Health Screenings - Southern Arizona VA Health Care System
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Southern Arizona VA Health Care System

 

Health Screenings

Health screenings are medical tests that doctors use to check for diseases and health conditions before there are any signs or symptoms. Screenings help find problems early on, when they may be easier to treat. Getting recommended screening tests is one of the most important things you can do for your health.

Abdominal Aortic Aneurysm Screening

One-time screening for AAA by ultrasound in men age 65-75 who have ever smoked, no screening for AAA in women.

Breast Cancer Screening

The American Cancer Society (ACS) recommends that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation).

  • Women aged 45 to 54 years should be screened annually (qualified recommendation).
  • Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation). Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation).
  • Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation).
  • ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).

Cervical Cancer Screening

  • Screening every 3 years with cervical cytology alone in average risk women aged 21 to 29 years.
  • Screening for average risk women aged 30 to 65 years with any of the following three options:
  • Every 3 years with cervical cytology alone
  • Every 5 years with high-risk human papillomavirus (HPV) testing alone, or
  • Every 5 years with high risk HPV testing in combination with cytology (contesting)
  • No screening for women younger than 21 years.
  • No screening for women older than 65 years of age with adequate prior screening and who are not otherwise at high risk for cervical cancer.
  • No screening in women who have had a total hysterectomy (cervix removed) and do not have a history of cervical cancer or high grade precancerous lesion.

Negative screening tests may not be definitive to rule out any type of cancer.

These recommendations do not apply to individuals who have been diagnosed with a high-grade precancerous cervical lesion or cervical cancer. These recommendations also do not apply to individuals with in utero exposure to diethylstilbestrol (DES) or those who have a compromised immune system (e.g., women living with HIV).1 These women are at increased risk and require individualized follow-up.

Chlamydia and Gonorrhea Genital Infection Screening

  • Screening for chlamydia and gonorrhea infections in:
    • 1) All sexually active women ages 24 years and younger
    • 2) Sexually active women ages 25 years and older who are at increased risk for infection.
  • Current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea infections in sexually active men presenting without symptoms.

Colorectal Cancer Screening

  • Screening for colorectal cancer in adults age 50 through 75 at recommended intervals.
    • Fecal Occult Blood Test (FOBT) annually with
      • FDA approved guaiac-based (gFOBT)
      • FDA approved fecal immunochemical testing (iFOBT/FIT)
    • Sigmoidoscopy every 5 years
    • Colonoscopy every 10 years
  • The decision to screen for colorectal cancer in adults age 76 through 85 should be an individual one, taking into account the patient’s overall health and prior screening history.
  • No screening for colorectal cancer in adults older than age 85 years.

Patients with certain family histories should have a colonoscopy at an earlier age as described below:

  • Veterans with a first-degree relative (parent, sibling or child) with CRC diagnosed at age less than 60 years of age, or two or more first-degree relatives diagnosed with CRC at any age, may be advised to have a screening colonoscopy (unless medically contraindicated) starting at age 40 years or 10 years younger than the earliest diagnosis in their family, whichever comes first.
  • Veterans with a first-degree relative with CRC diagnosed at age more than 60 years, or with two or more second-degree relatives (grandparent, aunt, or uncle) diagnosed with CRC at any age may be advised to begin screening at age 40 (using any of the recommended screening tests).

Screening for Cognitive Impairment

VHA does not recommend screening for cognitive impairment in asymptomatic older adults (those presenting with no signs or symptoms of cognitive impairment; age 65 or older). Clinicians should be alert to early signs or symptoms of cognitive impairment and evaluate as appropriate.

Warning signs include:

    • Asking the same questions over and over again.
    • Becoming lost in familiar places.
    • Not being able to follow directions.
    • Getting very confused about time, people and places.
    • Problems with self-care, nutrition, bathing or safety.

Hepatitis B Screening

VHA recommends AGAINST standardized risk assessment and laboratory screening for hepatitis B virus infection in the asymptomatic general patient population.

VHA recommends laboratory screening for hepatitis B virus infection in patients who are found to be at high risk for infection during the course of providing usual care.

High risk includes:

    • Previously unvaccinated and:
      • Household, needle-sharing, or sex contacts of persons known to be HBsAg positive
      • Injection drug users
      • Men who have sex with men
      • HIV-positive persons
      • Hemodialysis patients
      • Persons born to HBsAg positive mothers
    • Previously vaccinated and:
      • Persons who initiated risky sexual or injection drug use behaviors BEFORE receiving the hepatitis B vaccination series as adolescents or adults
      • Persons whose subsequent clinical management depends on knowledge of their immune status.
    • Regardless of vaccination status, i.e. previously vaccinated OR unvaccinated persons and:
      • Persons born in countries with HBsAg positivity prevalence ≥2%
      • U.S. born persons not vaccinated as infants whose parents were born in countries with HBsAg positivity prevalence ≥5%
    • The following list includes countries with HBsAg positivity prevalence ≥2%:
      • Africa—all countries
      • Southeast, East, and Northern Asia – all countries
      • South Pacific—all countries except Australia and New Zealand
      • Middle East—All countries except Cyprus and Israel
      • Eastern Europe—All countries except Hungary
      • Western Europe—Malta, Spain, and indigenous populations in Greenland
      • North America—Alaska natives and indigenous populations in Northern Canada
      • Mexico and Central America—Guatemala and Honduras
      • South America—Ecuador, Guyana, Suriname, Venezuela, and Amazonian areas of Bolivia, Brazil, Columbia, and Peru
      • Caribbean—Antigua-Barbuda, Dominica, Grenada, Haiti, Jamaica, St. Kitts-Nevis, St. Lucia, and Turks and Caicos Islands

Hepatitis C Screening

VHA recommends laboratory screening for Hepatitis C in patients born during 1945-1965, patients at high risk for infection, or in patients who request testing.

