PREVENTIVE SCREENING


AAFP references are up to date as of 1/07
Sources include
www.guidelines.gov as well as specific organizations' websites; also "Primary and Preventive Care: Periodic Assessments" ACOG Committee Opinion #229, 12/99

AAFP = American Academy of Family Physicians
AAP = American Academy of Pediatrics
ACOG = American College of Obstetrics and Gynecology
ACPM = American College of Preventive Medicine
ACR = American College of Radiology
ACS = Americal Cancer Society
AGA = American Gastroenterologic Association
AUA = American Urologic Association
CDC = US Centers for Disease Control and Prevention
NCEP = National Cholesterol Education Program
NIH = National Institutes of Health
USPSTF = US Preventive Services Task Force

TEST CONDITION COMMENTS

Ultrasound of the hips

Developmental dysplasia of the hip

0-4mo if breech, h/o metatarsus adductus, or torticollis, or family h/o CHD (Pediatrics 94:201, 1994)

AP Pelvis x-ray

Developmental dysplasia of the hip

4-12mo if breech, h/o metatarsus adductus, or torticollis, or family h/o CHD (Pediatrics 94:201, 1994)

Newborn metabolic screen

Metabolic diseases

If not previously done after 5do (required by law; specific components vary by state)

Urine reducing substances

Metabolic diseases

If not previously done after 5do (required in some states; not required in WA)

Hb or HCT

Iron deficiency anemia

CDC: If preterm or LBW, once 0-6mos; if at risk (cow's milk < 12mo, non-Fe-fortified formula x > 2mos; limited access to food b/c of poverty or neglect; chronic illness), once at 9-12mos then annually from 2-5yo; 5-12yo only if h/o Fe deficiency, low Fe intake, or "special health care needs." Nonpregnant women of childbearing age Q5-10y; annually if: extensive menstrual or other blood loss, low Fe intake, previous dx of Fe deficiency. USPSTF & AAFP: only screen "high-risk" infants at 6-12mos (poverty, immigrants from developing countries, preterm, LBW, consumption of unfortified cow's milk); AAP: Once at 9-15mos then once at 15mos-5y

Newborn hearing screen

Congenital hearing problems

NIH/AAP: Universal

USPSTF: Weak recommendation if: family h/o childhood sensorineural deafness, congenital perinatal infections, head/neck malformations, < 1.5kg birthweight, bact. meningitis, jaundice w/exchange transfusion, severe perinatal asphyxia, ototoxic medications, or evidence of any syndrome known to include hearing loss

Lead level

Lead poisoning

USPSTF, AAFP: If at risk, check least once, at 12mos; CDC, AAP: If at risk, check at 1y and 2y; if 3-6yo and never been tested, test once

during that age

PPD

Tuberculosis

AAP: Yearly from 1yo if at risk

Urinalysis

Asymptomatic bacteriuria

AAP: u/a at 5y and once during adolescence; ACOG: Yearly starting age 65

Total cholesterol

Dyslipidemia

AAP: At 2y if parent with tot. chol. > 240; ACOG: Q5y 45-75yo

Total cholesterol & HDL

Dyslipidemia

NCEP: Q5y starting at 20yo; AAFP 2007: "Periodically" starting age 35 in men and age 45 in women; start @ age 20 if risk factors present (DM, family h/o early-onset CAD or familial dyslipidemias, HTN, tobacco use); USPSTF: All men > 35yo; men 20-35yo if at increased risk of CAD; women > 20yo if at increased risk of CAD

Fasting lipid profile

Dyslipidemia

AAP: At 2y if parent or grandparent with CV disease < 55yo

Gonorrhea LCR

Screening for infectious diseases

USPSTF: Women < 25 with > 1 partner in the last year; AAFP 2007: screen high-risk females

Gonorrhea culture

Screening for infectious diseases

USPSTF: Women < 25 with > 1 partner in the last year; AAFP 2007: screen high-risk females

Chlamydia LCR

Screening for infectious diseases

USPSTF 2001, AAFP: Women < 25 sexually active with men and other women at high risk

HIV Ab

Screening for infectious diseases

 AAFP 2007: Screen if "at risk"

Hepatitis B Surface Antigen

Screening for infectious diseases

 

Hepatitis B Surface Antibody & Antigen

Screening for infectious diseases

 

Hepatitis C Antibody

Screening for infectious diseases

NIH: Screen if h/o hemodialysis, transfusions before 1990, IVDU, multiple sexual partners, or household contact of known HCV carrier

RPR

Screening for infectious diseases

 

Pap smear

Cervical Cancer

USPSTF, AAFP: Q3y starting when sexually active; stop at age 65 if consistently WNL or if have had hysterectomy for a reason other than Ca.

