage when it is most likely to be curable.

    In the UK, all women between the ages of 25 and 64 are eligible for an NHS cervical screening test every three to five years. The screening programme stops at age 64 for women as long as their last 3 liquid based cytology (LBC) tests were normal. Department of Health guidelines state that these women are very unlikely to develop cervical cancer. Women over 64 who have had an abnormal liquid based cytology (LBC) test will continue to be invited for regular tests in the normal way.

  • Bowel Cancer

    Bowel cancer is also known as colon, rectal or colorectal cancer. The lining of the bowel is made of cells that are constantly being renewed. Sometimes these cells grow too quickly, forming a clump of cells known as a bowel polyp (sometimes known as an adenoma). Polyps are not bowel cancers (they are usually benign), but they can change into a malignant cancer over a number of years. A malignant cancer is when cancer cells have the ability to spread beyond the original site and into other parts of the body.

    Bowel cancer is the third most common cancer in the UK, and the second leading cause of cancer deaths, with over 16,000 people dying from it each year.

    The UK National Screening Committee (NSC) reviewed the evidence for bowel cancer screening, and found that population screening of people over the age of 50 for non-visible (occult) blood in faeces can reduce the mortality rate for bowel cancer. A pilot screening project was conducted across two pilot sites with very encouraging results. See the English Bowel Cancer Screening Pilot and Evaluation of English Bowel (Colorectal) Cancer Screening Pilot

    The NHS Bowel Cancer Screening Programme now offers screening every two years to all men and women aged 60 to 69 in England. The age range is currently being extended to 60 to 74 and is open to individuals opting-in to be screened from age 75 and above. People within the age range are automatically sent an invitation, then their screening kit, so they can perform the test at home. After the first screening test, individuals are sent an invitation and screening kit every two years. For further information about the NHS Bowel Cancer Screening Programme see www.cancerscreening.nhs.uk/bowel/index.html. Separate screening programmes are offered in Wales, Scotland, Northern Ireland and the Republic of Ireland.
    Guidelines for bowel cancer screening in higher risk groups, for example, those with a significant family history, have been produced by The British Society of Gastroenterology.

    On 28 April 2010 the Lancet published ‘Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial’. This paper was the culmination of over 10 years work inspired by UK academic Professor Wendy Atkin. In October 2010 the Prime Minister announced that flexible sigmoidoscopy would become a new screening modality for the national screening programme. Poor cancer survival rates in the UK relative to other European countries provided the backdrop to this initiative with the prospect that a once-only flexible sigmoidoscopy would save 3000 lives a year. The National Screening Committee approved this modality in April 2011. Since 2013, men and women living in 6 pilot sites have been invited to participate in “Bowel scope screening” around the time of their 55th birthday. The Bowel scope screening programme aspires to be fully rolled out to all 55 year olds by the end of 2016 and will function in addition to the existing NHS bowel cancer screening program.

    The Screening Programme in England also intends moving the population-based screening from the current guaiac-based system (gFOBT) to a faecal immunochemical test (FIT). The immunochemical test is analytically superior, conferring increased analytical specificity for human haemoglobin, and through the use of sensitive detection systems, increasing test sensitivity to low blood concentrations. Instrumentation used for quantitative measurement also provides an opportunity to manually adjust the cut-off limit below which a test is reported as negative. FIT devices are currently being evaluated for the NHS by the Screening Hub in Guildford and a 6 month trial of FIT screening will commence in two areas in March 2014.

  • Diabetes

    While not recommended as a general screen, testing for diabetes is recommended based on known risk factors.
    This difficult-to-manage disease is now occurring with alarming frequency, affecting a younger age group and certain ethnic groups in particular. In the UK the prevalence of diabetes in the older age group is between two and five per cent, most having type 2 diabetes. It is likely that an equal number are undiagnosed. As many as 20 percent of Asians over the age of 40 have diabetes. Many are unaware that the have the disease, and there is concern about the complications that can develop. Although many experts say that more data are needed to justify the cost and value of earlier and broader screening, some groups have amended their recommendations to address this growing health problem. The NHS National UK Screening Committee policy position (March 2003) is that general population screening should not be offered except as part of a peer reviewed and ethically approved project. Diabetes UK lists high risk groups as including:

    • Caucasian people aged over 40 years and people from black, Asian and minority ethnic groups aged over 25 years, with:
      • a first degree family history of diabetes
      • overweight and who have a sedentary lifestyle
      • ischaemic heart disease, cerebrovascular disease, peripheral vascular disease or hypertension
    • Women who have had gestational diabetes (screen at one year post-partum and then three-yearly)
    • Women with polycystic ovary syndrome who are obese
    • Those known to have impaired glucose tolerance or impaired fasting glycaemia.

    Diabetes UK currently recommends active case finding every three years of those at increased risk of developing diabetes. For screening high risk groups for diabetes, a glucose tolerance test is the most comprehensive test but fasting glucose alone or venous glucose two hours following a glucose load are alternatives. Urine testing for glucose is not recommended as it is not sensitive enough i.e. it misses too many cases.

