| Alcohol and drug screening | Saitz recommends that the primary care clinician screen all patients for unhealthy alcohol use and drug use using basic screening questionnaires, e.g., the AUDIT-C for unhealthy alcohol use and the Substance Use Brief Screen for drug use.
Audit-C - How often do you have a drink containing alcohol?
- How many drinks containing alcohol do you have on a typical day when you are drinking?
- How often do you have six or more drinks on one occasion?
The answers are scored from 0 to 4, and the total score indicates the risk for problematic alcohol consumption. |
| Blood glucose, Diabetes | The USPSTF recommends screening that adults aged 40-70 who are overweight or obese should be screened for diabetes, and this screening should be part of a cardiovascular risk assessment. The American Diabetes Association (ADA) notes that many American adults who have diabetes are undiagnosed, and the ADA recommends screening adults for diabetes by assessing for risk factors (e.g., HTN, the presence of CKD) or with a risk assessment tool. Screening, detection, and implementation of lifestyle changes have been shown to significantly reduce the incidence of type 2 diabetes and the progression from pre-diabetes to type 2 diabetes. |
| Breast cancer | There are multiple recommendations for breast cancer screening, e.g., the American Cancer Society (ACS) recommendations, the American Society of Breast Surgeons (ASBS) recommendations. The recommendations involve identification of risk factors as part of the screening process, which methods to use and when, and when to start and stop screening. For example, the ASBS recommends an assessment of the risk of breast cancer in women > age 25, yearly mammograms for all women starting at age 40 and for women who have a higher than average risk for breast cancer, supplemental imaging should be offered. The ACS notes that breast cancer screening in women aged 40 to 69 has been associated with a decrease in deaths from breast cancer, and women who are at average risk should have screening mammography starting at age 45, and this should continue if the patient is likely to live 10 years or more. The USPSTF recommends that screening before age 50 should be done on a case-by-case basis, and women between 40-49 should consider the risks and benefits of screening.
Regarding breast self-exam or a physical examination of the breasts by a healthcare provider, the ACS states, “Research has not shown a clear benefit of regular physical breast exams done by either a health professional (clinical breast exams) or by women themselves (breast self-exams). There is very little evidence that these tests help find breast cancer early when women also get screening mammograms.” |
| BRCA mutation | BRCA1 and BRCA2 are genes that produce tumor suppressor proteins, and inherited BRCA1 and BRCA2 mutations are considered risk factors for breast cancer. The lifetime risk of breast cancer in women is approximately 12% but if these mutations are present, the lifetime risk is 69-72%.55 The USPSTF recommends that women who have a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations should be assessed with a familial risk assessment tool. |
| Cardiovascular risk assessment | Patients aged ≥20 years of age and older should have a cardiovascular risk assessment done every three years. This risk assessment can be done by using commonly available assessment tools: The Framingham risk score calculator or the American College of Cardiology/America Heart Association risk calculator. |
| Cervical cancer | The American College of Obstetricians and Gynecologists (ACOG) and the USPSTF recommend that screening for cervical cancer should begin at age 21; women < 21 should not be screened, regardless of when they became sexually active or the presence of other behavior-related risk factors Committee on Practice Bulletins—Gynecology, 2016. These women should be tested every 3 years with a cervical cytology test alone, and for women aged 30-65, contesting Cervical cytology and HPV testing should be done every 5 years, or they can have cervical cytology every 3 years Committee on Practice Bulletins—Gynecology, 2016. |
| Colorectal Cancer | THE ACS recommends that for people who have average risk, screening for colorectal cancer should begin at age 45, using a stool-based test or an invasive, visual test, e.g., colonoscopy. The stool-based test should be done every year or every 3 years (Stool DNA test), sigmoidoscopy and virtual colonoscopy every 5 years, and a colonoscopy every 10 years. Screening should continue if the patient is expected to live 10 years or more until age 75. From 76 to 85, the need for screening should be determined on a case-by-case basis, and after age 85, screening should not be done.
For people who have an above-average risk, (e.g., IBD, family history of colorectal cancer) screening may need to begin before 45 and be screened more often. |
| Depression | The USPSTF recommends screening for depression in the general population and in pregnant and postpartum women. The conclusions of the USPSTF were that screening improves detection and identification of depression; depression screening combined with treatment improves outcomes, and there is little to no risk from depression screening. The optimal timing and intervals for depression screening have not been established. The USPSTF did not recommend a specific screening tool, but it did mention that the various forms of the Patient Health Questionnaire (PHQ), the Hospital Anxiety and Depression Scales, the Edinburgh Postnatal Depression Scale, and the Geriatric Depression Scale are commonly used.
Pregnant and postpartum women who are at risk for perinatal depression should be referred for counseling. |
| Dyslipidemia | Sokol recommends that patients aged 17-21 be screened for hyperlipidemia. If the patient is high-risk and the initial screen is normal, men should be screened again starting at age 25 and women at age 35. If the initial screen was normal and the patient is not high-risk, rescreen again at age 35 for men and age 45 for women. |
| Hepatitis B | The CDC recommends screening for hepatitis B in the following populations: - All pregnant women
- People who were born in an area with an intermediate or high prevalence of hepatitis B
- People born in the United States to parents who are from an area with a high prevalence of hepatitis B
- Infants born to a mother who is hepatitis B surface antigen (HBsAg) positive
- Anyone who shares needles, has sex with, or lives with someone who is HBsAg positive
- Injection drug users
- Men who have sex with men
- Hemodialysis patients
- People who donate blood, plasma, organs, semen, or tissue
- People who have elevated liver enzymes of unknown etiology
- People who are on cytotoxic or immunosuppressive therapy.
