Health Screening Glossary

Yes, it is hard to understand the jargon and the acronyms. To help you understand your health screening results better, we have specially prepared the following glossary of technical terms (You may also download the download the glossary of blood test results here):

Biometric Measurement Blood Analysis Radiology
Body Mass Index Fasting Blood Glucose Electrocardiography (ECG)
Blood Pressure Fasting Blood Cholesterol Chest X-ray
Full Blood Count Breast Mammogram
Urine Analysis Kidney Function Test Breast Ultrasound
Urine Microalbumin Liver Function Test Ultrasound Abdomen / Pelvis
Urine FEME Bone Joint Disease PAP Smear
VDRL-Syphillis Bone Mineral Densitometry (BMD)
Stool Analysis Hepatitis A, B & C Treadmill Test
Stool Examination (Conventional) Thyroid Disorder
Cancer Markers
Others
Cardiovascular Disease Risk Assessment

 

BIOMETRIC MEASUREMENT

Body Mass Index
- Measurement of Height, Weight
Obesity is associated with increased cardiac risks, with 24.4% of our adult population being overweight and 6.0% being obese. Body Mass Index (BMI) = Weight (in kg) / [Height x Height] (in metres) The optimum BMI for a person is between 18.5- 22.9. Persons with BMI of lesser than 18.5 is said to be at risk of Osteoporosis and Nutritional Deficiency Diseases. If BMI is 27.5 and above, the person is at high risk of contracting Heart Disease and Diabetes.

Blood Pressure Measurement
This is closely associated with coronary artery disease, renal disease, and stroke.

CATEGORY SYSTOLIC mmHg DIASTOLIC mmHg
Normal BP <130 <85
High-Normal BP 130-139 85-89
Hypertension >140 >90

Systolic represents the peak pressure when the heart is maximally contracted, whilst Diastolic represents the lowest pressure when the heart is relaxed before the next contraction. Both readings are important when used for assessing the blood pressure for any individual.

 

BLOOD ANALYSIS

Fasting Blood Glucose
– Measurement of Fasting Venous Blood Glucose

This test screens for diabetes mellitus, which affects 9% of our adult population. Glucose is the main carbohydrate utilized by the body. The level of blood glucose is controlled by a complex interplay between dietary intake and hormones such as insulin.

< 6.0 mmol/L The blood glucose level is normal. There is no evidence of diabetes noted.
6.1-6.9 mmol/L The fasting glucose level may indicate presence of fasting hyperglycemia, impaired glucose tolerance or possible diabetes. Please consult your doctor for a repeat fasting glucose or an oral glucose tolerance test as further evaluation.
> 7.0 mmol/L The blood glucose level is high. This is suggestive of diabetes mellitus but a single measurement is not good enough to make a diagnosis in the absence of symptoms such as loss of weight, excessive thirst and increased frequency of urination. Please see your doctor for follow up. In the meantime, you should reduce the intake of sweet and sugary foods and eat more complex carbohydrates like unpolished rice and whole meal bread. Try to maintain a healthy weight. If you are a known diabetic, you should see your doctor for regular follow up for advice on dietary and medical management.

Fasting Blood Cholesterol
Measurement of Full Venous Fasting Lipid profile
- Total cholesterol
- HDL cholesterol
- LDL cholesterol
- Cholesterol/HDL ratio
- Triglycerides This full lipid profile is the optimal test in screening for cholesterol.

 

Total Cholesterol (mmol/L [mg/dL])
Desirable
5.2 – 6.1 (200 – 239) Borderline high
> 6.2 (240) High
LDL Cholesterol (mmol/L [mg/dL])
< 2.6 (100) Optimal
2.6 – 3.3 (100 – 129) Desirable
3.4 – 4.0 (130 – 159) Borderline high
4.1 – 4.8 (160 – 189) High
> 4.9 (190) Very high
HDL Cholesterol (mmol/L [mg/dL])
< 1.0 (40) Low
1.0 – 1.5 (40 – 59) Desirable
> 1.6 (60) High
Triglyceride (mmol/L [mg/dL])
< 1.7 (150) Optimal
1.7 – 2.2 (150 – 199) Desirable
2.3 – 4.4 (200 – 399) High
> 4.5 (400) Very high

 

LDL Cholesterol is the bad cholesterol and elevated LDL is closely associated with increased risk of heart disease and stroke. HDL is “good” cholesterol. A high level of HDL reduces arthrosclerosis and the risk of heart attack. Triglyceride is a form of fat. It is often associated with elevated LDL and total cholesterol levels and uncontrolled diabetes. An elevation in triglyceride levels increases one’s risk of coronary heart disease.