  • Heart disease

    Heart disease is the leading cause of death both in the UK and the US. The risk of heart attacks rises with age and men of 45 years of age and older and women of 55 years of age and older are often at an appreciable risk.
    NHS UK National Screening Committee recommended in 2003 that priority be given to the identifying people with established heart disease so that they can be given advice and treatment to reduce the risk of recurrent heart attacks. In December 2005 the Joint British Societies (JBS) recommended that Coronary Artery Disease (CAD or heart disease)
    prevention should focus equally on people with established disease, people with diabetes and those who appear healthy but have a high risk of heart attack(≥ 20% over 10 years).
    For people who are not in these high risk groups, the Joint British Societies priority is to promote lifestyle change and improve health education. Furthermore, the JBS recommend that all adults >40 years of age who do not have a history of CAD or diabetes, and are not already on treatment for blood pressure or lipids should be given a CAD risk assessment once every five years. It is suggested that although screening helps identify those with near-term risk who may benefit from drug therapy, the screening of younger adults helps promote lifestyle changes for longer term health benefits.
    These two recommendations are different and the National Screening Committee is leading work to integrate them with the National Service Framework for Diabetes to create the Diabetes, Heart Disease and Stroke Prevention Project.

  • Iron overload

    While not recommended as a general screen, screening for iron overload disease is recommended based on known risk factors.
    The most common of the known genetic disorders in the UK, hereditary haemochromatosis, or iron overload disease, causes the iron from a person’s diet to accumulate in the body’s organs. Over a lifetime and without treatment, serious and even fatal health effects can result.
    The NHS UK National Screening Committee policy position (March 2003) is that on the basis of present evidence population screening for haemochromatosis should not be recommended, but that the evidence should be reviewed within two years. Offspring and relatives of known cases are at risk and should be screened.
    The disease can be screened for using one of two blood tests: transferrin iron saturation percentage and serum ferritin. The DNA test and a liver biopsy are also recommended by some organizations but not by others for various reasons. For more information on testing for this disease, visit the Haemochromatosis Society.

  • Skin Cancer

    Skin cancer is the second most common cancer in the United Kingdom, with about 40,500 new cases each year. Of these, approx 6,000 are malignant melanomas. In the UK, approx 1 in 200 people have melanoma of whom approx 1,500 people die from the disease every year.
    The UK Skin Cancer Prevention Working Party Consensus statement gives advice on avoidance of sun exposure and sun induced skin damage as a means of preventing skin cancer.  More information can be found on Skin Cancer Hub and SunSmart Microsite.

  • Osteoporosis

    While not recommended as a general screen, screening for osteoporosis is recommended based on known risk factors.
    Up to 70% of fractures in persons aged 45 and older are due to porous bone (osteoporosis). The strongest risk factors for osteoporosis are:

    • being a woman
    • being aged over 60
    • a family history of osteoporosis
    • a history of a low impact fracture
    • loss of height

    Other risk factors include:

    • being of Caucasian origin
    • having had an early menopause
    • being underweight
    • having a sedentary lifestyle
    • smoking

    It seems that the more risk factors, the greater the risk. The UK National Screening Committee does not currently recommend population screening. The National Institute for Clinical Excellence (NICE) is carrying out a review of osteoporosis screening.

  • Thyroid Dysfunction

    In the UK, up to 10% of women over 55 have a raised TSH, and symptomatic hypothyroidism is present in 20/1000 women and 1/1000 men in this age group. The NHS UK National Screening Committee policy position (March 2003) is that screening by measurement of blood TSH levels cannot be justified at present, except in the context of peer-reviewed and ethically approved research. A research project funded by PPP Healthcare Trust started in 2001.

  • Prostate Cancer

    This is the most commonly diagnosed cancer in men other than skin cancer: more than 34,000 men in the UK are diagnosed each year.
    Current evidence does not indicate that PSA screening of men without symptoms for prostate cancer would reduce mortality. The Department of Health's Prostate Cancer Programme has developed the "Prostate Cancer Risk Management" Programme. Its aim is to ensure that men who are concerned about the risk of prostate cancer receive clear and balanced information about the advantages and disadvantages of the PSA test and treatment for prostate cancer. This will help men decide whether they want to have the test. General Practitioners have received advice about counselling and supplies of patient information sheets.

    The problems are that screening and treatment may do more harm than good for men who have a slow-growing cancer. Surgery and radiation may be more harmful or debilitating than a slow-growing prostate cancer, causing impotence and incontinence. Current medical tests cannot reliably tell a slow-growing cancer from a fast-growing one. The PSA test does not detect all prostate cancers and has other limitations. More research will help determine the best course of action.

  • Tuberculosis

    While not recommended as a general screen, screening for tuberculosis is usually recommended based on known risk factors.
    In the UK, the number of TB cases is rising. Alcoholics, HIV-positive individuals, some recent immigrants and healthcare workers are at increased risk. The disease is most commonly found in places such as hostels for the homeless, prisons, and centres for immigrants arriving from areas with high rates of HIV infection or inadequate health provision.

    Typically, you may not feel ill or have symptoms. If you are at risk of infection, for example you have come into contact with a person infected with tuberculosis, are HIV-positive or receiving immunosuppressive therapy, you may be given a tuberculin (Mantoux) skin test, a chest X-ray and sample of sputum or phlegm may be taken for laboratory examination.

    It is recommended by the Health Protection Agency that individuals working as healthcare workers who are previously unvaccinated, and who are negative or grade 1 on tuberculin testing, should receive BCG vaccination.

    For more information visit the Health Protection Agency and NHS Choices websites.