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NHS SCREENING FOR WOMEN OVER 40

Screening identifies those at higher risk of certain conditions among apparently healthy people. The NHS offers a range of screening tests to different sections of the population, depending on their age and other risk factors.

For women, there are nationally organised breast, cervical, and bowel screening programmes. The NHS Health Checks offer a general assessment for risks around cardiovascular disease, diabetes and high blood pressure. Your GP may also arrange screening for osteoporosis. For women who are over 40 and pregnant, screening for genetic disorders are also available. Screening is a statistical tool, however, so you should always report unusual or severe symptoms if they occur.

This article was included in issue 73 (summer 2017) of The Menopause Exchange newsletter.

Breast screening
Mammograms, a type of X-ray of the breast, are offered by invitation every three years to women aged 50 to 70, to spot cancers when they’re too small to see or feel. In some areas of the UK, this is being extended to start at 47, or if you’re at high risk. After 70, you can still arrange mammograms through your local screening unit, but won’t automatically get an invitation. However, at any age, if you get symptoms such as a lump, breast skin change, nipple indrawing or discharge, don’t wait for your next mammogram; see your GP immediately.

Cervical screening
The NHS Cervical Screening Programme aims to catch cervical cell changes early to reduce the number of women who would go on to develop cervical cancer. Since it was introduced in the 1980s, cervical cancer cases have decreased by about 7% annually. All women registered with a GP are invited for cervical screening:

  • aged 25 to 49 – every three years
  • aged 50 to 64 – every five years
  • over 65 – only women who haven’t been screened since age 50 or those with recent abnormal test results

Changes in the cells of the cervix are most often caused by the human papilloma virus (HPV). Of the hundreds of strains of HPV, HPV-16 and HPV-18 are considered to be highest risk for cervical cancer. Samples of cells are taken from the cervix using a small brush and are studied in the lab. In some areas, a trial is being done where they test for HPV first and the cell sample is only checked for abnormal cells if HPV is found. If HPV isn’t found, you’ll be offered a screening test again in three to five years depending on your age.

Bowel screening
To detect cases of bowel cancer early, the NHS offers two types of bowel cancer screening to adults registered with a GP in England:

Everyone aged 60 to 74 is invited to carry out a faecal occult blood (FOB) test. Every two years, you will be sent a home test kit, used to collect a stool sample. If you’re 75 or over, you can have this test sent by calling the freephone helpline on 0800 707 60 60.

Additional one-off testing called bowel scope screening is gradually being introduced in England for everyone aged 55. As an outpatient, a thin, flexible camera (colonoscope) is used to look inside the lower part of the bowel and if necessary remove polyps or take biopsies of any suspicious areas.

NHS health checks
The NHS Health check programme is for adults in England aged 40 to 74. It’s designed to spot early signs of stroke, kidney disease, heart disease, type 2 diabetes or dementia. Those in the 40 to 74 age group without a pre-existing condition (i.e. not those already being checked), can expect to receive a letter from their GP or local authority inviting them to a free NHS Health Check every five years.

A healthcare professional (usually a nurse or healthcare assistant) will ask some simple questions about your lifestyle and family history, measure your height and weight, take blood pressure and do a blood test – often using a small finger prick test. This assesses your chances of getting heart disease, stroke, kidney disease and diabetes. If you’re over 65, you’ll also be told about signs and symptoms of dementia. You’ll then be given advice on lowering your risk of these conditions and maintaining or improving your health, including how to improve diet and the amount of physical activity you do, taking medicines to lower your blood pressure or cholesterol, losing weight or stopping smoking.

Cardiovascular screening
Your GP, practice nurse, or district nurse if you’re housebound, can do a general check of blood pressure, heart sounds, peripheral arteries, and lipid profile to assess your risk of cardiovascular disease. It’s not part of the national programme, but is often done opportunistically when you’re seeing them for other reasons. Men also get an ultrasound aortic aneurysm screening in their 65th year but women are considered lower risk. However if you feel you may be at risk you can discuss this test with your GP.

Osteoporosis
Those at risk, as measured by their ‘Frax’ score, can get a screening DEXA scan of their bones and will then be advised about next steps to take, if any. This isn’t part of any national screening programme, but you can ask your GP to check your ‘Frax’ score if you feel you’re at risk, e.g. if you have a family history of osteoporosis, unexplained fractures, are on steroid medication or are a heavy smoker.

Other screening services
Pregnant women of any age may be offered NHS screening for a variety of conditions in pregnancy – e.g. for blood-borne diseases (hepatitis B/HIV/syphilis); chromosomal abnormalities such as Downs syndrome, Patau’s syndrome and Edwards syndrome; sickle cell disease and thalassaemia; and physical abnormalities (mid-pregnancy scan).

Patients with diabetes have retinal screening annually as part of a national programme to check for eye damage.

About the author

Gill Jenkins is a GP in Bristol with particular interest in lifestyle health, women’s health and travel. She is also a flight doctor monitoring and repatriating patients taken ill abroad.

Created Summer 2017

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