Dr R Prince, Dec 2022
People often only think about their health when it starts to decline. However, as a GP, I know all too well that it is more of a challenge to treat a condition once it has developed, than to try to prevent it from happening in the first place.
It may seem counterintuitive to book a GP appointment when you feel well but at Kent Family Medical, we are firm believers that prevention is better than cure and early detection is key.
Here are just a handful of examples of what we can screen for and some supporting medical evidence as to why they are so important:
Screening for Type 2 Diabetes
By checking your HbA1c (a blood test that tells us the amount of your red blood cells that have sugar attached to them) we can detect pre-diabetes (the stage just before diabetes) and diabetes itself, early-on. We often think of diabetes presenting with weight loss, increased infections, being thirsty and passing a lot of urine. This is definitely true but these are what we call ‘osmotic symptoms’ that happen when your sugars are very high. In the early stages of type 2 diabetes, you may not have any symptoms at all. If we detect Pre- diabetes early on, we can work with you to reduce your risk of developing diabetes. If we find that you do have early diabetes, we can gain better control of your sugars, earlier. This is hugely important because of something called the ‘legacy effect’. The better sugar control you have early on in diabetes, the less likely you are to develop complications. A huge study, spanning 44 years, was published in September 2022. It started in 1977 and allocated patients into 2 groups. One group was given intensive blood sugar control just after diagnosis and the other group did not have their sugars so tightly controlled. The study has shown that those patients who had very good sugar control, straight from diagnosis, had far less diabetes complications and had a longer life expectancy. These effects lasted throughout the 44 years that the study has been going on for. You can read more information about this here:
Oxford Journal Article
Detecting diabetes early and treating appropriately can have significant, long-lasting positive effects.
Cardiovascular risk assessment
At Kent Family Medical, we provide a cardiovascular screening package that looks at your blood tests results, personal and family history, to calculate your risk of a heart attack or stroke over the next 10 years. As well as age, ethnicity, blood pressure, family history, cholesterol and sugars, we also look at your kidney function, migraine history, history of autoimmune conditions and medication history – all factors that can affect your cardiovascular risk. This method of calculating cardiovascular risk is recommended nationally by the National Institute of Health and Care Excellence. You can find more information about this in the medical literature by following this link:
– https://www.bmj.com/content/357/bmj.j2099
Once we know someone’s cardiovascular risk, we can take individualised steps to minimise this – by giving tailored lifestyle advice, suggesting further investigation where warranted or even prescribing medication (appropriate for each individual) that has been proven to reduce the risk to your heart over time.
Urine microalbumin
Our kidneys act like a sieve – keeping bigger molecules such as protein in our body whilst filtering through smaller molecules in the urine. We recommend screening for microscopic protein molecules (microalbumin) leaking through into the urine in high blood pressure and diabetes.
This can be a sign that the small blood vessels that supply your kidneys are being affected by your blood pressure or sugars. This suggests that small blood vessels elsewhere may be starting to be affected as well. If we detect microalbumin in your urine we know that we need to prescribe certain medication and advise certain lifestyle changes to stop those blood vessel changes from progressing. For example, if we don’t act on microalbumin in the urine in patients with Type 2 Diabetes, patients have double the risk of dying from a cardiovascular event (heart attack or stroke) in the next 10 years and a 42% higher risk of developing diabetes-related kidney disease.
Urine microalbumin is therefore definitely worth screening for if you have diabetes or high blood pressure.
Bone health
The definitive way of diagnosing osteoporosis (clinically significant thinning of the bones) or osteopenia (the start of the thinning of the bones) is by a DEXA scan which measures bone density. If this finds that your bone density is low, we would recommend certain medication and lifestyle changes to build your bones up again.
However, even if a DEXA scan is normal, there may be other factors that put your bones at risk and we may recommend treatment earlier. By taking a full personal and family history, we can calculate something called a FRAX score – a way of calculating the risk of future significant bone fractures. Information that is required for this includes:
– Age
– Sex
– Weight
– Height
– Prior fracture
– Hip fracture in a parent
– Current smoking
– Steroid use
– Having rheumatoid arthritis
– Having a secondary cause of osteoporosis, such as hyperparathyroidism, multiple myeloma, Cushing’s disease, coeliac disease, or hyperthyroidism
– Drinking 3 or more alcoholic drinks per day
If your FRAX score indicates that your risk of fracture is high, medication and lifestyle changes can reduce that risk significantly.
You can read more about the FRAX score here:
– https://frax.shef.ac.uk/FRAX/tool.aspx?country=1
Cancer screening tests
There are a lot of simple tests that can be done that may lead us to look further for a possible cancer. Even simple things like an unexplained anaemia or a high platelet count (the cells that make your blood sticky).
There are specific tumour – marker tests as well such as a PSA (prostate specific antigen blood test), a CA-125 (ovarian cancer screening blood test) and a q-Fit (bowel cancer faecal test). Whilst these tests look for specific cancers, they must be interpreted in the context of a GP consultation and examination.
A positive result does not mean that you have a particular cancer but it does mean that we need to investigate further with specialist referrals, scans or a colonoscopy. For example, a raised PSA may indicate prostate cancer but a PSA can also be raised in a benign, enlarged prostate or a urine infection. A CA-125 can be elevated in ovarian cancer but also in endometriosis, fibroids or pelvic infections. A positive qFIT stool test result may indicate bowel cancer but equally it may be raised in bleeding piles or menstruation.
Cancer screening tests are important however. For example, ovarian cancer only tends to cause significant symptoms once it is advanced so testing for a CA-125 along with a clinical consultation, is a useful way of trying to detect cancer earlier, at a more treatable stage.
Cancer screening tests in the context of a personalised GP consultation can be very useful in early detection.
These are just a few examples of health screening in people who are fit and well and in those who have pre-existing diagnoses. We hope they highlight why prevention and early detection are so important.
