There are diseases whose signs can be found quite early, but it is not a fact that the person who has them will certainly get sick. For example, if a girl under 25 years old finds abnormal cells in the cervix, this does not mean that she will certainly develop cancer.
There are diseases that it’s simply useless to look for – because we really don’t know how to prevent and treat them. For example, Alzheimer’s disease , from which there is still no truly effective medicine. So far, all that is is drugs that allow them to remain operational and active for longer .
Screening is a set of tests and examinations that allow you to identify hidden diseases and start treatment on time. Ideally, screenings should prevent medical problems in healthy people, but in practice it’s much more complicated.
And finally, there are diseases in which early treatment does not guarantee the best result. A prime example is prostate cancer . In this case, a person has a whole year to make a decision, and this does not affect the result of treatment. Sometimes doctors hesitate not to start aggressive treatment earlier than necessary. At this time, active observation is used – in fact, treatment is postponed until symptoms appear.
In order not to frighten patients in vain, the doctors formulated five signs, with the appearance of which it makes sense to conduct a screening:
- the disease is common enough to threaten public health;
- the disease has an early asymptomatic stage that can be detected in a timely manner;
- a simple, inexpensive and accurate screening test has been developed to identify the early stage of the disease;
- the disease is treatable;
- early treatment improves prognosis.
Cardiovascular disease and diabetes meet these criteria. These pathologies are the main threat to human health; they can be detected and prevented in a timely manner, including by changing the way of life. It makes no sense to identify other diseases – because it is not clear what to do with this information later. So it’s not only a matter of saving money on health care, it’s a common approach – this is the case in Russia, the USA, and Europe.
What is screening in the USA and Europe?
Western screening options for men and women from 18 to 39 years old are almost the same.
Screening consists of four parts:
Test for predisposition to cardiovascular disease and diabetes . Every two years, everyone is weighed, their height and blood pressure are measured, their BMI is determined and they are asked to take two tests: the level of glucose and cholesterol in the blood.
Check for necessary vaccinations . A flu shot is given once a year, against tetanus and diphtheria once every ten years. Between the ages of 18 and 26, people are vaccinated against the human papillomavirus (HPV).
Tests for genital infections . For men – for syphilis, chlamydia, HIV and other STDs, for women under 25 years – for chlamydia and gonorrhea.
Screening for cervical cancer . From the age of 21, a woman every three years should undergo an examination by a gynecologist and take a PAP test (Pap smear). If she is vaccinated with HPV, and everything is fine with a smear, from 30 years old she needs to repeat the test less often – once every five years.
In addition, Westerners recommend visiting a dentist once a year for healthy people.
Visually impaired people are advised to check vigilance once every two years, and those with diabetes – once a year. People with blood pressure above 140/80, diabetes, heart disease, kidney problems, and certain other conditions are recommended to measure blood pressure once a year.
Both men and women whose relatives had cancer and hereditary diseases can recommend individual examinations.
How is screening in Russia
Russian screening options for young men and women are also very similar. Citizens of the Russian Federation have the right to undergo two examinations on the compulsory medical insurance policy – medical examination and professional examination.
Major preventive examination at a state clinic. From 18 years old, every Russian has the right to undergo a medical examination every three years.
Clinical examination consists of two stages. At the first, a person undergoes examinations, passes tests and visits a doctor. He is sent to the second, if at the first stage any problems are revealed. The first stage usually takes two or three visits: the first person undergoes examinations and passes tests, and at the second (or third) consults with the therapist.
The list of examinations depends on age and gender – what exactly awaits you in the hospital can be found on the EMIAS website . In 2018, when the order of the Ministry of Health of October 26, 2017, No. 869n, began, the medical examination became very similar to western screening. For example, the unnecessary and uninformative general analysis of urine and blood was removed from there , but the analysis for glucose and cholesterol levels was added.
Unlike screening in the West, we have:
- Questioning . Before visiting a doctor, Russians fill out a questionnaire on two sheets, which describe the state of health and everyday habits.
- Electrocardiography . On the primary medical examination, ECGs are done for everyone: both men and women from 36 years old.
- Total cardiovascular risk . Assessment of the risk of serious complications and death due to heart and vascular diseases in the next ten years.
- Fluorography . In Russia , everyone is subjected to this procedure to exclude pulmonary tuberculosis.