High risk includes:

    • Prior or current injection drug use2
    • Blood transfusion or organ transplantation prior to 1992
    • Hemodialysis
    • Vietnam-era service, defined by dates of service from 1964 through 1975
    • Recent needle stick injury or mucosal exposure to HCV-positive blood in a health care, emergency medical care, or emergency medical and public safety worker
    • Tattoos or body-piercings obtained in unregulated settings
    • Intranasal drug users who have shared paraphernalia
    • 50 or more lifetime sex partners
    • Current or past sexual partners of HCV-infected persons
    • HIV infection
    • Receipt of clotting factor concentrates prior to 1987
    • Persistently abnormal alanine aminotransferase (ALT) levels
    • Born to an HCV-positive woman
    • Incarceration

High Blood Pressure Screening

At least every 1-2 years (based on prior blood pressure readings). VA/DOD recommends annual screening for blood pressure.

To get the most accurate reading:

  • Do not consume caffeine, tobacco or perform vigorous physical activity for at least 30 minutes  prior to your blood pressure reading
  • Be seated for 5 minutes without talking prior to the reading; and no talking during the reading
  • Be seated with both feet on the floor, back supported, with your arm supported. No long sleeves or loose sleeves
  • Do not hold your breath

HIV Screening

At least once for all adults ages 18 years and older

At least annually for HIV-negative adults with new or ongoing risk factors. Risk factors include:

  • Men who have had sex with men after 1975
  • Men and women having unprotected sex with multiple partners
  • Past or present injection drug users
  • Men and women who exchange sex for money or drugs or who have sex partners that do
  • Individuals whose past or present sex partners were/are HIV-infected, bisexual, or injection drug users
  • Heterosexual individuals who have had, or whose sexual partners have had, more than one sexual partner since their most recent HIV test
  • Persons being treated for sexually transmitted infections (STIs)
  • Persons with a history of blood transfusion between 1978 and 1985
  • Persons who request an HIV test without disclosure of risk factors may also be at increased risk due to unreported high-risk behaviors

HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women.

Lung Cancer Screening

VHA recommends offering annual screening for lung cancer with low-dose computed tomography to adults aged 55 to 80 years who have a 30 or more pack-year history and currently smoke or have quit within the past 15 years and have a life expectancy of more than 5 years.

Osteoporosis Screening

VHA recommends screening* for osteoporosis to prevent osteoporotic fractures with bone measurement testing in women 65 years and older.

VHA recommends screening* for osteoporosis to prevent osteoporotic fractures with bone measurement testing in postmenopausal women younger than 65 years who are at increased risk for osteoporosis, as determined by a formal clinical assessment.

The current evidence is insufficient to assess the balance of benefits and harms of screening* for osteoporosis to prevent osteoporotic fractures in men.

*Note: All patients who have a newly diagnosed hip or vertebral fracture or any other fracture that may be due to osteoporosis, particularly if it occurred after minimal trauma, should be appropriately evaluated for osteoporosis, including by measurement of bone density using DXA. This use of DXA in this situation is not considered ‘osteoporosis screening’ but rather is for evaluation of a symptomatic patient.

Overweight and Obesity Screening

VHA recommends screening for overweight and obesity in adults aged 18 years and older by measurement of height and weight and calculation of body mass index (BMI).

VHA recommends that overweight adults (BMI 25-29) with one or more obesity-associated conditions and obese adults (BMI ≥ 30) be offered referral to an intensive, multi-component, behavioral weight management intervention. VA offers the MOVE! program.

Obesity-associated conditions include:

  • High blood pressure
  • Type 2 diabetes
  • Pre-diabetes
  • Cholesterol and other lipid disorders
  • Metabolic syndrome
  • Obstructive sleep apnea
  • Degenerative joint disease
  • Non-alcoholic fatty liver disease

Prostate Cancer Screening

Prostate screening is not recommended for men ages 18-54 and over 70 years of age. This screening is recommended for some men ages 55-69; ask your primary care provider.

Screening for Syphilis

VHA recommends syphilis screening in adults without symptoms who are at increased risk for infection.

VHA recommends early screening for syphilis infection in all pregnant women.

Those at increased risk include:

  • Person living with HIV
  • Men who have sex with men (MSM)
  • All pregnant women
  • Sexually active persons receiving pre-exposure prophylaxis (PrEP) for HIV
  • Other groups who may have a higher prevalence of infection, for whom providers may consider offering screening, including: Those with history of incarceration,
  • Those with history of commercial sex work,
  • Those with a history of exchanging sex for money or drugs,
  • Men younger than 29,
  • Persons living in geographic areas or communities with increased prevalence of syphilis. This may include members of particular ethnic or racial groups. Ask your provider.
  • Any Veteran who requests testing. Acknowledgement of being in a specific risk group is not required

Tobacco Screening & Counseling

VHA recommends screening adults for tobacco use at least once a year.

VHA recommends tobacco cessation interventions (brief counseling and an offer of pharmacotherapy), unless contraindicated, at least once a year for all tobacco users including augmented pregnancy-tailored counseling to pregnant women who smoke.

Contraindication: Veterans with a terminal illness and/or under the care of hospice. This is because the benefits from tobacco cessation are likely to be small to none in this population.