Guide to health screenings: All the recommended tests for different ages

When was the last time you went for a health screening test? No matter how old we are, it’s always better to be safe than sorry. Health should be a top priority no matter our age.

As the proverb goes, health is wealth. Health is the greatest gift of life — there is no other worthy substitute, no matter our station in life.

Of course, certain things in life are out of our control; for instance, no one can predict themselves developing diabetes, or cancer. Rather than suffer from tunnel vision and fixate on what is out of our control, what we must do is focus instead on what is within our control.

One of the most important things that we can do to take charge of our health is to proactively go for health screening tests. Regardless of our age, health screening allows for early diagnosis, medical intervention and treatment, leading to better outcomes for us. Even if we think we are healthy, they will also put our minds at ease and reassure us of our health.

Before you do so, it is important to know how to choose health screening tests that best suit us, the types of health screening tests available, and the recommended health screening tests for our age in Singapore.

Choosing health screening tests that suit you best

In order to determine which health screening tests we need, we should take into account some common sense risk factors that include:

• Age
• Gender
• Past medical history
• Family medical history
• Smoking status

Depending on the risk factors that you have, certain health screening tests would be more beneficial for you than others, while some may not be as useful.

For example if you are of advanced age and you have a strong family history of diabetes, it would be prudent for you to go for regular diabetes health screening tests as soon as possible.

Similarly, if you’re relatively young, without a history of alcohol dependence and are not a hepatitis B carrier, a health screening test for liver cancer may not be as necessary or urgent for you.

One good rule of thumb to observe is that, if you have a strong family history of a certain disease, you should definitely consider going for health screening tests for it regularly as soon as possible.

Regardless, if you are unsure of what health screening tests you should be arranging for yourself, you should consult a doctor at your earliest convenience to figure out your health screening needs.

Types of health screening tests

Under Singapore’s 2019 Screening Test Review Committee’s (STRC) guidelines, health screening tests administered by medical professionals can be broadly grouped into three categories:

Category 1 – Suitable for everyone in the population

Health screening tests in this category are proven by good and robust evidence to be clinically effective and cost effective for screening everyone in the population.

Category 2 – Suitable for individual-decision making

Health screening tests in this category may be useful for those with high risk factors or there is evidence proving that the test is clinically effective but it’s cost-effectiveness remains unevaluated or is not ideal

Category 3 – Not recommended

Health screening tests in this category are not suitable for anyone as there is not enough evidence to determine their usefulness or there is good evidence that the tests are not cost-effective or that the harm they pose to the individual outweighs any benefit

Naturally, whether you choose to get health screening tests at a private healthcare provider or at a national healthcare provider, you will definitely be asked to choose health screening tests from within Category 1 and Category 2, appropriate to your medical situation.

Regardless, if you’re uncertain, always remember that you have the right to ask your healthcare provider to clarify which category the health screening test they’re recommending falls under and what its purpose is.

Recommended health screening tests by age

Health screening tests are typically offered as a bundle in a health screening package, by private healthcare providers.

The Health Promotion Board (HPB) recommends a list of health screening tests available in Singapore that you can consider including in your health screening package. For ease of reference, we’ve organised them according to the age range they are usually recommended for.

18 and above

Many of the health screening tests for this age group fall under Category 2, and may be applicable for individuals with high-risk factors for specific diseases.

Obesity Screening Obesity refers to when a person’s body weight exceeds the normal weight range for their height and age.  Left unmanaged, obesity can lead to many medical complications, like diabetes, high blood pressure, heart disease, stroke, and even certain types of cancers.

If you are 18 years old or older, you should be screened once a year.

Generally the Body Mass Index (BMI) is used to determine if you are overweight or obese. The formula for BMI is calculated by dividing your weight (kg) by the square product of your height (m).

You can refer to the chart below to see if you are overweight or obese:

Hepatitis B Screening Hepatitis B infection is caused by the Hepatitis B Virus (HBV). Around 6 per cent of Singaporeans have chronic HBV infection. People with HBV infection can eventually become seriously ill, with abnormal liver functioning and even die from it or liver cancer. Generally, you should be screening for hepatitis B if you are:

• Pregnant
• A healthcare professional
• Undergoing kidney dialysis
• At high risk with a family history of HBV infection or liver cancer, or if you engage in high-risk behaviour.

High risk behaviour includes having soliciting paid sex or sexual contact with strangers, having multiple sex partners, sexual contact with another HBV infected person, anal sex, and sharing needles.

