Contents

1 Health Screening 1

2 Screening for high blood pressure 2

3 Screening for high blood cholesterol 2

4 Screening for obesity 4

5 Screening for diabetes mellitus 5

6 Screening for colorectal cancer 6

7 Screening for hepatitis B 7

8 Screening for liver cancer 8

9 Screening for tuberculosis 9

10 Screening for sexually transmitted 10

infections

11 Screening for cervical cancer 16

12 Screening for breast cancer 17

13 Screening for osteoporosis 19

14 Screening for prostate cancer 22

Available on the HPB website: www.hpb.gov.sg

This booklet is developed based on the Clinical Practice

Guidelines on Health Screening. Clinical Practice
Guidelines are recommendations to help doctors and
patients make appropriate choices about the patient’s
illness, based on the best scientific evidence currently
available. These guidelines do not replace the
judgement of the attending doctor. It is important to
remember that each person is different, and the Clinical
Practice Guidelines may not always apply to everyone.
1 Health Screening
Should you go for health screening?

Health screening helps to discover if a

person is suffering from a particular disease
or condition, even though he or she does
not have any symptoms. If a disease or
condition is discovered early through
screening, the person is able to receive
treatment early and avoid complications,
much suffering or even death.

Get tested for a particular disease or

condition especially if you have an
immediate family member who has the
same disease or condition.

What is health screening?

Health screening consists of tests like blood

or urine tests and other procedures like
X-rays and ultrasound. It is usually done at
regular intervals like once a year or once in
two to three years, or when a person
reaches a certain age.

However, not all screening tests are

necessary or helpful. It is best to consult
your doctor before going for health
screening.

1
 2 Screening for high
blood pressure
You have high blood pressure or
hypertension if your diastolic blood
pressure is at 90 mmHg (millimetres of
mercury) or higher or your systolic blood
pressure is at 140 mmHg or higher. Diastolic
pressure is the blood pressure when the
heart relaxes and systolic pressure is the
blood pressure when the heart is
contracting (pumping).

High blood pressure sometimes goes

unnoticed until complications like heart and
kidney failure sets in. These complications
can often be prevented with early detection
and treatment.

Should you be screened for high blood

pressure?
If you are 40 years or older, you should check
your blood pressure at least once a year.

Screening for high blood pressure

You can ask your doctor to check your blood
pressure or learn to check it yourself with
an electronic blood pressure meter.

3 Screening for high

blood cholesterol
A high blood cholesterol level means that
you have more cholesterol in your blood
than your body needs. The higher your
blood cholesterol level is, the greater your
risk of developing heart disease.

2
Should you be screened for high blood
cholesterol?
You should be screened if you:
● are 40 years old or older
● previously had a heart attack, or stroke
● are suffering from diabetes
● have several family members with high
cholesterol.

You can consider screening from age 30

years if you:
● have other risk factors for heart disease,
for example, you smoke, have high blood
pressure or have family members who
developed heart disease before 65 years
of age
● are Indian or with Indian parentage.

Screening for high blood cholesterol

The cholesterol screening, which is a blood
test, would include tests for all types of fats
present in the body. This would include:
● “bad” cholesterol [low-density
lipoprotein (LDL) cholesterol];
● “good” cholesterol [high-density
lipoprotein (HDL) cholesterol] and
● triglyceride (TG).

Only the last test (for TG levels), requires

you to fast for 10 to 12 hours.

Ask your doctor what is the desirable level

for blood cholesterol. If your results are in
the desirable range, blood cholesterol
screening every 3 years is recommended.

3
 4 Screening for
obesity
Obesity is the condition where the person’s
body weight is well over the normal weight
for his or her height and age.

Obesity can lead to many medical problems

like diabetes, high blood pressure, heart
disease, stroke and several cancers.

Screening for obesity

All persons aged 18 years and older should

be screened once a year. The Body Mass
Index (BMI) is used to measure an adult’s
body fat.

Weight (kg)
BMI =
Height (m) x Height (m)

How do you know that you are overweight

or obese?

Weight Status BMI

Healthy weight 18.5 to below 25

Overweight 25 to below 30

Obese 30 and above

4
5 Screening for
diabetes mellitus
Diabetes is a disease in which too little or
ineffective insulin is produced by the organ
called the pancreas. As a result, people with
diabetes have abnormally high levels of
glucose in their blood. This leads to damage
and failure of various organs such as the
eyes and kidneys which may even result in
kidney failure.

Should you be screened for diabetes?