 

HbA1C – HbA1C if glucose is above 7.0mmol/L

Full Blood Count
- Haemoglobin
- RBC (RCC)
- WCC (TWDC)
- 5 Part Differential Count
- Platelet Count
- PCV – MCH/MCV
- MCHC
- Blood Film Comment

These tests screens for diseases like anaemia (low red blood cell count), clotting disorders, leukemia and infections.

Kidney function Test
- Sodium
- Potassium
- Chloride
- Urea
- Creatinine

Our kidneys regulate the salt and water components in our body. They also help to excrete unwanted waste substance. This test analyses the blood content of sodium, potassium, chloride, urea and creatinine.

Liver Function Test
- Total Protein
- Albumin
- Globulin
- A/G Ratio
- Total Bilirubin
- Alkaline Phosphatase
- ALT
- AST
- Gamma GT

This panel of tests together with the AFP test is recommended for surveillance of persons with known chronic Hepatitis B infection. The liver function test is used for monitoring of liver function, which may be affected by chronic inflammation eg hepatitis B, prolonged consumption of medication and/or alcohol.

Bone & Joint Disease
- Calcium
- Phosphate
- Uric Acid
- Rheumatoid Factor

This panel of tests comprises Calcium and Phosphate, which are important bone minerals. A significantly elevated level may indicate bone disease, whilst low levels may indicate vitamin D deficiency or poor dietary calcium. A persistently low level may be associated with increased risk of developing osteoporosis.

Uric acid is formed as a product of nucleic acid metabolism. High levels of uric acid may precipitate as uric acid crystals which deposit in tissues and joints, resulting in pain, swelling, redness and warmth of the affected joint, a condition known as gout. The Rheumatoid Factor is associated with inflammatory joint disease (Rheumatoid Arthritis). You may wish to opt for this test if you suffer from recurrent joint pains.

VDRL
- Syphilis Antibody
- RPR if Syphilis Antibody is positive
- TPHA if Syphilis Antibody is positive

This test screens for syphilis, a sexually transmitted infection. If untreated, syphilis can cause chronic conditions such as brain and spinal cord damage, blindness, insanity, miscarriage and birth defects in pregnant women, and it is occasionally fatal. However, a false positive test may result from other conditions and a secondary confirmatory test (TPHA) is required to confirm the diagnosis.

Hepatitis A, B & C Screening
- Hepatitis A Antibody (HAV IgG)
- Hepatitis B Surface Antigen (HBsAg)
- Hepatitis B Surface Antibody (HBsAb)
- Hepatitis C Antibody (HCV)

Hepatitis A is an infectious disease which can cause acute liver swelling and yellowing of skin. It is transmitted by contaminated food or water as well as consumption of contaminated shellfish such as cockles, mussels and oysters. The test determines whether you have immunity against the Hepatitis A virus and is recommended if you are a known Hepatitis B carrier, or if you are a frequent overseas traveller, or if you have a habit of eating shellfish. Hepatitis A HAV IgG: Reactive — You are immune. No vaccination against Hepatitis A is required. Non Reactive — Primary course of 2 vaccinations at 0 and 6 months is recommended.

The Hepatitis B screen comprises the Hepatitis B surface antigen (HbsAg) and antibody (anti-HBsAb). 6% of the local population have chronic Hepatitis B infection and are at increased risk of liver hardening and liver cancer. If the HBsAg is reactive, this means that you are likely to have chronic Hepatitis B infection. Vaccination is recommended if immunity is tested negative. Hepatitis B Surface Antigen: Reactive — You have the Hepatitis B virus, please see your doctor for regular follow-up and screening. Non Reactive — You do not have the virus, please refer to Surface Antibody result for management. Hepatitis B Surface Antibody: Results >10 — You are immune. No vaccination is necessary. Non Reactive or Levels <10 — Vaccination Required

Hepatitis C viral infection is the most common cause for non-A, non-B cases of viral hepatitis in the community, and there is no vaccine available at this time. It is a blood-borne virus, easily transmitted when intravenous drug users share needles, through body tattoos or piercing. Transmission through sexual intercourse and from mother to baby are relatively rare, as is transmission through blood transfusion as donated blood is screened for Hepatitis C. Although mostly asymptomatic, individuals may experience weight loss, tiredness, nausea and vomiting, fever or abdominal pain and jaundice. Persons infected with Hepatitis C are at high risk of developing chronic Hepatitis C infection (about 75%), and although usually asymptomatic, it may progress to cirrhosis in 20-30% of patients, and liver cancer. Persons who have symptoms described above, or who fall within the high risk group should take this test.

