Adult Preventive Health Screening Guidelines



These guidelines for adult health screening and preventive services are derived from the most recent United States Preventive Services Task Force (USPSTF) and other nationally recognized standards of practice from organizations such as: American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG), American Cancer Society (ACS), and American College of Physicians (ACP), and others. Age, sex and risk factor specific USPSTF recommendations can be found using the ePSS app found on the USPSTF website.Required interventions are italicized and considered to be an integral component of primary care, and consequently, the compliance of each PCP in performing these services is audited by Partnership HealthPlan of California HC (during the Facility Site Review[FSR]), at least every 3 years). *The U.S. Preventive Services Task Force (USPSTF) recommends clinicians discuss these preventive services with eligible patients and offer them as a priority. All these Services have received an “A” (strongly recommended) or a “B” (recommended) grade from the Task ForcePREVENTIVE CAREFREQUENCY/DETAILSAspirin for the Primary Prevention ofCardiovascular Events*The USPSTF (April 2016 guidelines) recommends the use of aspirin for men and women from age 50 to 70 years who have a 10% or greater 10-year CVD risk, are not at risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose daily aspirin for at least 10 years. Class B for ages 50 to 59, Class C for ages 60 to 69. However, a meta-analysis in the Jan 22, 2019 issue of JAMA concluded that there was no net benefit for use of aspirin for primary prevention of cardiovascular disease.Cardiovascular risk can be calculated by the heart risk calculator found at or the ASCVD Risk Calculator Plus for mobile devices. Assessment for Hearing ImpairmentAge 65+ at the time of the periodic health examination.High Blood Pressure ScreeningInitial entry into PCP practice, then at least every 2 years.Colorectal Cancer Screening*Starting at age 50: Fecal occult blood test (FOBT) or Fecal Immunochemical Test (FIT) annually, OR Colonoscopy every 10 years, OR Flexible Sigmoidoscopy every 5 years OR FIT-DNA test every 3 years (See USPSTF for other variations).The USPSTF recommends against routine screening for colorectal cancer in adults age 76 to 85 years. There may be considerations that support colorectal cancer screening in an individual patient.The USPSTF recommends against screening for colorectal cancer in adults older than age 85 years.Height & WeightInitial entry into PCP practice.Age 18 - 64: weight at least every 2 years.Age 65+: weight annually.HIV Screening*USPSTF recommends testing each adolescent and adult ages 15 to 65 without risk factors once in their lifetime. In addition, all adolescents and adults at increased risk for HIV should be tested every year. Pregnant women should be tested with each pregnancy. Hepatitis C*The USPSTF recommends a 1 time screening for adults aged 18-79.Lung Cancer Screening* The USPSTF (in 2014) recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 pack-year smoking history and IN ADDITION currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem thatsubstantially limits life expectancy or the ability or willingness to have curative lung surgerySyphilis Infection, Screening*Screen persons at increased risk for syphilis. At highest risk are men who have sex with men and persons living with HIV. Other risk factors are: history of incarceration, history of commercial sex work, male younger than 29 years old, and (in our PHC region), current homelessness and current use methamphetamines.Screen all pregnant women for syphilis infection.TB ScreeningIf risk factors for continued exposure to TB, or risk of progression of TB if exposed, then TB screening should be done every 2 years. Risk factors for exposure include (Highest priorities from CDPH in bold):Current close contact of known or suspected TBHomeless in the last two yearsInjects IV drugs in last two yearsResident or employee of nursing home, community clinic, adult day services, hospital, homeless shelter, correctional facility.US resident traveling to high risk country for at least 3 months.Emigrated from high risk countries.HIV positiveDrug abuse, alcohol abuseRisk factors for HIV (including use of injection drugs)If risk factors for TB progression, AND born in USA AND no continued risk of TB exposure: one time test. If risk of progression AND born outside USA, test every 2 years. Risk factors for TB progression are:Patient on immunosuppressive therapy (equivalent of >15mg prednisone/day for 1 month)Patient with chronic medical conditions that suppress immune system: diabetes, renal insufficiency, cirrhosis/hepatic disease, rheumatologic conditions, cancerHistory of silicosis, gastrectomy or jejunoileal bypassCurrent tobacco smokerGlaucoma ScreeningAAFP and USPSTF find insufficient evidence for or against. Medicare recommends screening for those in these high risk categories: 1. Persons with diabetes, 2. Family history of glaucoma, 3. African American and aged 50 or older, or 4. Hispanic and age 65 or older.Screening for Hyperlipidemia (needed for full cardiovascular risk factor evaluation)The USPSTF recommendations covering lipid screening have been archived. UpToDate? recommends obtaining a fasting or non-fasting lipid profile when an adult enters care at a new practice to screen for familial hypercholesterolemia and for cardiovascular risk assessment, with rescreening as part of a cardiovascular risk analysis every 5 years. Earlier re-screening may be indicated depending on patient-specific factors.Lipid Lowering Therapy* Lipid Lowering Agents should be considered for adults aged 40 to 75 years with 1 or more CVD risk factors (ie, dyslipidemia, diabetes, hypertension or smoking), AND a 10-year cardiovascular risk of >10% (Class B) or 7.5% to 10% (Class C). VaccinationBased on age and risk factors. For updated schedule, reference the CDC guidelines. Mellitus in Adults, Screening for Type2 and PrediabetesScreening for diabetes (several options available) every 3 years indicated for Adults over age 45 without risk factors.Adults under age 45 with BMI >25 plus one other risk factor. Risk factors include: low physical activity, history of gestational diabetes, high risk ethnicity (Hispanic, Native