Enhanced Screening: A Personal Choice

Enhanced screening remains a subject of ongoing debate. While it offers clear benefits, there are also potential drawbacks to consider, depending on individual circumstances, the type of screening, and the healthcare context.

Positives:

Early Detection: Enhanced screening can identify diseases at an earlier stage, which is often associated with better outcomes, such as lower treatment burden and improved survival rates. However, the benefits of early detection depend on the specific condition. For diseases with slow progression or those for which effective treatments exist at later stages, early detection may not always significantly improve outcomes.

Proactive Health Management: Regular screening can provide valuable insights into your overall health, helping individuals identify and manage risk factors before they develop into more serious conditions. This aligns with the principles of preventive medicine.

Negatives:

Cost: The financial burden of enhanced screening varies widely. In public healthcare systems, universal enhanced screening may not be cost-effective or feasible due to limited resources. For individuals, allocating a budget for tests based on personal risk factors and priorities is a pragmatic approach.

Increased Anxiety and Over-Diagnosis: Screening can lead to unintended psychological effects, such as anxiety or stress related to abnormal findings. Over-diagnosis—detecting conditions that may never cause harm—can result in unnecessary treatments or interventions.

Managing the Drawbacks:

To mitigate anxiety and over-diagnosis, it is helpful to approach screening with a clear understanding of its limitations. Abnormal findings are not always harmful—for instance, benign tumors are common and often do not require intervention. Additional tests may be needed to assess whether an abnormality poses a real risk. Over time, as a baseline is established through regular testing, the uncertainty associated with initial screenings tends to decrease for many individuals.

Personal Choice:

The rising incidence of cancer in younger individuals (under 50 years) presents unique challenges. In these cases, cancers often appear more aggressive and are discovered at later stages. This trend is partly due to younger patients falling outside traditional age brackets for early screening, as well as the tendency of physicians to associate cancer with older age groups.

Given these challenges, the choice to pursue enhanced or more in-depth screening is highly personal. While public healthcare systems often cannot support large-scale early screening for younger populations due to cost constraints, individuals may choose to invest in private or supplemental screening based on personal risk factors, family history, and preferences. Risk stratification—targeting higher-risk individuals—helps allocate resources but may miss cancers in low-risk populations where the disease can still take a heavy toll.

Ultimately, deciding to pursue enhanced screening is about weighing the potential benefits against financial costs, psychological impacts, and your individual health priorities.

Looking to the Future:

The rapid development of AI and medical technologies is reshaping the landscape of healthcare. AI is already improving diagnostics, risk prediction, and patient monitoring.

As screening technologies evolve, it seems increasingly likely that early and continuous health monitoring will become the standard of care. Tools like wearable devices, AI-driven diagnostic algorithms, and advanced blood-based tests (e.g., for cancer or cardiovascular risk) are making proactive healthcare more accessible and practical.

Ultimately, this allows individuals to take a more active role in managing their long-term health.

The focus on the guide below is generally focussed on cancer screening, cardiovascular and certain metabolic screening.

Genetic Testing

Genetic testing provides detailed insights into whether you are at higher risk for certain types of cancer, cardiovascular as well as many other diseases. Many companies, including Invitae, Blueprint, and Myriad Genetics, offer this service, typically through a clinician. These tests can be invaluable for guiding preventive care and making informed decisions.

Full Body MRI

Full-body MRI scans are increasingly used for early disease detection, identifying issues like tumors, aneurysms, and organ abnormalities before symptoms arise. Offered by companies like Prenuvo and Ezra, these scans provide a comprehensive look at your health and are becoming more accurate and affordable as technology advances.

These scans can reveal early signs of serious conditions, offering peace of mind and potential lifesaving intervention. However, they may also detect incidental findings—abnormalities unrelated to health concerns—that could lead to unnecessary follow-up tests, anxiety, or overdiagnosis, potentially resulting in unnecessary treatments. While such findings might uncover hidden issues, not all will require intervention, and improper follow-up could lead to harm.

