Screening Tests for Adults (age 50 and above)

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.

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 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. In 2006, the NHS Bowel Cancer Screening Programme began and offers screening every two years to all men and women aged 60 to 74 in England. The Screening Programme is also 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. 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.

From 2013, some 55 year olds across England were invited to attend Bowel scope screening which involved the self-administration of an enema followed by visualisation of the colon by flexible-sigmoidoscopy. Following a review by the UK NSC, this part of the Screening Programme was discontinued in 2020.

In 2020, the UK National Screening Committee agreed that the Bowel Cancer Screening Programme should start from the age of 50. From April 2021, age-extension will begin across the programme. This will take place gradually over the next few years until all men and women in England age 50-74 are invited to participate every two years. Scotland already invites men and women age 50-74 and there are proposals for Wales and Northern Ireland screening programmes to do the same.

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 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.