How often do you need to be diagnosed and which doctors

“A preventive medical examination is carried out for the purpose of early (timely) detection of conditions, diseases and risk factors for their development, non-medical use of narcotic drugs and psychotropic substances, as well as in order to form health status groups and develop recommendations for patients” ^[1].

“Prophylactic medical examination is a set of measures that includes a preventive medical examination and additional methods of examinations conducted to assess the state of health (including determining the health group and the dispensary observation group) and carried out in relation to certain groups of the population in accordance with the legislation of the Russian Federation” ^[2].

It is these definitions of preventive examination and medical examination that are included in the Order of the Ministry of Health of the Russian Federation dated March 13, 2019 No. 124n “On approval of the procedure for conducting preventive medical examination and medical examination of certain groups of the adult population” ^[3]which is still relevant today.

According to this order, the medical examination is carried out:

1. Once every three years for the population aged 18 to 39 inclusive;
2. Annually at the age of 40 years and older, as well as in relation to certain categories of citizens (disabled veterans of the Great Patriotic War, invalids of military operations, etc.)

Preventive medical examination is carried out annually:

• as an independent event;
• within the framework of medical examination;
• within the framework of dispensary observation, during the first dispensary reception in the current year (examination, consultation).

Prevention and early detection of various diseases (screening) have different features for different population groups depending on gender, age, specific goals (for example, preparing for pregnancy or finding the causes of fatigue).

What is the difference between preventive examination and screening?

Screening aims at early detection of an existing disease or problem that is asymptomatic ^[4]. It is worth noting that screening is not 100% accurate, but only indicates the likelihood of a risk of the presence or absence of the desired disease. ^[5]. Simple examples of mass screening are screening for tuberculosis and screening for cervical or breast cancer in women. The benefits of these examinations are obvious: they are easier and more effective to treat at an early stage, and in the case of tuberculosis, the risks of its spread are also reduced.

The purpose of a preventive examination is to reduce the likelihood of a disease that does not yet exist, and perhaps will not, or will someday ^[6]. Due to such a “foggy” forecast, it is difficult to convince a person of the need for preventive measures, since the problem is not relevant for him at the moment and the risk of its occurrence is not at all obvious. Moreover, prevention often involves changing the usual way of life, habits, taking actions that are ambiguous for someone. Examples of preventive measures include vaccination and the use of certain drugs in patients with cardiovascular disease to prevent cardiovascular events (heart attacks, strokes).

Types of screening and prevention for different populations

As mentioned above, early detection and prevention activities have their own characteristics for different population groups. Below is a list of measures.

Screening and prevention in newborns

Basic screening activities in newborns are necessary to quickly identify hereditary diseases and malformations that require timely treatment, and sometimes urgent measures (for example, malformations) ^[7]. In Russia, screening is done for 5 hereditary diseases: adrenogenital syndrome, phenylketonuria, congenital hypothyroidism, cystic fibrosis and galactosemia. To do this, take blood from the heel in the maternity home.

In addition, research is being done on:

• determination of the level of bilirubin in the blood (to detect hemolytic disease of the newborn);
• determination of blood glucose levels (to detect hypoglycemia – low blood glucose), usually carried out for children from risk groups: those born to mothers with diabetes and premature babies;
• audiometric screening (to detect congenital hearing loss);
• pulse oximetry (to detect heart defects).