Hepatitis B screening uses a simple blood test to test for the presence of HBV antigen (HBsAg) and antibodies (antiHBs). It should be done before vaccination. Should you have been found to have antiHBs, you are immune to Hepatitis B and do not require any vaccination.

Liver cancer screening

Liver cancer screening is not typically required if you do not have any risk factors. You should screen for liver cancer if you have:

• Chronic hepatitis B infection
• Hepatitis C liver cirrhosis, or scarring of the liver
• Liver cirrhosis from other causes

Liver cancer screening tests include:

• Alpha Fetoprotein (AFP) Tumor Marker Test. Alpha Fetoprotein is a protein found in the blood that is elevated when you have liver cancer.
• Ultrasound Scan of the liver, including gallbladder and bile ducts.

You should get AFP Tumour Marker Tests done every 3 to 6 months, and ultrasound scans of your liver done every 6 to 12 months.

Tuberculosis screening Tuberculosis (TB) is a serious infectious disease affecting your lungs and other parts of your body.  Without symptoms, however, it is not necessary to go for annual chest X-rays for TB screening as the infection rate is very low.

You should consider going for an x-ray to screen for TB if you experience a persistent cough for more than 3 weeks.

20s and above

Cervical cancer screening

Cervical cancer refers to cancer of the neck of the womb and is one of the most common cancers in Singapore among women.

You are at higher risk of developing cervical cancer if you:

• Smoke
• Engaged in sexual intercourse at an early age
• Have a history of sexually transmitted infections
• Are infected with the Human Papillomavirus (HPV)
• Are HIV positive
• Have a weak immune system

Conversely, you have a lower risk of cervical cancer if you have not engaged in sexual intercourse.

Cervical cancer screening uses the Papanicolaou (PAP) smear test . Women who’ve had sexual intercourse should get their first Pap smear test done by the age of 25.

You should go for a Pap smear every 3 years. If you are HIV positive, you should go for a Pap smear every year.

You can stop taking the Pap smear test after you turn 65 if your Pap smear taken at age 65 and those  in the past have been clear.

A Pap smear test is not necessary if you have not had sexual intercourse.

Chlamydia Screening Chlamydia is one of the most common sexually transmitted infections. It causes inflammation of the urethra in men and of the cervix and area around the uterus and ovaries in women. Non-pregnant women should get screened for chlamydia if they:

• Are 25 years or younger
• Have a new sexual partner
• Have a partner with symptoms of an STI
• Have had two or more sexual partners in the past 12 months
• Have had unprotected sex
• Have had an abortion alongside the above risk factors

Pregnant women should be screened for chlamydia if they:

• Are 25 years and younger
• Have had two or more sexual partners in the last 12 months,
• Have sexual partners with symptoms of STI.

Men who practice unsafe sexual behaviours, such as unprotected sex, frequent change of sexual partners, and soliciting paid sex, should get screened for chlamydia.

Chlamydia screening is done by examining tissue from the urethra in men and from the cervix in women. Screening for chlamydia should be done about 1 week after unsafe sexual contact or a change of sexual partner.

40s and above

High blood pressure (Hypertension) screening

If you are 40 years old and above, you should check your blood pressure at least once a year. High blood pressure happens when your diastolic blood pressure is at 90mmHg (millimetres of mercury) or higher, or when your systolic blood pressure is at 140 mmHg or higher.

Diastolic pressure refers to the blood pressure when the heart is at rest and systolic pressure refers to when the heart is pumping. High blood pressure can sometimes present with no symptoms until complications like strokes or heart attacks take place.

Early detection and treatment can often stop them from happening. Ask your doctor to check your blood pressure or you can also learn to check it yourself with an electronic blood pressure meter.

High blood cholesterol screening

Generally, you should be screened for high blood cholesterol if you:

• Are 40 years or older
• Have a history of strokes or heart attacks
• Have diabetes
• Have a strong family history of high blood cholesterol

You may consider screening for high blood cholesterol from the age of 30 onwards if you:

• Have other risk factors for high blood cholesterol such as smoking, high blood pressure, or a family history of developing heart disease before the age of 65.
• Are Indian or have Indian ancestry

Blood cholesterol screening uses a blood test which tests for every type of fat present in your body which includes:

• High-Density Lipoprotein (HDL) cholesterol, or ‘good’ cholesterol
• Low-Density Lipoprotein (LDL) cholesterol, or ‘bad’ cholesterol
• Triglyceride (TG)

Do take note that testing for TG requires you to fast 10-12 hours beforehand.