- Additional procedures . This may include a visit to a surgeon, urologist or obstetrician-gynecologist, preventive consultation and spirometry to assess the condition of the lungs in smokers and in people at risk of bronchopulmonary diseases.
- Conversation with the therapist and definition of the health group . There are three total health groups. People from the first group are healthy and most likely will not get sick in the near future, the doctor will talk to them for no more than ten minutes. People from the second group run the risk of getting a chronic illness in the near future, the therapist will talk with them for about 45 minutes. People from the third group have chronic diseases or a high risk of getting a cardiovascular disease. The therapist directs patients from the third group to a specialized doctor.
But we do not have:
- Checks for necessary vaccinations . But the therapist may ask about vaccinations – at least ask if a person has been vaccinated against the flu this year.
- Test for genital infections . Nevertheless, the therapist can ask about the nature and frequency of sexual activity.
An abbreviated preventive examination that can be done every two years. It is planned that from the 1st quarter of 2019, a professional examination can be held once a year.
For a physical examination, you need to come to the clinic twice. On the first visit, the person is examined and passes tests, in the second – he talks with the therapist.
In 2019, the examination includes :
- measurement of height and body weight of the patient with the calculation of BMI;
- blood pressure measurement;
- determination of cholesterol and glucose in the blood;
- determination of the degree of cardiovascular risk;
- fluorography of the lungs;
- measurement of intraocular pressure.
What is the difference between screening and check
The difference is in the approach.
Screening (in Russia – medical examination and professional examinations) is free, they are organized by the state. Screenings include only those tests and examinations that can objectively predict the most common diseases.
Chekapy are expensive, they are carried out by commercial clinics at the request of the patient. Oncologist Ilya Fomintsev emphasizes that chekapy often include unnecessary examinations that are not justified in terms of evidence-based medicine.
The list of expensive tests and analyzes that are often included in the check-in, but healthy people do not need:
- Oncomarkers are not suitable for diagnosis, and even more so for cancer screening – these tests are done to monitor the effectiveness of treatment . Oncomarkers often produce false positive and false negative results. For example, they are elevated in people who do not have cancer, and normally , those who actually have cancer.
- Examination of the whole body with CT, MRI and PET is not suitable for screening, because it often gives false-positive and false-negative results – that is, it either makes patients anxious in vain, or lulls vigilance. Computed tomography (CT) and positron emission tomography (PET) are also associated with radiation – that is, they expose patients to an absolutely unnecessary risk.
- Abdominal ultrasound and retroperitoneum not reduce deaths from ovarian cancer , kidney cancer , uterine cancer ( endometrial ), prostate cancer , breast cancer , pancreatic cancer .
- Endoscopic examinations . Gastroscopy is not prescribed for people without symptoms. Screening colonoscopy is recommended from the age of 50.
Before agreeing to a check, it is worth consulting with a therapist or family doctor.
Oncoscreening: what and when to do
Not all oncological diseases can be predicted and stopped – for example, pancreatic cancer is extremely difficult to detect at an early stage, so they are not screened. The same cancers that nevertheless can be detected in a timely manner, it is advisable to search from a certain age .
If there are no symptoms and a hereditary predisposition, only one oncoscreen is appropriate at the age of 18 to 39: PAP test for cervical cancer for women. It is carried out from 21 to 65 years (according to WHO – from 30 years , if the country has no other recommendations). Repeat the screening once every three years. Young men who have n’t had colon cancer in their family history do not need cancer screening at all.
There are two more effective screenings – for breast cancer (mammography) and colorectal cancer (feces for occult blood). But the first is recommended for women only from 40 years old , and the second – for all people from 50 (45) to 75 years old .
Oncologist Sergei Barchuk hopes that in the future the list of oncological diseases for the detection of which it makes sense to carry out screening will replenish lung cancer and prostate cancer, but at the current level of technology, screening for these diseases is impractical.
There is another circumstance that is important to keep in mind for everyone. According to Sergey Barchuk, in our country there are very few doctors who really know how to conduct screenings. This is a separate complex skill, which is not widely taught in Russia.
Psychologically, it is easier for the doctor to conduct a full examination of the patient than simply send him home. There are polyclinics, of which 80% of patients after mammography are sent for follow-up examination – although objectively only 5% need this. Everyone else will have to be nervous and make time for examinations, which they most likely do not need.