Thyroid Disorder
- Free Thyroxine (Free T4)
- TSH (Thyroid Stimulating Hormone)

The thyroid gland controls our basal metabolic rate. An increased level may result in: loss of weight, increased appetite, heat intolerance and/or short temperament. A decreased level will cause the opposite to occur. This test measures the free thyroxine level. We recommend this test if you suffer from any of the above symptoms. An additional test, the TSH (thyroid stimulating hormone) may be performed in cases where the fT4 is too low or too high. An elevated TSH is associated with hypothyroidism whilst a low TSH is associated with hyperthyroidism.

Cancer Markers
- Tumour Marker Liver (Alpha fetoprotein – AFP)
- Tumour Marker Colon & Lungs (Carcinoembryonic Antigen – CEA)
- Tumour Marker Prostate (PSA) – for male
- Tumour Marker Ovarian (CA125) – for female – Tumour Marker Pancres (CA19.9)
- Tumour Marker Nose (EBV EA-IgA)

CEA (Carcinoembryonic Antigen) may be elevated in selected cases of cancers of the large intestines and lung. However, mild elevations may also be seen in smokers. You may wish to opt for this test if you have a family history of related cancers.

AFP (alphafetoprotein) test together with the liver function test is recommended for surveillance of persons with known chronic Hepatitis B infection.

PSA – Adenocarcinoma of the prostate is the sixth most common cancer among men here. As screening with PSA has the potential of diagnosing organ confined disease, the use of PSA for early detection is available here for the gentleman who is aware of the potential risks and benefits

This tests for CA 125, a protein that may be elevated in cases of ovarian cancer. You may consider this if you have a family history of ovarian cancers or experience persistent abdominal pain which is related to menses.

Serum CA 19.9 is a screening test used to detect pancreatic cancer. Serum CA 19-9 levels are raised in up to 80% of patients with pancreatic cancer, in 54-89% with stomach cancers and 64% with colorectal cancers. Occasionally, benign diseases like acute and chronic pancreatitis, cystic fibrosis, inflammatory bowel disease, cirrhosis and cholangitis may also result in elevated levels. However, in benign diseases, it does not usually exceed 100 U/ml. Levels above 300 U/ml have a high predictive value of over 90%. Persons who have had pancreatic cancer and are treated should take this test as a means of monitoring. Persons with symptoms of chronic pancreatic disease, such as upper abdominal pain radiating to the back, nausea, vomiting and weight loss, may also consider taking this test.

The Ebstein Barr Virus , EBV is linked to the development of nasopharyngeal carcinoma. The EBV EA IgA is a screening test for (NPC), and its specificity and sensitivity are both above 95%. In the early stages, NPC is usually asymptomatic, or may present as non-specific symptoms easily confused with common cold or nose bleed. Other symptoms include hearing loss, tinnitus, ear pain, neck or throat lumps and headaches. It should be noted that for diagnostic purpose, the positive result obtained must be correlated with other clinical and laboratory findings. High risk individuals with family history of NPC, cigarette smokers, and persons who consume large quantities of salted vegetables, meat and fish high in nitrosamines, should consider taking this test. Persons with symptoms listed above should also take this test.

 

URINE ANALYSIS

Urine Microalbumin
Albumin is a small protein molecule produced by the liver, and is present in high concentrations in blood. When the kidneys are functioning well, virtually no protein is allowed to leak into the urine. However, persons with kidney damage, these proteins are detectable in the urine. Creatinine is a product of muscle breakdown, and is excreted in the urine consistently. Measurement of the ratio of microalbumin to creatinine (ACR) allows us to identify persons with increased risk of developing kidney damage, especially in persons with pre-existing disease like diabetes and hypertension, or kidney disease. Persons with pre-existing conditions which may lead to increased risk of kidney impairment, such as high blood pressure, diabetes, congenital kidney disease, should take this test.

Urine FEME (Full and Microscopic Examination of Urine)
In this test, the urine sample is tested biochemically as well as examined under the microscope for protein, glucose, specific gravity, pH, ketones, red and white blood cells. The detection of the presence of glucose, protein & blood in the urine may suggest underlying diabetes mellitus or kidney disease. Recommended for those worried about kidney stones, urinary tract infection or presence of blood in urine.

