Screening is an assessment to identify apparently healthy people who are at a risk for a disease or health condition.
Excerpts from the Clinical Practice Guidelines for primary and secondary prevention of cardiovascular disease in Malaysia (2017)
The Malaysian adult population (≥18 years) has high levels of cardiovascular risk factors.
• 63.6% of men, and 64.5% of women are either overweight or obese.
• 43% of men smoke, 59% of women between the ages 21-30 smoke.
• 43.5% of men, and 52.2% of women have hypercholesterolemia.
• 30.8% of men, and 29.7% of women have hypertension.
• 16.7% of men, and 18.3% of women have diabetes mellitus.
Recommendations for screening in the older Malaysian population
Screening for cardiovascular risk based on risk factors:
• Advancing age
• High total serum cholesterol
• High low density lipoprotein cholesterol
• Low high density lipoprotein cholesterol
• Type 2 diabetes and hypertension
• Increased BMI and waist circumference
• Cigarette smoking & vaping
• Family history of coronary artery disease (myocardial infarction or sudden death of father or other male first degree relative before the age of 55 years or death of mother or other female first degree relative before the age of 65 years.
• Hypertension is a silent disease; the majority of cases (61%) in the country remain undiagnosed.
• Blood pressure should be measured at every chance encounter.
• Untreated or sub-optimally controlled hypertension leads to increased cardiovascular, cerebrovascular and renal morbidity and mortality.
• A systolic BP of 120 to 139 and/or diastolic BP of 80 to 89 mmHg is defined as prehypertension
Screening for Diabetes is based on risk factors
• Family history
• Polycystic ovarian disease
• Gestational diabetes
Screening is ideally done with HbA1c or fasting glucose tests
Excerpts for Clinical Practice Guidelines for Management of Type 2 Diabetes in Malaysia (2016)
• Individuals with risk factors for diabetes should be screened annually
• An HbA1c ≥ 6.3% is diagnostic of diabetes mellitus in Malaysian adults.
• Patients with pre-diabetes are 2 to 3 times at risk of developing cardiovascular diseases and diabetes.
• Universal screening for diabetes with Glucose Tolerance Test should be performed on all pregnant women between week 24 to 28.
Advantages of screening and treatment
• Lowering the systolic blood pressure by 10 mm Hg with blood pressure medication in women aged 60 -69 years can prevent 41% of stroke and 22% of coronary artery disease. It can cut down the risk of strokes by 30%, dying from a stroke by 39% with a 64% reduction in the rate of heart failure.
• Aggressive blood pressure control in in people with diabetes leads to 51% risk reduction of cardiovascular events.
• Lipid lowering drugs causes a 30% decrease in coronary heart events.
The peak incidence of breast cancer in Malaysian women is between 50 – 69 years. Screening of women aged 40 and above showed a 14% relative risk reduction of breast cancer.
In Malaysia, screening mammograms are recommended for women who are at high risk such as women with previous breast atypia, breast or ovarian cancer, family history of breast cancer in first or second degree relatives before the age of 50 years.
Due to limited resources, it is not advised for all eligible women. Many women are advised to take advantage of the government subsidized mammograms offered in various centers on a regular basis or to have their mammograms done at private hospitals.
Screening mammograms can be done for any woman after the age of 40 years and then repeated at 2 yearly intervals.
Ultrasound breasts are advised for women below the age of 40 years, and women with dense breasts.
Early intervention after early detection can reduce the risk of breast cancer mortality by 14%.
Cervical cancer is the second most common cancer in Malaysia. Around 5 women die from cervical cancer daily. However only 23% of women have their pap smears done yearly. Around 80% of cervical cancers are detected in the late stage.
Pap smears should be ideally done 1- 3 yearly from the age of 20 – 65 years.
Colon cancer is the 3rd leading cause of death in women in Malaysia. Faecal occult blood testing beginning at 50 years should be done and continued until 75 years every 2 years. This can reduce the risk of dying from colon cancer to 13% from 21%.
Those at high risk should see their gastroenterologists and carry out colonoscopies if necessary.
Peak bone mass is achieved by the age of 30 years after which men and women tend to lose bone. To achieve a higher peak bone mass there should be an aim to lead an active life with adequate exercises, avoiding long term steroids and having an adequate calcium rich diet in our youth.
Women who are at a higher risk for osteoporosis are those
• who are of advanced age
• with a previous fracture
• on long-term glucocorticoid therapy
• low body weight (less than 58 kg [127 lb])
• family history of hip fracture
• cigarette smoking
• excess alcohol intake
A FRAX (Fracture Risk Assessment Tool) score can be conducted by your doctor to look at your 10 year probability of fracture. Follow up and treatment can then be planned.
A DEXA (Dual Energy x ray absorptiometry) test is the best way to determine bone density, however it is not easily available.
Sazlina SG. Health screening for older people – what are the current recommendations? Malaysian Family Physician 2015;10(1)
Lindsay et al. Recommendations on screening for high blood pressure in Canadian adults. 2013;59(9);927-33
National Cancer registry Malaysia. Ministry of Health 2006
Gotzsche PC, Jergensen K. Screening for breast cancer with mammography. Cochrane Database 2013