Health Screening

The Importance Of Screening

Screening For Endocrine Disorders In Primary Care

Many endocrine (hormonal) disorders have a significant delay between the time of initial presentation to a physician and diagnosis. This delay occurs as endocrine conditions can present with vague symptoms which may have been attributed to non-endocrine conditions.

Common symptoms or signs of endocrine disorders seen, often daily, in primary care include mood and cognitive changes, elevated blood pressure, elevated blood sugar, headache, menstrual irregularities, loss of libido, body hair changes and erectile dysfunction, electrolyte disturbances, disruption of thermoregulation, changes in bone mineral density, and fatigue.

The aim of a screening programme is to reduce the current delay in the diagnosis of endocrine disorders, the most common of which are diabetes or pre-diabetes, thyroid disorders, a raised blood calcium level, low bone density and reproductive disorders whilst rarer diagnoses include pituitary and adrenal disorders.

Cardiac Screening in Primary Care

The most common Heart Arrhythmia is Atrial Fibrillation. It can be detected by clinical examination and an ECG (heart tracing). Sometimes more technical tests will be required. Once detected, condition can be managed effectively to reduce the risk of harmful medical events (see below). 

The European Society of Cardiology reports that 

• The risk of developing Atrial Fibrillation for people of European descent at the age of 55 years is 37% which will depend on the person's age, genetics, and other clinical factors.
• The estimated prevalence of Atrial Fibrillation in adults is 2–4%.
• The prevalence of Atrial Fibrillation increases progressively with age.
• The lifetime risk of Atrial Fibrillation is higher in men compared with women.
• Atrial Fibrillation accounts for 20–30% of all ischaemic strokes. Atrial Fibrillation increases the risk of stroke five-fold, depending on the presence of additional risk factors. Unfortunately 25% of atrial fibrillation diagnoses are made when a person presents with a stroke which is a direct consequence of the atrial fibrillation’s irregular rhythm causing formation of clot (thrombus) in the heart chambers that then travels in the blood stream until it blocks a blood vessel in the brain.
• Atrial Fibrillation can precipitate or exacerbate heart failure, resulting in significantly greater mortality than either condition alone. 20–30% of people with AF are affected by heart failure or left ventricular dysfunction due to excessive ventricular rate and/or irregular ventricular contractions.
• A large meta-analysis [Odutayo, 2016] of 104 cohort studies (n = 587,867 people with AF) found that Atrial Fibrilation was associated with: 
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  • A 46% increase in all-cause mortality.
  • A 61% higher risk of ischaemic heart disease.
  • A 64% higher risk of chronic kidney disease.
  • An 88% higher risk of sudden cardiac death.
  • A 96% higher risk of a major cardiovascular event.
  • A two-fold increase in cardiovascular mortality.
  • A 2.3-fold increased risk of stroke.
  • A five-fold increased risk of heart failure, representing the highest absolute risk increase amongst all the outcomes studied.

Coronary Heart Disease is the narrowing of some or all of the 3 coronary arteries by plaque within their walls. This can be screened for during discussion and examination with the doctor, ECG (heart tracing) and a CT scan of the coronary arteries. Effective risk reduction strategies are now available. 

The most serious manifestation of coronary heart disease is Myocardial Infarction (heart attack) which is the death of heart muscle due to oxygen deprivation. 

• Heart attack is usually caused by blockage of a coronary artery by a thrombus (clot) formed from a ruptured or eroded atherosclerotic plaque.
   

The British Heart Foundation (BHF) estimates that in the UK:

• Coronary Heart Disease is one of the leading causes of death (responsible for around 68,000 deaths each year) and the most common cause of premature death. 
• Around 2.3 million people are living with Coronary Heart Disease (about 1.5 million men and 830,000 women).
• In the UK, around 100,000 hospital admissions each year are due to heart attack (equivalent to 290 admissions daily or one admission every five minutes). 
• Around 1.4 million people have survived a heart attack in the UK (about one million men and 380,000 women).

Screening For Lung Cancer In Primary Care

Lung cancer remains one of the most prevalent and deadliest cancers in the UK. Each year, approximately 49,200 new cases are diagnosed, equating to more than 130 new cases daily. Tragically, it is responsible for around 35,000 deaths annually, making it the leading cause of cancer-related mortality in the country.

One of the greatest challenges in lung cancer management is late-stage diagnosis, which severely limits treatment options and survival rates.Currently, around 75% of lung cancers in the UK are diagnosed at stage III or IV, when curative treatment is often no longer possible. As a result, the five-year survival rate remains low at just 16%. In contrast, when detected early, survival outcomes are significantly improved.

The Role of Screening in Early Detection

Lung cancer is often asymptomatic in its early stages, making proactive screening essential for improving survival rates. The Targeted Lung Health Check Programme has been instrumental in detecting lung cancer earlier, diagnosing over 5,000 cases since its launch. Encouragingly, around 75% of these cancers were identified at stage I or II, when treatment is far more effective.

The earlier lung cancer is detected, the greater the chance of a complete cure. For instance, if a tumour is diagnosed at less than 10mm in size, the cure rate with surgical resection exceeds 92%. However, if the tumour grows beyond 30mm or involves lymph nodes, cure rates drop below 60%. When lung cancer spreads to distant organs, the five-year survival rate plummets to below 10%.

Advancements in Robotic Bronchoscopy for Early Diagnosis

New technologies such as robotic-assisted bronchoscopy are transforming early lung cancer detection by allowing precise, minimally invasive biopsy of small or hard-to-reach lung nodules. This innovation enables clinicians to access and biopsy nodules as small as 5mm, including those in previously unreachable areas of the lung.

By improving diagnostic accuracy and allowing earlier intervention, robotic bronchoscopy helps reduce the time to treatment, which is crucial in preventing disease progression. As technology advances, combining robotic bronchoscopy with techniques such as liquid biopsy and AI-driven imaging analysis could further enhance early detection and personalised treatment strategies.

Lung cancer remains a major public health challenge in the UK, with late-stage diagnosis continuing to drive poor survival outcomes. However, significant progress is being made. Through expanded screening programmes and technological advances like robotic bronchoscopy, we now have more effective tools to detect lung cancer at an earlier, more treatable stage