ACOG 2009  (http://journals.lww.com/greenjournal/documents/PB109_Cervical_Cytology_Screening.pdf-JW):

  • Start at age 21 regardless of age of onset of sexual activity

  • Q2y from 21-29yo except more frequently in women who are HIV-positive, immunosuppressed, had in-utero exposure to diethylstilbestrol, or have been treated with CIN 2-3 or cervical Ca (in those cases, 2x during first year then Q1y)

  • Women > 30yo with 3 consecutive negative screens and none of the above risk factors can be tested A3y

  • No need for cervical Ca screening in women who had hysterectomies for benign disease and have no h/o CIN

  • OK to stop screening after age 65 or 70 in women with 3 or more consecutive negative tests and no cervical abnormalities in prior decade

  • Annual screening should continue x 20y after occurrence of CIN 2-3 or cervical Ca

Fasting glucose

Type 2 Diabetes Mellitus

USPSTF: No recommendation; ACOG: Q3y starting age 45

AAFP  2007: Screen adults with HTN or dyslipidemias

ADA: No screening for type 2 DM; for type 2, screening with fasting glucose or 2h GTT if Q3y if:

  • > 45yo

  • Obese (> 120% ideal body weight or BMI of 27 or above)

  • 1st-degree relative with DM

  • High-risk ethnicity (African-American, Latino, Native American, Asian-American, Pacific Islander)

  • Have delivered a baby > 9lb or past h/o GDM

  • HTN

  • HDL < 35, TG > 250

  • h/o impaired glucose tolerance or impaired fasting glucose

Mammogram

Breast Cancer

USPSTF 2009: Q2y 50-74; AAFP: Q1-2y > 40yo; ACPM Q1-2y 50-69; consider also for > 69yo; ACS, ACR: Q1y > 40yo; NCI: Q1-2y 40+ (http://www.nih.gov/news/pr/mar97/nci-27b.htm); ACOG: Q1-2 40-49; Q1y 50+

 

Genetic testing for BRCA1 and BRCA2 mutations Breast Cancer USPSTF recomments screening for BRCA1 and BRCA2 mutations if:
  • Known family h/o harmful BRCA1 or BRCA2 mutations
  • A first-degree relative with bilateral breast Ca
  • A male relative with breast Ca
  • A history of breast Ca AND ovarian Ca in first or second-degree relatives (doesn't have to be in same person)
  • 2 first-degree relatives with breast Ca, one diagnosed at < 51yo
  • > 2 first-degree relatives with breast Ca
  • 2 first- or second-degree relatives with ovarian cancer

TSH

Hypothyroidism

Click on link to left for details

PSA

Prostate Cancer

ACP: "Individualize decision to screen" from 50yo+; USPSTF, ACPM, AAFP 2006: No recommendation to screen; ACS, AUA: Q1y 50+--consider from 45yo in African Americans

Fecal occult blood testing

Colorectal cancer

USPSTF, AAFP either FOBT or flex sig or both be done "periodically" after 50yo; ACS, AGA recc Hemoccults Q1y AND flex sig Q5y after 50yo; ACOG: Q1y starting age 50

Flexible sigmoidoscopy

Colorectal cancer

USPSTF, AAFP either FOBT or flex sig or both be done "periodically" after 50yo; ACS, AGA recc Hemoccults Q1y AND flex sig Q5y after 50yo; ACOG: Q3-5y starting age 50

DEXA of femoral neck Osteoporosis USPSTF, AAFP 2007: Screen women:
  • 60-64yo if at risk (e.g. body weight < 70kg, smoking, sedentary, family hx)
  • > 65 universally
  • No recommendation as to frequency of screening
North American Menopause Society, 2010:
  • 50-64yo if:
    •  History of postmenopausal fx (other than skull, face, ankle, or digit)
    • Weight < 127lb or BMI < 21 kg/m2
    • Parental history of hip fx
    • Rheumatoid arthritis
    • Current smoking
    • Current alcohol intake of more than 2 drinks/day
  • > 65 universally (total hip, femoral neck, lumbar spine; use lowest score to determine management)
Ultrasound of the Abdominal Aorta Abdominal Aortic Aneurysm USPSTF in 2005 recommended one-time screening by ultrasound for men 65-75yo who ever smoked, with periodic repeat ultrasound if 3cm or greater (e.g. Q2-3y if < 4cm or Q6-12mos if diameter is 4-5.4cm). (Ann. Int. Med. 142:198, 2005--JW)

AAFP 2007 recommends once for men 65-75yo who PlaceCehave ever smoked

Snellen Eye Chart Testing Visual disorders AAFP recommends "in elderly persons"
Hearing testing Age-related hearing loss USPSTF recomments screening elderly for hearing loss by periodically asking them about it, with ear exam and audiometry if they affirm hearing probCCanlems