Screening for diabetes should begin at 40

years. Screening should be considered at
an earlier age e.g. 30 years if you:
● are overweight / obese [body mass index
(BMI) ≥ 25 kg/m2]
● have high blood pressure (BP ≥ 140/90
mmHg)
● have a close relative who has diabetes
● had diabetes during pregnancy
● suffer from coronary heart disease
● suffer from polycystic ovary disease
(multiple cyst of the ovaries)
● have abnormal lipid (fat) levels
● have previously been confirmed with a
borderline high fasting blood sugar level.

Screening for diabetes

You can be screened with a blood test for

fasting blood glucose.

5
 6 Screening for
colorectal cancer
Colorectal cancer is cancer of the colon (the
main part of the large intestine) and rectum
(the passageway connecting the colon to
the anus). Colorectal cancer is the most
common cancer among men and women
in Singapore.

Should you be screened for colorectal

cancer?
If you do not show any symptoms and are
not considered to be at high risk, you should
undergo screening for colorectal cancer
from the age of 50.

If you are at high risk, you will need to go

for screening at a younger age and at more
frequent intervals. Please consult your
doctor for advice.

You are at high risk if one or more of your

close relatives have colorectal cancer or an
abnormal growth (colorectal polyps) in their
large intestine.

Women who have had cancer of the womb,

ovaries or breast may have a slightly higher
risk of colorectal cancer.

Screening for colorectal cancer

Several different tests can be used. Each can
be used alone. Usually, Faecal Occult Blood
Test is used first and if positive, it will be
followed by one of the other tests.

● Faecal Occult Blood Test (FOBT)

This is a test for the presence of blood in
stool. When test results are positive,
colonoscopy may have to be performed.

6
● Double-contrast barium enema
This is an x-ray examination of the large
intestine using a special substance to
improve images.
● Flexible Sigmoidoscopy
This procedure examines the internal
lining of the lower end of your large
intestine. A short, flexible, lighted tube
is inserted into your rectum and slowly
guided into your sigmoid colon.
● Colonoscopy
A longer, flexible lighted tube is used.
This enables the entire large intestine to
be examined.

7 Screening for
hepatitis B
Hepatitis B infection is infection with the
Hepatitis B Virus (HBV). About 6% of
Singaporeans have chronic hepatitis B
infection.

People with HBV infection may eventually

become seriously ill with or may die from
abnormal liver condition and/or from liver
cancer. Liver cancer is one of the top 10
cancers affecting males in Singapore.

Should you be screened for hepatitis B?

You should be screened if you are:
● pregnant
● a healthcare worker
● a person undergoing kidney dialysis
● at high risk, if you have a family history
of HBV infection or liver cancer, or
engage in high-risk behaviour.

7
 High risk behaviour includes having had sex
with prostitutes or strangers, having many
sex partners, having a sex partner who has
HBV infection, men who have sex with men,
drug addicts who share injection needles.

Screening for hepatitis B

Screening is done with a blood test for the

HBV antigen (HBsAg) and antibody (anti-
HBs). It should be carried out before
vaccination. If the antibody is present, the
person is immune to hepatitis B infection
and vaccination is not required.

8 Screening for
liver cancer
Liver cancer is the 4th most common cancer
among Singaporean men. A Singaporean
man is four times more likely to suffer from
liver cancer than a Singaporean woman.

Should you be screened for liver cancer?

Generally, there is no need to screen for liver

cancer if you are not at risk. Those with
chronic hepatitis B infection, hepatitis C liver
cirrhosis, and liver cirrhosis from other
causes should be screened for liver cancer.

Screening for liver cancer

The tests include:

● Serum alpha feto-protein (αFP) level.
αFP, a protein in the blood is raised in
hepatitis and liver cancer.

8
● Ultrasound of the liver including the
gallbladder and bile ducts.

While testing for αFP levels should be done

every 3 to 6 months, ultrasound scan of the
liver should be done every 6 to 12 months.

9 Screening for
tuberculosis
Tuberculosis (TB) is a serious infectious
disease that affects the lungs and other parts
of the body.

Should you be screened for TB with a

yearly chest X-ray?

You do not need to go for yearly chest

X-ray if you have no symptoms as the pick-
up rate for TB is very low.

You should however, go for a chest X-ray

if you have persistent cough for more than
3 weeks.

Close contacts of infectious TB patients

should undergo screening for latent
(hidden) TB infection. This helps to identify
persons for treatment to prevent the
progression of latent TB to active TB
disease. Close contacts are screened for
latent TB infection using the tuberculin skin
test.

9
 10 Screening for
sexually
transmitted
infections
A sexually transmitted infection is one
which is spread mainly by sexual contact
with an infected person. Examples are
chlamydia trachomatis infection, syphilis,
gonorrhoea, genital herpes, HIV and
genital viral warts (human papillomavirus
infection).