Screening for all populations

1. General examination by a therapist, including anthropometric measurements (height, weight, BMI – body mass index, OT – waist circumference); measurement of blood pressure, auscultation, palpation.
2. Screening for tuberculosis (X-ray or fluorography of the chest) – from the age of 18 1 time in 2 years ^[8].
3. Detailed general clinical blood test – annually from the age of 18 ^[9].
4. General clinical analysis of urine – annually from the age of 18.
5. Biochemical blood test: glucose, total protein, total bilirubin, urea, creatinine, AST, ALT, total calcium, albumin – annually from the age of 18. Expansion of biochemical analysis according to indications.
6. ECG (electrocardiography at rest) – at the first preventive examination from the age of 18, then at the age of 35 years and older – annually.
7. Measurement of intraocular pressure during the first routine examination.
8. Screening for vitamin D: blood test for 25(OH)D – initially for all, then the multiplicity depending on the initial level and correction scheme.
9. Screening for sexually transmitted infections is mandatory if you have had unprotected sex and you have not previously been fully examined.
10. Screening for melanoma – people at risk (having a hereditary history of melanoma), examination by a dermatologist once a year or two for a general examination and dermatoscopy. All suspicious moles and skin formations require an immediate visit to an oncodermatologist.
11. Blood pressure screening – measurement of blood pressure at least once a year if the upper digit of BP (systolic pressure) is in the range from 1 to 120, or the lower digit (diastolic pressure) in the range of 139 to 80 mm Hg. st, if the upper number is higher than 89, and the lower one is higher than 140, then you should contact a general practitioner or cardiologist and undergo a more in-depth examination.
12. Screening for hypercholesterolemia (elevated serum cholesterol levels). The recommended age to start screening is 20-45 years, depending on many factors (obesity, the presence of diseases, aggravated heredity, etc.). A blood test is examined for total cholesterol and its fractions: high (“good cholesterol”) and low (“bad cholesterol”) density lipoproteins and triglycerides. The analysis is called a lipid profile. The frequency of the analysis depends on the nature of the diet, weight. In the absence of aggravating risk factors, it is recommended once every 5 years. In the presence of diabetes mellitus, cardiovascular and kidney disease, more careful and frequent monitoring may be required.
13. Screening for diabetes. In the presence of overweight or obesity, aggravated heredity in first-line relatives of type 1 diabetes mellitus or an increase in blood pressure above 140/90 mm Hg, it is imperative to take a blood test for glucose and sometimes glycated hemoglobin at least 1 time per year.
14. Screening for hypothyroidism (blood test for TSH every 2-3 years, the frequency is not precisely defined).
15. Screening for the detection of malignant neoplasms of the esophagus, stomach and duodenum: at the age of 45 – esophagogastroduodenoscopy (EFGDS).
16. Screening for colon cancer from 40 to 64 years old inclusive – examination of feces for occult blood by an immunochemical qualitative or quantitative method – once every two years; colonoscopy – once every 10 years, after 50 years, or earlier if there are polyps or inflammatory bowel disease; if someone in the family had colon cancer (screening starts 10 years earlier than the age of the youngest family member with cancer). After 75 years, screening stops without any special indications.
17. Lung cancer screening – smokers with pack/year= and >30: low-dose CT from 55 to 80 years. X-rays and fluorography are not substitutes for and do not detect lung cancer.
18. Screening for HIV, hepatitis B and C
19. Visiting the dentist – 1-2 times a year (for professional teeth cleaning and treatment of minor caries).
20. Seeing an ophthalmologist is every 2-4 years for ages 40 to 54 and every 1-3 years for ages 55+, or more often if you already have vision problems or are at risk of glaucoma.
21. Screening for prostate cancer. May lead to overdiagnosis. But if a decision is made to screen, then it is performed from

Screening and check-ups for women aged 18 and over

1. Examination by an obstetrician-gynecologist or paramedic (midwife) – annually from the age of 18 ^[10].
2. Screening for cervical disease: Pap test starting at age 18 (or 3 years after onset of sexual activity) annually or every 3 years if done in combination with a human papillomavirus (HPV) test. After age 65, the test is not performed if there have been three negative tests within the last 10 years.
3. Screening for breast diseases ^[11]:- women younger than 39 years old from the intermediate risk group who do not present any complaints, need only self-examination of the breast and annual examination by a gynecologist or mammologist, as well as ultrasound of the mammary glands once every 2 years. – Mammography of both mammary glands in two projections with double by reading radiographs is carried out for women from 40 to 75 years old – every 2 years. From the age of 35, women from a high-risk group of breast cancer (burdened heredity, there is a BRCA mutation, there was breast irradiation at the age of 30, precancerous processes according to the results of a biopsy, a 5-year risk of breast cancer is more than 1,7% according to Gail model).
4. Screening for ovarian cancer in women at risk from 30-35 years old or 5-10 years earlier than the age of the youngest family member with such a diagnosis if: – BRCA mutations and preserved ovaries; – with Lynch syndrome (hereditary non-polyposis colorectal cancer) and ovaries are preserved. A blood test for CA-125 and ultrasound of the pelvic organs are performed annually. Screening is not indicated for women who are not at risk.
5. Screening for osteoporosis – x-ray densitometry (DXA) – “gold standard”: after 65 years, all women must; after 50 years, if there have already been bone fractures or there are risk factors for osteoporosis (premature menopause, taking medications); according to indications sometimes earlier than 50 years.