Consult your doctor to figure out which blood cholesterol range is most suitable for you. If your results are healthy, you should screen for blood cholesterol every three years.

Diabetes screening

As a rule of thumb, you should begin screening for diabetes at the age of 40.

You may wish to start screening even earlier from the age of 30 onwards for instance, if you have other risk factors like:

• Obesity/Overweight (BMI of 25 and above)
• High blood pressure (BP of 140/90 and above)
• Close relatives with diabetes
• History of gestational diabetes or diabetes during pregnancy
• Coronary heart disease
• polycystic ovary disease (multiple cyst of the ovaries)
• High cholesterol levels
• History of confirmed borderline high fasting blood glucose levels.

Diabetes screening uses a simple blood test for fasting blood glucose levels.

Breast cancer screening
Breast cancer is the most common cancer among women in Singapore. Early detection helps to improve the effectiveness of treatment and outcomes.

Here’s how often you should be screening for breast cancer:

Women below 40 years of age, there is no need to go for breast cancer screening.

Women between 40 and 49 years of age, it’s recommended to go for breast cancer screening every year.

Women above 50 years of age, should go for breast cancer screening every 2 years.

Women with high risk of breast cancer should consult their doctor for the frequency of breast cancer screening that they should go for.

50s and above

Colorectal cancer screening

Colorectal cancer is the most common cancer in Singapore and refers to cancer of the colon and rectum which includes your large intestine and anus.

If you have no symptoms, and do not belong to a high-risk group, you should start screening for colorectal cancer screening at the age of 50.

You are at higher risk for colorectal cancer if you:

• Have close relatives with colorectal cancer or abnormal growths in their large intestine
• Have had cancer of the womb, ovaries, or breast

If you are at high-risk, you are strongly advised to go for screening from a younger age and at more frequent intervals. Consult a doctor and seek advice.

Colorectal cancer screening tests include Faecal Occult Blood Test (FOBT), double-contrast barium enema, and colonoscopy.

Prostate cancer screening Prostate cancer is the 6th most common cancer among men in Singapore. Prostate cancer can only be cured if it has not spread to the rest of the body.

You should get screened for prostate cancer if you are above 50 years old with a family history of immediate relatives having prostate cancer below the age of 60. Men in these categories are at high risk for prostate cancer.

Prostate cancer screening is done through a Digital Rectal Examination (DRE) DRE, a quick and reliable physical examination of the prostate gland through the rectum with a gloved finger. Suspicious lumps in the prostate gland can be picked up by the DRE.

If you’d prefer something less invasive you can also choose to take the Prostate Specific Antigen (PSA) blood test, which can detect the onset of cancer in the prostate gland.

60s and above

Osteoporosis Screening Osteoporosis refers to when your bones have become weak and brittle, leading to a greater chance of breaking after minor trauma. The condition typically happens as you progress to an advanced age. You should be screened for osteoporosis if you have the following risk factors as an adult:

• Personal history of past fracture as an adult
• History of fracture in an immediate relative (especially mother)
• Low body weight and old age
• Smoking
• Heavy alcohol consumption
• Early menopause
• Surgical removal of the ovaries before the age of 45 years
• Long-term medication e.g. oral steroids, thyroid medication
• Being bed-bound for a prolonged period
• Poor health
• Low calcium intake for most of your life (< 500 mg/day)
• Lack of regular exercise or physical activity

Osteoporosis screening uses a painless procedure called dual-energy X-ray absorptiometry (DXA). This test measures the density or strength of the bones known as bone mineral density or BMD.

If you are being followed up for osteoporosis, you should get screened once every year. If you have mild decreases in bone mass, you should get screened once every 1-5 years. If your bone mass is normal, you should get screened once every 5 years. Consult a doctor to figure out what’s right for you.

Making a health screening plan

Now that you’re familiar with the types of health screening tests and which medical conditions you should get screened for, you’re ready to start making a health screening plan and decide on what kind of health screening package to get.

Before choosing, you are advised to consult a doctor to ensure that the health screening tests you choose are suitable and useful for you. Remember to also discuss with your doctor how frequently you should be taking these tests.

If you’d like to avoid the hassle and crowds at clinics, our Homage care professionals are able to provide selected health screening tests in the comfort and privacy of your own home.

Navigating health screenings alone can be a daunting task but that doesn’t have to be the case. 

This article was first published in Homage.