Chlamydia Trachomatis infection

Chlamydia trachomatis infection causes the
following:
● Inflammation of the urethra (the tube that
releases urine from the bladder) in men
● Inflammation of the cervix (the neck of
the womb)
● Inflammation of the area around the
uterus and ovaries.

Should you be screened for chlamydia

trachomatis?

Non-pregnant women
You should be screened for chlamydia
trachomatis if you are:
● A woman 25 years or younger:
o who has a new sexual partner
o who has a partner with symptoms of
an STI
o who has had two or more sexual
partners in the past 12 months
o whose partner does not use condoms.

10
● A woman who had gone through an
abortion with the risk factors stated
above.

You should discuss how often you should

be screened with your doctor. Screening
for chylamdial infection should be done
about 1 week after unsafe sexual contact or
a change of sexual partner.

Pregnant women
You should be screened if you are:
● pregnant and aged 25 years and younger
● pregnant and fall under the following
higher risk groups:
o those who have had two or more
sexual partners in the last 12 months,
or
o have sexual partners with symptoms
of STI.

Men
All men who practise unsafe sexual
behaviours should be screened. They
include those who:
● do not use condoms
● have frequent change in sexual partners
● have sex with prostitutes.

Screening methods for chlamydia

trachomatis

Screening can be done by obtaining tissues

from the lining of the neck of the womb
(cervix) in women and from the urethra in
men.

11
 Syphilis
Syphilis is an infection that is transmitted
from one adult to another through sexual
contact or from the mother to her baby
during pregnancy.

Screening for Syphilis

Screening is recommended for those who

practise unsafe sex, including the following:
● Those who exchange sex for money or
drugs
● Those who have other STIs (including
HIV) and ulcers on the genitals
● Those whose partners have syphilis.

You should be screened 1 month after

possible contact, and again after 3 months.

Pregnant women should be screened at

their 1st antenatal visit.

Pregnant women who practise unsafe sex

should be screened again in the 3rd trimester.
Such behaviour includes having:
● a partner with symptoms of an STI
● sex with multiple partners
● a partner who has multiple sex partners.

Screening methods for syphilis

Screening is done using blood tests.

12
Gonorrhoea
Gonorrhoea is an infection that causes
inflammation of the sexual organs.

Screening for gonorrhoea

The following groups of women, who are

at higher risk, should be screened for
gonorrhoea:
● Those who exchange sex for money or
drugs
● Those with repeated gonorrhoea
infections
● Those who have two or more sexual
partners in the past year.

The following groups of men should be

screened:
● Those who have sexual partners with
symptoms of STI
● Those who do not use condoms
● Homosexual men with frequent change
of sexual partners.

When should you be screened?

Screening for gonorrhoea should be done

about 1 week after sexual contact with an
infected person.

Screening methods for gonorrhoea

The best way to test for gonorrhoea is

identifying the bacteria by obtaining
specimens from the infected areas.

13
 Genital Herpes Simplex Virus (HSV)
Infection
Genital Herpes is a viral infection that is
transmitted through sexual intercourse.

Screening for genital Herpes Simplex

Virus Infection

Routine screening for genital HSV in healthy

men, women or pregnant women is not
recommended as there is insufficient
evidence to suggest that it is useful.

Human Immunodeficiency Virus

(HIV) Infection

HIV infection is caused by the Human

Immunodeficiency Virus. Acquired
immunodeficiency syndrome (AIDS) is the
final stage of HIV infection. Some persons
infected with HIV do not have any
symptoms for more than a decade.

Screening for HIV Infection

If you are at increased risk of infection, you

should be counselled and tested for HIV.

Persons at increased risk are:

● Those with other STIs
● Men who have sex with men
● Past or present injecting drug users
● Persons who exchange sex for drugs
or money, and their sex partners
● Persons whose past or present sex
partners were HIV-infected

14
● Persons who have had a blood
transfusion or an organ transplant that
had not previously been screened.

Pregnant women should be tested in the 1st

trimester.

How often should screening be done?

The following guidelines are recommended:

● Persons who continue practising unsafe
sex should be screened every 6 months
● Persons with recent unsafe sexual
conduct should be screened at 1 month,
3 months, and 6 months interval after
the last possible contact to rule out a
possible initial false negative result.

Screening methods for HIV

Screening is done using a blood test for HIV

antibody.

Genital Human Papillomavirus (HPV)

Infection
Genital HPV is a viral infection common
among sexually active adults. Infection is
mostly through sexual contact.

Screening for HPV Infection

Genital HPV infection with no obvious signs

and symptoms may exist. However, no
screening tests are available for such cases
and routine screening is not recommended.

15
 11 Screening for
cervical cancer
Cervical cancer is the cancer of the neck
of the womb (cervix). Cervical cancer is
the 4 th most common cancer among
Singaporean women.