Whether to pursue a full-body MRI is a personal decision based on individual health priorities and risk factors. Consulting a healthcare professional is essential to weigh the benefits and limitations, ensuring the scan aligns with your needs. While these scans can be a powerful tool for proactive health management, it’s important to proceed with a clear understanding of their potential benefits and drawbacks.

Cancer Screening

Mole Mapping

One in six Canadians will develop skin cancer in their lifetime. Scanning capabilities for early detection have significantly improved, particularly with the use of AI. FotoFinder is one of the most widely recognized tools used in dermatology centers to monitor and map moles, helping with early detection of skin cancers.

Colon Cancer Screening

Colonoscopy remains the gold standard for colon cancer screening. It’s generally recommended every 2-10 years, depending on individual risk factors. Other screening methods include stool DNA testing and CT colonography. Most early-stage colon cancers can be “cured” through removal. Colon cancer rates are sharply rising among individuals under 50 (while government protocols in Canada only recommend that screening start at 50 for those without an elevated risk profile). Unfortunately, many younger patients are diagnosed with stage III or IV colorectal cancer, which is harder to treat.

Breast Cancer Screening

Screening methods for breast cancer include self-examination and mammograms. However, the sensitivity (ability to correctly identify those with the disease) and specificity (ability to correctly identify those without the disease) of these tests can vary, particularly depending on breast tissue density. While mammograms are valuable, knowing whether you have dense breast tissue is crucial, as this can affect screening accuracy. If you have dense tissue, you may need additional screening, such as breast ultrasound or MRI. Additionally, genetic testing for BRCA1 and BRCA2 mutations is important, as these genes significantly increase the risk of both breast and ovarian cancer.

Ovarian Cancer

While pelvic MRI can detect ovarian tumors, ultrasound is more commonly used for screening. Genetic testing for BRCA1and BRCA2 mutations is essential for determining an increased risk of ovarian cancer.

Lung Cancer

A low-dose CT scan is recommended for high-risk individuals in Canada to screen for lung cancer. This method has been shown to reduce mortality rates in individuals with a history of heavy smoking.

Testicular Cancer

Self-examination (looking for lumps) is the first line of detection. If there are concerns, an ultrasound should be performed as well as biomarker tests (blood tests for Alpha-fetoprotein (AFP), Human Chorionic Gonadotropin (hCG), and Lactate Dehydrogenase (LDH)).

Prostate Cancer

PSA (Prostate-Specific Antigen) testing and digital rectal exams (DRE) are key tools for routine prostate health screening. If abnormal results occur, additional tests such as Free vs. Total PSA, PSA Velocity, PSA Density, or advanced imaging like rectal ultrasound or multiparametric MRI (mpMRI) can improve diagnostic accuracy.

Men with a family history of prostate or related cancers should consider BRCA1 and BRCA2 genetic testing, as these mutations increase the risk of aggressive prostate cancer.

Mouth Cancer

Your dentist should conduct a cancer screening at every visit to identify potential oral cancers early.

Liquid Biopsies

Liquid biopsies are non-invasive blood tests that detect cancer-related genetic material, such as circulating tumor DNA (ctDNA). They offer a less invasive alternative to tissue biopsies, with higher sensitivity observed in advanced cancers due to increased ctDNA shedding. However, their accuracy varies by cancer type and stage, and negative results in early-stage cancers or low-shedding tumors often require confirmation with traditional biopsies.

The Galleri test by GRAIL (Illumina) is a leading liquid biopsy technology. It demonstrates high specificity (99.5%), meaning it rarely produces false positives. Its overall sensitivity is 51.5%, with better performance for cancers like liver, ovarian, and pancreatic, which shed more ctDNA. Sensitivity also improves in advanced stages (III and IV) compared to early stages (I and II).

