At different times of life, there are some tests we're all advised to take – some better known than others. Here are some to pencil into your diary.
Most of us probably visit the doctor when we’re sick, but the occasional check-up to help prevent future illness can also be important.
In general, your doctor will try to make sure you are in good health by talking to you about your diet, exercise, smoking and alcohol intake, but they will also recommend regular tests at certain points in your life.
"Whilst it’s a bit icky to talk about testing your poo or having a cervical screen, I think that the ramifications of not doing that are far worse," says Dr Paula Conroy, deputy chair of the Royal Australian College of General Practitioners, Queensland.
The tests and screening programs are not necessarily without risks. Research has found that screening can lead to overdiagnosis, which can expose healthy people to more unnecessary tests, invasive procedures and anxiety about their wellbeing.
Dr Conroy and Dr Tim Jones, a Hobart GP, both say the best way to make sure you're getting the right tests at the best time is to talk to your GP.
"Most good GPs out there will be trying to sit down with their patients, work out what their family history is, and then try and offer some individualised recommendations,” Dr Jones says.
What tests do you need in your 20s and 30s?
Dr Jones says most testing and screening at this stage is about helping “identify if people have any risk factors at a younger age that may cause trouble if nothing is done about them in 10, 20, 30 years' time”.
Doctors keep an eye out for high blood pressure as it can be a risk factor for cardiovascular disease, and blood pressure should be checked roughly every two years.
Another check-up you should be getting regularly is dental. While, conventionally, dentists might recommend an annual check-up, says Dr Mikaela Chinotti from the Australian Dental Association, it really depends on the advice of your own dentist.
Your dentist will look for signs of tooth decay, gum disease and even oral cancer by examining your head and neck area, looking at the soft tissue inside your mouth and then visually examining your teeth, she says.
“It’s better to stay on top of these things than it is to come back and try and fix it once it’s already started to develop,” Dr Chinotti says.
Skin cancer checks are recommended based on personal circumstances, as factors such as a family history of skin cancer, fair skin or freckles will put you at higher risk than others. Dr Conroy says this check can be done either by your GP or a dermatologist, and involves a head-to-toe visual check using a torch and specialised magnifying glass.
Sexual health checks are also important in early adulthood. If you have more sexual partners, you should be tested more regularly, Dr Conroy says.
Women used to get pap smears every two years from about the age of 18 but in 2017 the pap smear test was replaced with a new national screening program that tests women every five years from the age of 25.
Thanks to a combination of screening and the human papillomavirus (HPV) vaccination program – a series of two or three vaccinations provided free to girls and boys in high school, depending on their age – experts predict cervical cancer will no longer be a public health problem in Australia by 2028.
Dr Conroy says cervical screening, which involves taking a sample of cells from the cervix, is not something women should be embarrassed about.
“As a female GP, I do a lot of these and I certainly try to make it as natural and comfortable an examination as possible.”
What's on the list for when you're over 40?
From this age, you should start getting tested for type 2 diabetes roughly every three years.
Dr Jones says this blood test is important because people can have diabetes for months or even years before they develop symptoms.
“If it’s detected early, the prognosis – in terms of people's health remaining good – is far better than if we leave it until they develop symptoms,” he says.
When you reach your mid-40s, it’s time to go and see your GP for an assessment of your risk of cardiovascular disease. A cholesterol blood test is important, as high cholesterol is a risk factor for cardiovascular disease.
You'll also need to have a complete cardiovascular risk assessment. Dr Conroy says your GP will plug a bunch of details – your age, gender and whether you're a smoker or drinker – into a computer program, which will then calculate your likelihood of experiencing a "cardiovascular event" in the next five years.
"Depending on whether it's low, medium or high-risk, we will then intervene with either medications or lifestyle measures based on that risk assessment," she says.
Dr Conroy adds that these tests are important to help prevent heart disease, which is Australia’s “No. 1 killer”. One in five adults self-reported they had cardiovascular disease in 2014-2015, according to the Australian Institute of Health and Welfare, and the disease made up 11 per cent of all hospitalisations that year.
