Cervical smear test
The NHS cervical smear programme offers regular cervical smears, every three to five years, to all women aged 20 to 64, and may soon be extended to include women up to the age of 70. The smear test is unique in that it can detect pre-cancerous changes in cervical cells up to five years before cancer develops. This enables the 'rogue' cells to be destroyed well in advance of a cancer arising. Very specific cell changes have been identified on the route between normal cells and cancer, so priority can be given to women who are well on the way to developing cancer, and a policy of regular monitoring can be made for those women with only minor cell abnormalities, as these often revert to normal over a six- to 12-month period.
In spite of the wide availability of smear testing, and an active national recall system, many women never attend for their smears. Some of these women feel too embarrassed at the prospect of even a short internal examination, whereas others feel that they are at low risk, so don't see the need for regular testing.
Sadly, in an age where cervical cancer is almost completely preventable, almost 2,000 women in the UK die from cervical cancer each year. Most of these have never had a smear test, or have stopped attending regularly.
Routine eye examination
Now that it's possible to buy a pair of 'off the peg' reading glasses at most supermarkets and pharmacies, many people are doing away with a regular eye examination by a qualified optometrist. But this examination is so much more than a vision test. A properly conducted, thorough eye examination can detect a whole host of other medical problems, often before symptoms have developed.
I regularly get letters from local optometrists asking me to check a patient, as their eye examination has revealed findings suggestive of high blood pressure or diabetes. Early detection of these conditions in a person who is unaware that they have any problems can make a wealth of difference to their long-term health prospects.
The routine eye examination also checks for glaucoma, an insidious eye condition that can result in blindness. In glaucoma, the pressure inside the eyeball is raised, which causes patchy damage to the retina (the membrane at the back of the eye that collects light signals). The sufferer is usually unaware that vision is being lost until a critical amount of damage has been done to the retina, by which time it is often too late to save the sight. The routine eye examination checks the pressure in the eyeball, and if this is even slightly raised, checks for areas of retinal damage.
Everyone should have a routine eye examination every two years, with more frequent checking recommended for higher-risk groups of people.
Dental check-ups
With NHS dentists being something of a rarity in many parts of the country, many people are not having the traditional six-monthly dental check. But does it matter? Well, for many it does, as tooth decay is a common problem, made worse by our passion for sugary foods, sweets and fizzy drinks. Gum disease is also very widespread, with more teeth being lost to gum disease than to actual tooth decay.
A regular dental check should include an assessment of dental hygiene, and regular review and instruction about diet, brushing, etc.
More serious medical problems may be revealed at routine dental examinations, with cancers of the mouth, tongue and throat often being first detected at a routine check-up. Although many people won't require a six-monthly check, it is certainly advisable to be checked at least once a year.
Chlamydia testing
The Department of Health has given an undertaking to implement a national screening programme for chlamydia at a future date, and at the present time around 26 screening programmes are up and running in the UK. This only provides around 25% coverage, however, so it is still up to individuals to seek chlamydia testing in the majority of cases.
Chlamydia is the most widespread sexually transmitted infection in the UK. It is only possible to estimate the incidence, in the absence of a screening programme, but it is thought to infect at least 10% of all sexually active people aged 16-25 (around 600,000 young people). It has been dubbed the 'silent epidemic' because 70% of infected women and 50% of infected men have no symptoms at all. Infection has major implications for women, as 10% of all infected women will be made infertile as a result of infection in the fallopian tubes. A single episode of unprotected sex can result in chlamydia infection. Condoms offer a considerable amount of protection, but don't completely eliminate risk. Anyone who feels that they are at risk should attend their local GUM clinic for testing.
Cholesterol testing
Cholesterol is high profile at the moment, with many pharmacies offering free cholesterol tests. This is because, for the first time, a cholesterol-lowering drug (simvastatin) has been made available over the counter at pharmacies.
A cholesterol measurement is of little value in isolation. Raised cholesterol is a major risk factor for coronary heart disease (around 46% of under-75s who die from heart attacks have high cholesterol), but has to be taken in the context of other risk factors such as smoking, raised blood pressure, family history, obesity, diabetes, age and gender. On that basis, there is little point in a 25-year-old woman, with no other risk factors for coronary heart disease, having a cholesterol test, unless she knows that a very high cholesterol problem runs in her family (familial hypercholesterolaemia).
People with one other non-medical risk factor, such as age, smoking or obesity, may find it useful to have a pharmacy-based cholesterol test. People with more than one risk factor or medical problems such as high blood pressure or diabetes, should discuss cholesterol testing with their doctor.
Full medicals
Much of the content of a full medical is irrelevant to many people, and they tend to be expensive. What is more likely to be valuable, across the board, is a 'well-person check' with a practice nurse. This will usually include blood pressure measurement (very important), urine testing, height and weight measurement, and a discussion about lifestyle, including smoking habits, alcohol, diet and exercise.