While promising, liquid biopsies are not a complete replacement for tissue biopsies, which remain the gold standard for definitive diagnosis and tumor analysis. However, they are valuable for monitoring disease progression, detecting recurrence, and assessing hard-to-reach tumors. Advances in technology are expected to further enhance their accuracy and utility.

Cardiovascular Screening

Comprehensive Lipid Panel

This test goes beyond a standard lipid panel to provide a detailed assessment of cardiovascular risk:

LDL Cholesterol (Low-Density Lipoprotein): Often called “bad cholesterol,” small, dense LDL particles are more atherogenic (likely to cause plaque buildup in arteries) than large, fluffy LDL particles.

HDL Cholesterol (High-Density Lipoprotein): Known as “good cholesterol,” it helps remove excess cholesterol from the bloodstream.

Triglycerides: High triglycerides are a risk factor for cardiovascular disease.

Apolipoprotein B (ApoB): Reflects the number of atherogenic particles in the blood and is considered a better indicator of cardiovascular risk than LDL alone.

Apolipoprotein A-I (ApoA-I): The primary protein component of HDL, playing a role in heart health.

Lipoprotein(a) [Lp(a)]

Purpose: A genetic marker of cardiovascular risk. Elevated Lp(a) levels are an independent risk factor for heart disease and are largely unaffected by lifestyle changes.

Significance: Testing Lp(a) provides critical information for individuals with a family history of cardiovascular disease.

AI-Powered Coronary Computed Tomography Angiography (CCTA)

Purpose: AI-powered CCTA is a non-invasive test that visualizes coronary arteries, detecting plaque and narrowing with speed and precision using advanced machine learning.

Significance: By automating plaque analysis, AI-enhanced CCTA enables early detection of heart disease and personalized care. Cleerly AI leads in this space, helping clinicians assess risks and tailor treatments to prevent cardiac events.

CT Coronary Calcium Score (CAC)

Purpose: This non-invasive test uses a CT scan to measure calcium buildup in the coronary arteries, providing a direct assessment of heart disease risk.

Significance: CAC scoring can predict cardiovascular risk more accurately than cholesterol levels alone, particularly in individuals with normal cholesterol.

High-Sensitivity C-Reactive Protein (hs-CRP)

Purpose: A marker of inflammation in the body, which is a key driver of atherosclerosis and cardiovascular events.

Significance: Elevated hs-CRP levels may indicate an increased risk of heart attack or stroke, even in people with normal cholesterol levels.

Carotid Intima-Media Thickness (CIMT) Test

Purpose: An ultrasound test that measures the thickness of the inner layers of the carotid artery to detect early signs of atherosclerosis.

Significance: CIMT is valuable for assessing cardiovascular risk and monitoring disease progression.

Stress Testing

Purpose: Evaluates the heart’s response to physical activity and can identify reduced blood flow to the heart.

Types: Advanced options like exercise echocardiograms and/or cardiac MRI provide more detailed insights.

Significance: Useful for diagnosing coronary artery disease and guiding treatment decisions.

Electrocardiogram (ECG)

Purpose: A basic, non-invasive test to detect irregularities in heart rhythm or electrical activity.

Significance: Helps identify arrhythmias or other conditions that increase cardiovascular risk.

Abdominal Ultrasound

Purpose: Screens for abdominal aortic aneurysms, particularly in individuals at higher risk (e.g., men over 65, smokers, or those with a family history).

Significance: Detecting aneurysms early can prevent life-threatening rupture through timely interventions.

Metabolic Blood Testing

Fasting Blood Glucose

Purpose: Measures blood sugar levels after an overnight fast to assess the risk of diabetes or prediabetes.
Significance: Elevated fasting glucose levels indicate impaired glucose metabolism, which is a hallmark of insulin resistance and metabolic syndrome.

Hemoglobin A1c (HbA1c)

Purpose: Reflects average blood glucose levels over the past 2–3 months.
Significance: HbA1c is a critical marker for diagnosing diabetes and monitoring long-term blood sugar control in individuals with diabetes.