American, Pacific Islander or African American), fasting triglycerides above 250mg/dl, HDL cholesterol <35mg/dl, obesity, acanthosis nigricans, hypertension, polycystic ovary syndrome, family history of DM. (Standards of the American Diabetes Association)Dental disease and referral to dental providerInitial entry into PCP practice, then yearly or as indicated by the PCP and/or dental care provider.BEHAVIORAL CONDITIONSAlcohol Misuse and Behavioral counseling Interventions*Screen all adults annually; if present, offer behavioral interventions to reduce alcohol misuse. (USPSTF Class B)Diet, Behavioral Counseling in Primary Care to Promote a Healthy Lifestyle*The USPSTF recommends offering or referring adults who are overweight or obese and have additional CVD risk factors to intensive behavioral/counseling interventions to promote a healthful diet and physical activity for CVD prevention. Individuals with a diagnosis of prediabetes should be referred to participate in a Diabetes Prevention Program, if available.Depression *The USPSTF recommends screening for depression in the general adult population, including pregnant women and post-partum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow up. There is little evidence regarding optimal timing for screening. The USPSTF also recommends that pregnant women at risk of depression should be referred for counselling even if not currently depressed. Risk factors include low socio-economic status, so all pregnant PHC members should be referred for at least one counselling session. The California Perinatal Services Program (CPSP) includes provision of counseling services. If a CPSP program is available, all PHC members should be referred to a CPSP program, for counselling and other services.Obesity*The USPSTF recommends screening all adults for obesity. Clinicians should offer or refer patients with a BMI of 30 or greater to intensive, multicomponent behavioral interventions. Tobacco Use and Tobacco Caused Disease Counseling to Prevent*For all adults who are not pregnant, the USPSTF recommends that clinicians ask them about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and USDA (FDA) approved pharmacotherapy for cessation. For all pregnant women, the USPSTF recommends that clinicians ask them about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant women who use tobacco. Unintended pregnancyScreen all reproductive aged women at risk for unintended pregnancy (and males who may cause unintended pregnancy); offer counseling and access to contraceptives, including emergency contraception.Recommended screening question: “modified one key question”:“Do you, or any of your sensual or sexual partners, want to become pregnant in the coming year.”FOR MEN ONLYAbdominal Aortic Aneurysm Screening* One time screening by ultrasound in men 65-75 who have smoked 100+ cigarettes in their lifetime.Prostate Cancer screening (Prostate Specific Antigen blood test*)Asymptomatic average risk men aged 55 to 69 years should have shared decision making with their clinician about the pros and cons of screening (Class C draft recommendation of USPSTF)High risk men under age 55 should have shared decision making. Risk can be estimated at: (for unknown PSA) (once PSA is known) Men aged 70 years and older should not be screened. However, men with prostate symptoms may have a PSA as part of their diagnostic evaluationFOR WOMEN ONLYScreening for Intimate Partner Violence*All women of childbearing age (USPSTF Class B), when a routine health maintenance exam is performed (consensus).Breast Cancer Screening by Mammography*The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. Women age 40 to 49 should be counseled on risks and benefits of mammography; mammography is covered if woman chooses.Breast cancer , Chemoprevention*Discuss with women at high risk for breast cancer and at low risk for adverse effects of chemoprevention (USPSTF Class B). Clinicians should inform patients of the potential benefits and harms of chemoprevention which includes medications such as tamoxifen or raloxifene.A breast cancer risk assessment tool is available at bcrisktool Breast and Ovarian Cancer Susceptibility, genetic risk Assessment and BRCA Mutation Testing*Recommended for women at high risk. See policy on Genetic Testing (MCUP3131) for details.Breastfeeding, Behavioral Interventions to Promote*The USPSTF recommends interventions during pregnancy and after birth to promote and support breastfeeding.Cervical Cancer Screening*Women aged 21-29 should have cytology screening every 3 years. Women aged 30-65 may have cytology screening every 3 years or may have high-risk HPV testing every 5 years Women under age 21 should not be screened. Women over age 65 should only be screened if they have never been screened previously, or if one of their last 3 screenings had any type of cervical atypia.Routine cervical cytology testing should be discontinued in women (regardless of age) who have had a total hysterectomy (removal of the cervix along with the uterus) for noncancerous reasons, as long as they have no history of high-grade CIN.Chlamydia Screening*Gonorrhea Screening*Annual screening recommended for: Sexually active women 24 and younger and other asymptomatic women at increased risk for infection. Osteoporosis in Postmenopausal Women, ScreeningScreen with bone measurement testing every 2 years:65+ years old. 55-64 years old if at risk for osteoporotic fractures, as determined by osteoporosis risk calculator. such as the FRAX tool, found at: Osteoporosis in Postmenopausal Women, PreventionThe Food and Nutrition Board of the Institute of Medicine recommends a minimum Calcium intake of 1000 to 1200mg/day and a minimum Vitamin D intake of 600 IU/day, primarily from dietary sources. The USPSTF finds inconclusive evidence that the benefits outweigh the risks for Calcium or vitamin D supplements used to prevent fractures.Resources: United States Preventive Services-Task Force recommendations, American Academy of Family Physicians (AAFP), American College of Obstetricians & Gynecologists (ACOG), American College of Physicians (ACP), Food and Nutrition Board of the Institute of Medicine, The American Diabetes AssociationDistribution: Provider Manual, Department HeadsLast Revision Date: April 2020 ................
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