Cardiac examination

The purpose of a preventive cardiological examination is the timely detection of an existing disease of the cardiovascular system, as well as minimizing the risks of developing so-called cardiovascular disasters or events (heart attack, stroke, etc.). The insidiousness of cardiological diseases lies in the fact that up to this very catastrophe they may not manifest themselves in any way, and well-being is a very unreliable guideline. That is why a cardiac check-up is a very healthy thing in terms of longevity and improvement in prognosis and quality of life. It is recommended for all men over 40 and menopausal women (48-55 years) even in the absence of complaints and good health. Provides:

1. Examination by a cardiologist (complaints, heredity of cardiovascular diseases, lifestyle features, percussion, auscultation, blood pressure measurement; determination of individual cardiovascular risk).
2. Laboratory tests: general clinical blood test, general clinical urinalysis; biochemical blood test (fasting plasma glucose, ALT, AST, CPK, creatinine, TSH); lipid profile including total cholesterol, LDL, HDL, triglycerides.
3. Instrumental studies: resting ECG, echocardiography.

According to the indications after the initial examination by a cardiologist, the following can be additionally prescribed: UZDG BCA (ultrasound scanning of the vessels of the head and neck to detect or exclude atherosclerotic vascular lesions); daily monitoring of ECG and / or blood pressure; exercise test (veloergometry/stress echocardiography).

Endocrinological examination

An approximate examination plan for an initial consultation with an endocrinologist includes:

1. General clinical blood test.
2. Biochemical blood test (serum glucose, glycated hemoglobin, creatinine, urea). ALT, AST, GGT, alkaline phosphatase, total calcium, lipid profile (total cholesterol, HDL, LDL, triglycerides), serum iron, ferritin, C-reactive protein, homocysteine, vitamin D (25(OH)D), vitamin B12, folic acid.
3. TSH, free T4, free T3, AT to TPO, AT to TG.
4. Ultrasound of the abdominal cavity and thyroid gland.

In the presence of overweight or obesity: additional insulin and on a separate day – cortisol against the background of a night suppressive test with dexamethasone: at 22-23:00 – drink 2 tablets of dexamethasone, the next morning at 8-9:00 a blood test for cortisol.

In the presence of diabetes mellitus, menstrual irregularities, arterial hypertension at a young age, formation in the pituitary / adrenal glands, nodes in the thyroid gland and thyrotoxicosis, infertility and PCOS (polycystic ovary syndrome), osteoporosis / osteopenia, hyperparathyroidism, the examination plan will differ and include additional examinations.

Examination of the kidneys and urinary system

The main tests for diagnosing kidney disease include ^[12]:

1. General clinical analysis of urine.
2. The concentration of creatinine and urea, total protein in blood plasma.
3. Calculation of the glomerular filtration rate (GFR).
4. Ultrasound of the kidneys, bladder and urinary tract.

Additionally, you may need: urine culture for microflora with the determination of sensitivity to antibiotics, CT or MRI, as well as survey or excretory urography.

Examination for rheumatic diseases

The etiology (cause) of many rheumatic diseases is not fully understood: they can be genetically determined, or they can be activated by various environmental factors. But it is known that inflammation plays a key role in the pathogenesis (flow mechanism). In the laboratory diagnosis of rheumatic diseases, the priority is the detection of circulating autoantibodies in the blood. The purpose of such a search is to confirm the diagnosis of autoimmune rheumatic diseases in the event that the clinical manifestations of the diagnosis are not enough.

At the same time, the detection of autoantibodies against the background of the absence of clinical manifestations is not the basis for the diagnosis of an autoimmune disease. Autoantibodies specific to a single rheumatic disease are very rare. Many autoimmune rheumatic diseases are characterized by the simultaneous presence of several types of autoantibodies in the blood. This is called the autoantibody profile, and its elevation is of diagnostic significance and laboratory diagnostic value in making a diagnosis.