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| Intimate partner violence | Approximately 36% of women and 33% of men in the United States have experienced intimate partner violence (IPV) at least once. There is evidence that screening for IPV can detect IPV and that screening, detection, and intervention can reduce the risk of IPV violence to women; there is inadequate evidence that screening and detection are preventive for men. Ther is no evidence that screening causes harm. Tools that can accurately screen women for IPV include the Humiliation, Afraid, Rape, Kick (HARK); Hurt, Insult, Threaten, Scream (HITS); Extended–Hurt, Insult, Threaten, Scream (E-HITS); Partner Violence Screen (PVS); and Woman Abuse Screening Tool (WAST). |
| Latent tuberculosis | The USPSTF recommends screening for latent TB in adult populations who are at risk for the disease. At-risk persons include: - Those who were born in an area, or formerly resided in an area, with a high prevalence of tuberculosis
- People who live in close proximity to others, e.g., residents of homeless shelters or people who are incarcerated
- People who are immunosuppressed
- Anyone who has contact with someone who has active tuberculosis.
Approximately 30% of people exposed to tuberculosis will develop latent TB, and as many of 10% of people who develop latent TB will develop the active disease or have a reactivation. Although there is no evidence that screening adults for latent TB provides a direct benefit, the screening tests (tuberculin skin tests and interferon-gamma release assays) are moderately sensitive and specific, and if the patient is positive, treatment of latent TB does decrease the risk of progression to the active disease. There does not appear to be a risk for harm for this screening. The optimal timing interval for latent tuberculosis screening has not been determined. |
| Osteoporosis< | The USPSTF recommends that post-menopausal women < 65 years of age who have an increased risk for osteoporosis be screened. Osteoporosis is very common, women are especially susceptible, and screening in this population has been shown to provide a moderate benefit. |
| Pregnancy | All pregnant women should be screened for chlamydia, hepatitis B, HIV, and syphilis. In addition, a standard panel of tests should be done, including (but not limited to) a complete blood count, documentation of immunity to rubella and varicella, urine protein, and ABO and Rh type and antibody screen should be done.
All pregnant women should be screened for gestational diabetes. The ADA recommends the one-step technique: A 75-gram oral glucose tolerance test done at 24 to 28 weeks gestation. |
| Prostate cancer | The USPSTF recommends that the risks and benefits of prostate-specific antigen (PSA) testing should be discussed with men aged 55 to 69. Prostate cancer is very common in older men, and screening can detect prostate cancer, but there is no evidence that it reduces all-cause mortality, and screening can result in unnecessary treatment, overtreatment, and complications and harm from treatment. |
| Sexually transmitted diseases | The CDC recommendations for screening for sexually transmitted diseases (STDs) are:
Chlamydia- Sexually active women < 25 years of age
- Sexually active women ≥ 25 years of age if they have risk factors
- Men should be tested if they are in a high prevalence area for chlamydia or if they are men who have sex with men
- People infected with HIV should be screened at the time of diagnosis and at least once a year after that. More frequent screening should be considered if the patient has risk factors for chlamydia
Gonorrhea- Sexually active women < 25 years of age
- Sexually active women ≥ 25 years of age if they have risk factors
- Men who have sex with men should be tested at least once a year at the sites of contact, e.g., rectum, urethra, even if condoms have been used
- People infected with HIV should be screened at the time of diagnosis and at least once a year after that. More frequent screening should be considered if the patient has risk factors for chlamydia
Herpes- Serologic testing should be considered for women and men who have an STD, are presenting for evaluation of an STD, and especially for women who have multiple sex partners
- For men who have sex with men, serologic testing should be considered if the patient’s herpes infection status is not known and the patient has had a previously undiagnosed genital tract infection and/or if the patient is at increased risk for being infected with HIV
- Serologic testing should be considered if the patient is infected with HIV
Syphilis- Men who have sex with men should be tested at least once a year and should be tested every 3 to 6 months of they are at high risk
- People infected with HIV should be screened at the time of diagnosis and at least once a year after that. More frequent screening should be considered if the patient has risk factors for syphilis infection
Trichomonas- Screening should be considered if the patient has a high risk for infection or she is receiving care in a high prevalence setting like an STD clinic or a correctional facility
- Women who are infected with HIV and are sexually active should be tested at the time of entry to care and at after that, at least once a year
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| Skin cancer | Adults who have fair skin should be counseled about minimizing exposure to ultraviolet radiation to reduce the risk of skin cancer. |
| Smoking | The USPSTF recommends that clinicians determine their patients’ pattern of tobacco use, advise them to stop smoking, and offer behavioral interventions and FDA-approved smoking cessation pharmacotherapy. |
| Statins and prevention of CVD disease | The USPSTF recommends that adults aged 40-75 years of age who do not have a history of cardiovascular disease (CVD) but have 1 or more risk factors for CVD like dyslipidemia, diabetes, HTN, obesity, or smoking or have a calculated 10-year risk of developing CVD that is ≥ 10% should be prescribed a statin drug. Patients who have < 10% risk may be considered for statin therapy; the decision to do so should be made on a case-by-case basis. Evidence has shown that statin therapy provides what has been described as a moderate level of reduction in CVD events and mortality, and the harm of this therapy is small. The ACC/AHA Pooled Cohort Equations can be used to calculate 10-year risk. |
| Immunizations | The adult immunization schedule recommended by the CDC can be viewed here. |