 

STOOL ANALYSIS

Stool Occult Blood – Conventional
This test for blood that is not visible to the naked eye and is one of the screening tools for colorectal cancer. If present it may indicate bleeding from the gut caused by piles, growths or infections. A positive test result should be followed up by a colonoscopy. The lifetime probability of an individual developing colorectal cancer is approximately 5%, and the faecal occult blood test is a recommended screening test for all above 50 years of age of average risk.

 

RADIOLOGY TESTS

Electrocardiography (Resting ECG)
Electrocardiography is the recording of the heart’s electrical activity over a short period of time by means of skin electrodes. Electrical impulses in the heart stimulate the heart muscles to contract and these electrical waves can be measured by selectively placed electrodes on different sides of the heart. Thus ECG measures the overall rhythm of the heart and is used to detect abnormal rhythms that may suggest weak or damaged conductive heart tissues. The ECG cannot reliably measure the heart’s pumping ability for which other tests may be employed.

Chest X-Ray
Chest X-Ray is typically performed as the first imaging test for symptoms of shortness of breath, persistent cough, chest pain, chest injury or fever. Chest x-rays are useful in picking up abnormal conditions involving the lungs, heart and great vessels. Pneumonia, heart failure, emphysema, lung cancer and other medical conditions can be diagnosed or suspected on a chest x-ray. Low doses of radiation are used to create an image of the chest. Thus, x-rays are to be generally to be avoided if you are or suspect that you are pregnant

Breast Mammogram
Mammography is recommended annually for women over 40 years of age and once every 2 years for women over 50 years of age as a diagnostic screening tool to aid in the detection of breast cancer. Low doses of radiation is used to generate an image of the breast to look for characteristic masses or microcalcifications.

Breast Ultrasound
The Ultrasound Breast is generally used to further evaluate masses found in mammography or palpable masses not seen on mammograms. The procedure uses sonography or high frequency sound waves to produce images of the internal structures of the breast. The images can help determine if an abnormal lump is suspected to be cancerous or a fluid filled benign cyst.

Ultrasound Abdomen / Pelvis
An ultrasound abdomen procedure uses sonography or high frequency sound waves to produce images of the internal organs of the abdomen including the liver, gallbladder, spleen, pancreas and kidneys. A pelvis ultrasound displays images of the pelvic structure. Both are useful in aiding investigations of abnormalities in the abdomen or pelvis evidenced by abdominal or pelvic pain.

PAP Smear is a screening test for cervical cancer. Pap smear checks for changes in the cells of the cervix which may develop into cancer at the later stage. All woman aged between 25 and 64 who have had sex before, are advised to have a Pap smear done annually.

Bone Mineral Densitometry (BMD)
Bone Mineral Densitometry is a test to measure the mineral density of a person’s bone. The measurements are generally useful to assess a person’s risk of developing osteoporosis.

Treadmill Test
Treadmill test allows an objective assessment of exercise capability and may enhance diagnostic accuracy in some diseases.

Cardiovascular Disease Risk Assessment

To effectively manage the problem of high cholesterol, doctors vary the treatment based on the person’s risk profile.

In general, a person is classified according to their risk of developing heart disease or heart attack in the next 10 years. This risk is assessed based on the presence of modifiable and non-modifiable factors as listed below:

Non-Modifiable Risk Factors Modifiable Risk Factors
Pre-existing heart disease High cholesterol (total and LDL)
Diabetes mellitus Low HDL
Stroke, artherosclorosis, peripheral arterial disease or
abdominal aneurysm
Cigarette smoking
Age – Men above the age of 45 years, and women above
the age of 55 years
High blood pressure, or already on hypertension
medication
First degree relative in the family with heart disease (male
developing heart disease at age below 55 years; female at
age below 65 years)
Indian race

 

Whilst you may be unable to alter the non-modifiable ones, do take special effort to minimize your modifiable risk factors with:

1) Healthy dietary habits such as replacing food rich in saturated fats (pork, beef, cheese, coconut milk) and cholesterol (egg yolk), liver) with skinless poultry, fish and low fat milk. Avoid oily, fatty and fried food as well as sugary food and starches
2) Exercise regularly (3×20 mins of aerobic exercise per week) to maintain/achieve high level of HDL (ie ‘good cholesterol’)
3) Quit cigarette smoking, if you are a smoker
4) Increase intake of fruits, vegetables and garlic.
5) Reduce salt intake in your diet by avoiding presalted, canned and preserved food
6) Maintain a healthy weight range