Are you at risk?

You have a higher risk of cervical cancer if

you:
● smoke cigarettes
● have sexual intercourse at an early age
● have multiple sexual partners
● have a history of sexually transmitted
infections
● are infected with a certain kind of viral
warts (HPV infection)
● are HIV positive
● have a weak immune system to fight
infection.

You have a lower risk of cervical cancer if

you have never had sexual intercourse.

Should you be screened for cervical

cancer?

All women who have had sexual intercourse

should have their first Pap smear by 25 years
of age.

You can stop taking the Pap smear test after

65 years of age if your Pap smear taken at
65 years old and the Pap smears taken in
the past have been clear.

16
You do not need to go for Pap smear if you
have never had sexual intercourse.
However, if you have abnormal vaginal
discharge, you should consult a doctor.

How often should screening be done?

You should go for a Pap smear every 3 years.

HIV positive women should go for a Pap

smear every year.

Screening for cervical cancer

Screening for cervical cancer involves a Pap

smear test. The Pap smear is a simple
procedure where the doctor or nurse
obtains some scrapings from the neck of
the womb (cervix) and sends them for
examination under the microscope.

12 Screening for
breast cancer
Breast cancer is the most common cancer
among women in Singapore. One in 20
women here has a chance of developing
breast cancer in her lifetime.

Should you be screened for breast cancer?

Early breast cancer screening will be able

to detect the cancer in its early stages for
effective treatment.

17
 Screening for Breast cancer
● Regular mammography is the most
reliable way to detect breast cancer
before the lump can be felt.
● Breast Self-Examination (BSE) is breast
examination done by the woman herself.
BSE should be done from age 30
onwards. BSE helps women detect
changes in their breast that may arise in
the interval between regular mammo-
graphy.

How often should screening be done?

The following screening guidelines are
recommended for different groups of
healthy women:

1. Women above 50 years

Screening every 2 years is recom-
mended.

2. Women between 40 – 49 years

Annual screening is recommended.

3. Women below 40 years

There is no need for women in this age
group to go for screening.

Women at high risk

Women in the high risk category should
consult their doctor regarding the frequency
of screening. High risk women have a
history of:
● Breast cancer in several close members
of the same family
● Other cancers, especially cancer of the
ovary and colon, as well as breast cancer,
in members of the same family
● Breast cancer in a close relative under
the age of 40.

18
13 Screening for
osteoporosis
Osteoporosis, which means “porous
bones”, is a condition in which the bones
become weak and brittle, resulting in a
greater likelihood of breaking after minor
trauma.

Are you at risk for osteoporosis?

Check the risk factors below which might

make it more likely for you to have
osteoporosis.

Should you be screened for osteoporosis?

Yes, if you are an adult, and have the

following risk factors:
● Personal history of past fracture as an
adult
● History of fracture in an immediate
relative (especially mother)
● Low body weight & older age
● Smoke cigarettes
● Heavy alcohol intake
● 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
due to illness
● Poor health
● Low calcium intake for most of your life
(< 500 mg/day)
● Lack of regular exercise or physical
activity.

19
 Osteoporosis Self-assessment Tool for
Asians (OSTA)

For those who have not suffered fractures,

the Osteoporosis Self-assessment Tool for
Asians (OSTA) is a quick and easy test to
find out your risk of osteoporosis. OSTA,
which is based on age and weight, groups
Asian women who have reached
menopause into high, moderate or low risk
of having osteoporosis.

Measure your weight in kilograms and look

at the OSTA chart on the following page to
identify your risk. If your risk is moderate or
high, see your doctor. You may need to be
screened for osteoporosis.

20
21
 Screening test for osteoporosis

Osteoporosis can be easily detected though

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.

How often should screening be done?

You could measure BMD once a year if you

are being followed up for osteoporosis.

Frequency of screening varies from 1-5

years if you have mild decrease in your
bone mass or osteopenia and once in
5 years if your bone mass is normal.

14 Screening for
prostate cancer
Prostate cancer is the 6th most common
cancer among Singaporean men.

Prostate cancer can only be cured if it is

limited to the prostate gland and has not
spread to the other parts of the body.

Should you screen for prostate cancer?

You should go for screening if you are at

high risk. Men above 50 years with a history
of immediate family members who have
had prostate cancer below 60 years of age
are at high risk.

22
Screening for prostate cancer

Digital rectal examination (DRE)

DRE is a quick and reliable clinical exami-
nation of the prostate gland through the
rectum with a gloved finger. DRE can pick
up suspicious lumps in the prostate gland.

Prostate Specific Antigen (PSA) blood test

The PSA test can detect the onset of cancer
of the prostate gland.

23