In addition to autoantibody panels, a list of primary (screening) tests in the diagnosis of rheumatic diseases has been developed; secondary (confirmatory) and additional serological tests.

Screening tests should be highly sensitive, but are generally nonspecific.

Confirmatory tests should be highly specific.

Standard autoantibody profiles for diagnosing rheumatic diseases

The main goal of laboratory diagnostics of rheumatic diseases (RD) is to obtain objective information about the presence and nature of immunopathological changes. This is an important tool for early diagnosis, assessment of activity, severity of the course, prognosis of the disease and the effectiveness of therapy. ^[13].

In various life situations and problems, an examination may be necessary for the correct prognosis and determination of treatment tactics.

Examination before pregnancy planning

They conduct medical examinations before planning pregnancy, which are included in the complex of preconception preparation ^[14].

1. A blood test for TSH (on any day of the menstrual cycle) is a screening for thyroid diseases, since its proper functioning is very important for the normal development of the embryo / fetus.
2. Blood test for IgG to measles and rubella – in the absence of antibodies (negative result), vaccination and reliable contraception are necessary within a month after it.
3. Blood test for syphilis, HIV, hepatitis B and C.
4. Vaginal swab to detect chlamydia, gonorrhea, trichomoniasis and genital mycoplasma, if such examinations have never been performed before.
5. Pap test by liquid cytology + HPV analysis (cotesting) is possible – the result is valid for a year and you can avoid taking a Pap test during pregnancy.
6. Dental consultation and oral cavity sanitation.

Additionally, it is possible to determine the level of ferritin if there is a risk of iron deficiency, and consultation and treatment from related specialists is also necessary if there are chronic diseases.

You can also take a blood test for IgG to toxoplasma / cytomegalovirus (CMV), and herpes viruses, to understand whether there was a meeting with them before pregnancy. But this is not necessary, since there is no specific prevention.

Hormone tests

You need to take blood tests for hormones on certain days of the menstrual cycle. ^[15].

1. pituitary hormones: – FSH, LH: to assess the ovarian reserve – 3-5 days, to assess ovulation – 12-16 days (peak period); – prolactin – 3-5 days is convenient (any day is allowed); – TSH, T4 free, T3 free, AT to TPO, AT to TG, etc. – any day.
2. “Ovarian reserve”: – inhibin B – 3-5 days; – AMH (anti-mullerian hormone) – any day.
3. Adrenal hormones: – DHEA-SO4 – 3-5 days (up to 8 is allowed); – 17-OH-progesterone – 3-5 days; – cortisol – any day.
4. Sex hormones: – testosterone 3-5 days (up to 8 is allowed); – estradiol – depending on the duration of the cycle; – progesterone – on the 6th-7th day after ovulation.

Tests for chronic fatigue

When signs of rapid fatigue and fatigue appear, when already in the morning, the feeling that you have not rested, and there are no obvious reasons, that is, you do not work 12-16 hours 7 days a week, have not rested for more than 2 years, you are the mother of a newborn baby who does not sleep well at night and you do not get enough sleep, you can assume conditions for which such a symptom is very typical and undergo an examination to clarify the correctness of the assumption.

1. Anemia and iron deficiency: general clinical blood test, blood test for serum iron, ferritin, TIBC, vitamin B12 and B6.
2. Diseases of the thyroid gland (more often a decrease in function – hypothyroidism, at first it can manifest itself in this way): a blood test for TSH (thyroid-stimulating hormone) – it is initially sufficient to screen for disorders of the thyroid gland.
3. Decreased sodium and calcium levels: Blood test for electrolytes (potassium, sodium chloride), calcium.
4. Viral hepatitis: blood test for hepatitis B (HBsAg – Australian antigen) and C (Anti-HCV-total – antibodies to hepatitis C virus).

For a more detailed examination and exclusion of diseases of the kidneys, liver, lungs, you may additionally need: R-graphy of the lungs, ultrasound of the retroperitoneal space and abdominal cavity, as well as to exclude rheumatological diseases, an additional blood test for C-reactive protein (protein), ALaT, ASAT, total and direct bilirubin, urea, creatinine, total protein and albumin.

Such examinations should not be carried out on your own, but you should contact a competent therapist to prescribe a competent and complete diagnosis.

