Screening and checks

National cancer screening

• Bowel: immunochemical faecal occult blood test every 2 years, 45 to 74. Colonoscopy within 30 days of a positive test. Not for people with symptoms.
• Breast: mammogram every 2 years. Invited at 50 to 74, free from 40.
• Cervical: HPV test every 5 years, 25 to 74. Self-collection is open to everyone. Every 3 years if immunocompromised.
• Lung: low-dose CT every 2 years, for people aged 50 to 70 with at least 30 pack-years who smoke now or quit within the last 10 years, and have no symptoms.
• Prostate: no organised program. PSA every 2 years from 50 to 69 after an informed discussion, from 45 for higher risk. Action level 3.0 at usual risk aged 50 to 69.
• Skin and AAA: no national screening program. People at high risk of skin cancer are checked regularly.

Heart, diabetes and kidneys

• Cardiovascular risk: assess from 45 to 79; from 35 with diabetes; from 30 for Aboriginal and Torres Strait Islander people. High risk is 10% or more over 5 years.
• Diabetes: AUSDRISK from 40; screen Aboriginal and Torres Strait Islander people from 18.
• Kidney Health Check: from 18 for First Nations people, from 60 for everyone else. Use urine albumin to creatinine ratio, not a dipstick.
• Diabetic eye checks: at least every 2 years.
• Blood pressure thresholds: clinic 140/90; home or daytime 135/85; 24-hour average 130/80.

Bones

• DXA: refer when the FRAX 10-year major fracture risk is 10% or more.
• Osteoporosis: T-score of -2.5 or lower.

Pregnancy

• First visit: within 10 weeks.
• Combined first trimester screening: 11 to 13+6 weeks. NIPT from 10 weeks. Morphology scan: 18 to 20 weeks.
• Glucose tolerance test: 24 to 28 weeks for everyone, earlier with risk factors.
• Group B streptococcus swab: 35 to 37 weeks.
• Syphilis: first visit, 26 to 28 weeks, and 36 weeks or birth.
• After gestational diabetes: glucose tolerance test 6 to 12 weeks after birth.
• Perinatal depression: EPDS in pregnancy and 6 to 12 weeks after birth; 13 or more suggests depression.

Newborns and children

• Newborn bloodspot (heel prick): 48 to 72 hours after birth.
• Hearing: universal newborn hearing screening.
• Growth charts: WHO charts to 2 years, CDC charts from 2.
• Development and growth checks are recorded in each state's child health record (the Blue Book in NSW).

Preventive health checks

• Aboriginal and Torres Strait Islander health check: MBS item 715, yearly.
• Heart Health Checks are funded by Medicare.
• The RACGP Red Book lists every preventive activity by age and risk.

Principles worth knowing

• Screening only helps when finding a disease earlier changes the outcome.
• The best evidence for a screening test is fewer deaths from the disease in randomised trials.
• In low prevalence, the positive predictive value falls even when the test is good.