Screening for Abdominal Aortic Aneurysm
- USPSTF recommends screening men 65-75 years old who have ever smoked, with ultrasound. Anything less than 3cm is normal. 3cm-3.9cm require surveillance every 2-3 years. 4cm-5.4cm require surveillance every 6 months. Aneurysms 5.5cm or larger require surgical referral. [Grade B recommendation]
Screening for Breast Cancer
- USPSTF recommends mammogram starting at age 50, then repeat every 2 years, until the age 74. They also recommend against teaching breast self exams, because they say it did not reduce breast cancer mortality, but instead caused women to get more “unnecessary” imaging and biopsies done.
- ACOG suggests mammogram starting at age 40 every 1-2 years, then after 50, every year. They recommend monthly breast self exams and clinical breast exams every 3 years starting at age 20.
Screening for Cervical Cancer
- ACOG guidelines are to start pap smears at age 21, regardless of whether or not the patient has become sexually active.
- USPSTF guidelines is to do pap spear cytology every 3 years from age 21 to 65. For those age 30-65 who don’t want to test that often, alternatively you can do pap smear PLUS HPV testing every 5 years.
- If the patient has been negative the entire time, stop at 65.
- Guidelines apply whether or not you’ve been vaccinated against HPV.
Screening for Diabetes
- USPSTF recommends screening all overweight or obese adults 40-70 years old. Currently, there are no recommendations for optimal re-screening intervals. [Grade B recommendation]
Screening for Gonorrhea/Chlamydia
- USPSTF recommends screening sexually-active females under age 25. At this age, people tend to be more “promiscuous.” Screen while doing a pap smear. Often chlamydia is asymptomatic, but can cause tubal strictures and infertility. [Grade B recommendation]
Screening for Colorectal Cancer
- USPSTF recommends to start screening at age 50 and repeat every 10 years until age 75
- There are several screening options: You could either do a fecal occult blood test yearly, or flexible sigmoid every 5 years PLUS fecal occult blood test every 3 years, or do colonoscopy every 10 years.
- If you have polyps, then screen again 3-5 years later depending on size or number of polyps.
- If patient has no polyps but has family history of colorectal cancer, then start screening at age 40, or 10 years younger than the youngest case in the family, whichever comes first. Then repeat screening every 3-5 years.
- If there’s a family history Familial Adenomatous Polyposis (FAP), then do genetic screen at age 10-12. If genetic screening is positive, then consider colectomy to prevent future polyps. Otherwise, if you choose not to do colectomy but is positive for FAP, then do a flexible sigmoidoscopy every 1-2 years until age 35, then every 3 years after that.
Screening for Hyperlipidemia
- USPSTF recommends screening men from age 35 and onward if there are no risk factors. If they do have risk factors, start screening anytime between 20-35. For women, there are no recommendations if you have no risk factors, but if you do, start screening at 45.
- Screen every 5 years. If you have an increased risk for coronary artery disease, like if you smoke, have diabetes, have hypertension, or have a family history of coronary artery disease, then screen more often.
- Total cholesterol should be 200 or less and HDL >35.
Screening for Hypertension
- USPSTF recommends people getting screened for hypertension starting at 18.
- Because of variability of blood pressure measurements in each individual, you need to have 2 measurements done at least one week apart from each other to make a diagnosis.
- Systolic at and above 140, and/or diastolic at and above 90 is considered hypertension (if you are under 60 years old per JNC 8).
- Repeat every 2 years if blood pressure is 120/80 or less. If it’s between 120/80 and 139/89, then repeat every 1 year.
Screening for Lung Cancer
- USPSTF recommends those 55-80 years old who have 30+ year smoking history who continue to smoke or have quit within 15 years to be annually screened with low-dose CT for lung cancer. [Grade B recommendation]
- AAFP, however, disagrees with USPSTF and says there is insufficient evidence to recommend for or against lung cancer screening.
Screening for Osteoporosis
- USPSTF recommends all women get a DEXA bone density scan at age 65. [Grade B recommendation]
- Consider osteoporosis screening earlier for patients who have history of fracture, sarcoidosis, etc.
- Not enough evidence for screening men.
- The USPSTF currently does not recommend screening for prostate cancer. The decision to screen should be made after thorough discussion with patient.
Screening for Scoliosis
- USPSTF and AAFP do not recommend asymptomatic adolescents to be screened for scoliosis. It causes low-risk adolescents to undergo expensive and unnecessary testing and treatments. Those who actually need treatment will be detected without screening.
- AAP, on the other hand, recommends scoliosis screening, but says more thought needs to be put into deciding which patients with positive results need further evaluation.
- Influenza vaccine — give annually every year after age 50.
- Pneumococcal vaccine — There are two types: pneumococcal conjugate vaccine (PCV13 aka Prevnar) and pneumococcal polysaccharide vaccine (PPSV23 aka Pneumovax). Prevnar is the one given routinely as a 4-dose series to kids, as well as to adults >65 years old who have never had Prevnar before. Pneumovax is the one given once to all adults >65 or to anyone >2 years old at high risk for pneumococcal disease (heart disease, lung disease, sickle cell, diabetes, COPD, HIV, asplenia, leukemia, lymphoma, patients on long-term steroid, patients on chemotherapy, or immunocompromised). Per ACIP (CDC) guidelines, those who received Pneumovax before 65 years old should receive another dose of the vaccine at age 65 years if at least 5 years have passed since their last dose. Those who have never received either Prevnar or Pneumovax, should receive Prevnar first at age 65, followed by Pneumovax a year later. For example, if you have had all your childhood immunizations, and are diagnosed with COPD at 63 yrs old, then you should get Pneumovax once at 63, then once again 5 years later at 68. If you are a healthy adult with all childhood vaccines up to date, you should get Pneumovax once at 65. If you are a healthy adult with no pneumococcal vaccines in the past, you should get Prevnar at age 65, then Pneumovax at age 66.
- TDAP, Zostervax — give over age 50.