Sometimes, even a very detailed examination does not reveal changes and does not provide an explanation for such complaints. In this case, depression or chronic fatigue syndrome should be excluded.

What tests should not be taken in some cases?

Well, it is important to write about tests that do not need to be taken. In addition to the fact that these tests cause financial damage to the patient’s wallet, they give a false diagnostic vector, which means ineffective and useless treatment.

1. Analysis of feces for dysbacteriosis. Unfortunately, many doctors like to prescribe it. However, you need to understand that it does not have a clear norm, the variability of “violations”, when some bacteria grow today, others tomorrow, a high percentage of false results, the impossibility of cultivating anaerobic bacteria, the difference between fecal flora and parietal flora living in the microfolds of the intestinal mucosa, do this analysis is absolutely useless, and sometimes even harmful.
2. Determination of immunoglobulin G to any infections in children under one year old, since it is impossible to distinguish maternal antibodies from children’s.
3. Re-determination of IgG antibodies to all herpes and toxoplasma, if a positive result has already been obtained. Their discovery suggests that the body has met with this infection, they do not provide information about the disease at the moment, once detected, they will not go anywhere else, and their quantitative fluctuations do not carry any diagnostic load, except for huge profits for laboratories.
4. Detection of the Epstein-Barr virus in saliva by PCR. A single detection does not confirm infection. But even if the virus is isolated repeatedly, this will not affect the treatment tactics in any way.
5. Detection of Mycobacterium tuberculosis by PCR in the blood. It is clear that it can be found there during the generalization of the process, but in this situation more obvious ways of confirming the diagnosis will be relevant.
6. Determination of viral load of hepatitis C (PCR HCV quantitative method). It’s expensive, but it’s of little use. For modern antiviral therapy (not with interferons), but with direct-acting drugs, the number of RNA copies of the virus does not matter. Regardless of their number, the outcome of treatment will be the elimination (destruction) of the virus from the body.
7. Any tests for herpes types 1,2,3, rubella, measles, mumps (mumps) in the presence of typical manifestations of the disease. These diagnoses are based on the clinical picture.
8. Any tests for herpes 6 and 7 types. Since recommendations for treatment have not yet been developed, and the drugs are in the phase of clinical trials.
9. Cortisol in the blood in the morning on an empty stomach. If it is elevated, and often it is, then this does not mean an excess of cortisol, in most cases, it indicates that you were worried before the analysis, nervous the day before, or afraid of an injection. And lowered cortisol in saliva in the evening does not mean that there is adrenal insufficiency, since there is no lower reference limit for this analysis. It can only be used to rule out a pathological excess of cortisol, since it should normally be low in the evening (it’s time for us to sleep).
10. Insulin, C-peptide and leptin in non-obese individuals with normal blood glucose levels.
11. 17-OH-progesterone in women without infertility and with a couple of successful births in history, as it is not a hormone, but a metabolite, a marker of congenital adrenal dysfunction. It makes no sense to look for this disease in women with normal reproductive function, as well as during pregnancy or in dynamics.
12. Thyroglobulin in terms of primary diagnosis of thyroid diseases. The only situation when it needs to be controlled is the observation of a patient after radical treatment for thyroid cancer. If thyroid tissue is not removed for cancer, it does not need to be examined.
13. Aldosterone in the absence of elevated blood pressure. It is always checked together with renin/renin activity (ratio calculated) and only in the presence of elevated blood pressure, adrenal formation.
14. Determination of the level of prolactin in the blood without complaints, in the absence of infertility, and also during pregnancy.
15. Determination of the level of androgens during pregnancy, since an increase in their synthesis occurs necessarily, as well as 17-OH-progesterone, because estrogens must be formed from them. The degree of androgen increase is unknown, the norms are not defined, although they are prescribed in many laboratories, and even in trimesters. But it is impossible to make a diagnosis of hyperandrogenism during pregnancy, so there is no point in this analysis during it.
16. Determination of specific immunoglobulin G to food allergens, or IgE + IgG to products at the same time.
17. Immunoglobulin E (IgE) to allergens in feces.
18. The sensitivity of blood leukocytes to interferon preparations and / or interferon inducers and / or other immunomodulators.

19. Determination of allergy to anesthetics by blood test.

Sources of