What tests should you sign up for when you hit 50?
Expect to receive a poo test in the mail – and that's just for starters.
“The key age for people is 50 – that is the age where the chance of developing a significant problem really starts to ramp up,” says Dr Jones.
The Health Department has screening programs for bowel and breast cancers, and these tests do not have to be done at your GP’s office.
The National Bowel Cancer Screening program involves taking a stool sample at home and returning it to a lab for analysis, and should be done every two years.
Bowel cancer is the second most common cancer in men and women in Australia, according to the Cancer Council, and causes the second-highest number of cancer deaths in the country. Diagnoses of bowel cancer are also rising in people under the age of 50.
Despite this, only 41 per cent of eligible people participated in the bowel screening program in 2016 to 2017, according to the Australian Institute of Health and Welfare.
The Health Department says the test can reduce your risk of dying from bowel cancer by up to a third, and Dr Conroy says early detection of bowel cancer can prevent far more invasive treatment.
“Early treatment is the removal of a polyp via a colonoscopy, for example, as compared to a full bowel resection with chemotherapy and potential radiotherapy, [which] is obviously far more invasive,” she says.
While breast cancer is the second most common cause of cancer-related death in Australian women, the Health Department says breast cancer mortality has dropped since the national BreastScreen program began in 1991.
Breast cancer screening involves a free breast X-ray, called a mammogram, which the department recommends doing every two years. However, questions have been raised about potential overdiagnosis in otherwise healthy women. Just over half of women 50 or older had the scan in 2016-2017, says the Institute of Health and Welfare.
Another disease doctors will start looking out for is osteoporosis, which is a condition in which bones thin and become more susceptible to fractures.
Dr Conroy says your GP will use a tool similar to the cardiovascular disease risk assessment, putting details such as your family history of the disease into a computer program to assess the likelihood of you developing the disease.
Your doctor can then do a bone mineral density test, which is a low-radiation body scan that has three classes of results. If you are in the normal category you will need to repeat the test in five years, if it comes back moderate it will need to be done more frequently and the last group actually diagnoses osteoporosis, Dr Conroy says.
"We'll need to start treatment at that stage, and then repeat the bone density a year or two after treatment [begins]."
What about when you're over 65?
GPs will begin monitoring you for fall risk – falling over can lead to all sorts of injuries that can land you in hospital – and they'll start keeping an eye on your vision and hearing.
"The falls-risk questionnaires that we use ... determine how strongly we get involved," Dr Jones says.
Dr Conroy says that as patients get older, doctors can also do an assessment called a frailty score, which is complex but important for elderly patients as it addresses how stable they are on their feet and can help doctors find out how they are coping at home.
Your mid-60s is also when you need to think about getting the pneumococcal vaccine and the shingles vaccine, conditions that largely affect older people, Dr Conroy says.
People aged over 65 are also given an enhanced influenza vaccine – which this year offers extra protection against the A/H3N2 strain – to better protect them.
What testing don’t you need?
Plenty of patients still believe they need to have an annual blood test, but Dr Jones says this is no longer part of standard clinical practice.
“If you’re healthy and not on any particular long-term medication, certainly the idea of having routine blood tests is no longer recommended by RACGP and general practice.”
The recommendations for the PSA blood test for prostate cancer have also changed.
Instead of routine testing for all men, which led to overdiagnosis in some patients, doctors are now advised to take a more nuanced approach by discussing the benefits and potential negatives of having the PSA test with patients.
For men at average risk of developing prostate cancer (age and a family history of the cancer play a role), the Urological Society of Australia and New Zealand recommends testing every two years between the ages of 50 and 69.
And if you have symptoms outside these guidelines?
Dr Conroy says it's important not to wait if you think something is up.
“We don’t want patients to ignore symptoms because they're out of the screening window,” she says.
“[If you] develop symptoms, say chest pain, but [think] 'Oh, I had my blood pressure check done', it doesn't matter: you've now got symptoms so you come in for a diagnostic work-up.”