Health Screening and Adult Immunizations
Craig Nielsen
Richard S. Lang
RAPID BOARD REVIEW—KEY POINTS TO REMEMBER:
Primary prevention aims to reduce the incidence of a disease.
Secondary prevention aims to reduce the prevalence of a disease.
CARDIOVASCULAR DISEASE
Blood Pressure
Screen asymptomatic persons at least every 2 years, beginning at age 18 years.
Diabetes Mellitus
Screen asymptomatic patients with sustained blood pressure (treated or untreated) >135/80 mmHg (U.S. Preventive Services Task Force—USPSTF). The American Diabetes Association has broader screening recommendations.
Fasting plasma glucose levels >126 mg/dL on two separate occasions or a hemoglobin A1C >6.5% are diagnostic of type 2 diabetes mellitus.
Cholesterol
Screen with a total and high-density lipoprotein serum cholesterol level in a nonfasting state “asymptomatic” adults, every 5 years beginning at age 35 years in men and 45 years in women, and those with additional cardiovascular risk factors (USPSTF) at younger ages (20 to 35 years in men and 20 to 45 years in women).
Screen with a fasting lipid profile all adults, at least every 5 years, beginning at age 20 years. An age to stop screening is not established (National Cholesterol Education Program).
Abdominal Aortic Aneurysms
Screen with an abdominal ultrasound all men between the ages of 65 and 75 years who have ever smoked at least the equivalent of 100 cigarettes.
Electrocardiography, Exercise Treadmill Test, Calcium Scoring, Computed Tomography Angiography
Do not screen adults at low risk for coronary heart disease events (USPSTF).
Aspirin
Use aspirin for men aged 45 to 79 years when the benefit to reduce myocardial infarctions outweighs the potential harm due to gastrointestinal hemorrhage (USPSTF).
Use aspirin for women aged 55 to 79 years when the benefit to reduce ischemic strokes outweighs the potential harm due to gastrointestinal hemorrhage (USPSTF).
CANCER SCREENING
Breast Cancer
Annual or biennial mammography screening after the age of 40 years.
Magnetic resonance imaging only in patients at very high risk for breast cancer.
Lung Cancer
Annual low-dose computed tomography screening for individuals aged 55 to 79 years with at least a 30 pack-year history of smoking (American Association for Thoracic Surgery).
Colon and Rectal Cancer
In the low- or average-risk patients, start screening at the age of 50 years, with a fecal occult blood test yearly, sigmoidoscopy every 5 years, or colonoscopy every 10 years.
In high-risk patients, start screening at an earlier age, usually around age 40 years, or 10 years earlier than the earliest diagnosed colon cancer in the family, whichever number is lower, with a colonoscopy every 5 years.
In very high-risk patients (e.g., familial polyposis, inflammatory bowel disease), refer to a specialty center for more aggressive screening and monitoring.
Prostate Cancer
Definitive evidence supporting prostate cancer screening is still lacking.Stay updated, free articles. Join our Telegram channel
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