Oral Glucose Tolerance Test (OGTT)

Purpose: Evaluates how the body processes glucose by measuring blood sugar levels before and after consuming a glucose-rich drink.

Significance: Useful for diagnosing diabetes, prediabetes, and gestational diabetes, particularly in individuals with borderline fasting glucose levels.

Insulin Fasting and Insulin Resistance (HOMA-IR)

Purpose: Measures fasting insulin levels and calculates insulin resistance using the HOMA-IR index.

Significance: High insulin levels or HOMA-IR values suggest insulin resistance, a key driver of metabolic syndrome and type 2 diabetes.

C-Peptide

Purpose: Assesses pancreatic function by measuring the production of insulin.

Significance: Elevated or suppressed C-peptide levels can help differentiate between type 1 and type 2 diabetes or identify insulin resistance.

Alanine Aminotransferase (ALT)

Purpose: A liver enzyme that helps assess liver health and potential liver damage.

Significance: Elevated ALT levels may indicate non-alcoholic fatty liver disease (NAFLD), a common complication of metabolic syndrome and insulin resistance.

Serum Ferritin

Purpose: Measures stored iron levels in the body.

Significance: High ferritin levels are associated with metabolic dysfunction, including insulin resistance and inflammation, while low levels may indicate iron deficiency.

Thyroid Function Panel

Purpose: Includes TSH, Free T4, and Free T3 to assess thyroid gland activity.

Significance: Thyroid dysfunction, such as hypothyroidism, can contribute to weight gain, metabolic slowdown, and insulin resistance.

Magnesium

Purpose: Measures blood magnesium levels to evaluate overall mineral status.

Significance: Low magnesium levels are associated with insulin resistance, cardiovascular disease, and poor glucose control.

Uric Acid

Purpose: Measures uric acid levels in the blood, which can accumulate due to poor metabolic health.

Significance: Elevated uric acid is linked to gout, insulin resistance, and an increased risk of cardiovascular disease and kidney dysfunction.

Retina
Screening

A retina test (or fundus exam) is recommended as part of a comprehensive approach to preventive health because changes in the retina offer valuable insights into vascular health, cardiovascular risk, and other underlying conditions such as diabetes and hypertension.

Key Reasons for Retina Testing:

Reflection of Vascular Health

The retina contains blood vessels that are the only ones in the body that can be directly viewed without surgery. Changes in these vessels can indicate vascular issues affecting the heart, brain, and other organs. Damage to retinal blood vessels (retinopathy) may signal atherosclerosis, increasing the risk of heart disease and stroke.

Early Indicator of Cardiovascular Disease

The retina can show early signs of subclinical cardiovascular disease. Retinal changes such as microaneurysms, cotton wool spots, and retinal hemorrhages are often linked to high blood pressure and increased cardiovascular risk. These signs can help identify issues before more serious symptoms develop.

Detection of Diabetes

Diabetic retinopathy is a common complication of uncontrolled blood sugar. It can often be detected in the retina before a formal diagnosis of diabetes. Early detection can prevent progression and help manage diabetes more effectively, reducing long-term complications.

Self Monitoring

While enhanced screening offers valuable tools for early detection, it is not a substitute for staying in tune with your own body.

Self-monitoring and regular self-exams are critical components of proactive health management:

Monitor Changes: Be aware of changes in your body, such as new or changing moles, unexplained weight loss or gain, and persistent fatigue.

Perform Self-Exams: Regular self-checks, such as breast exams, testicular exams, and skin checks, can help identify abnormalities early.

Pay Attention to Symptoms: Do not ignore unexplained symptoms, even if they seem minor. Persistent pain, unusual bleeding, or changes in appetite or digestion should prompt medical attention.

Being proactive about your health means combining modern screening tools with self-awareness. Early recognition of potential issues—through both personal monitoring and advanced tests—can significantly improve outcomes.