AIM Clinic- Chart Summary of USPSTF Recommendations Senior Team QI Project- A Garan, L Gedmintas, M Hamm

Age
18 20		Cervical Cancer 3 years after sexually active or				Diabetes High risk <45 years BMI>25, HTN, HDL<35 or TG>250, sedentary, FH of DM, AA, Latino, Asian American, h/o gestational DM			For All Patients HTN BP > 140/90 on 2 readings at least 1 week apart Obesity BMI >30, lifestyle modification Healthy Diet For pts with CV risk factors, high chol, diet related chronic disease: low sat fat, high fruit/veg and fiber Tobacco Amount of use, type of use. Behavioral counseling, pharmacotherapy Alcohol CAGE: cut down, angry/annoyed, guilty, eye-opener Depression Depressed mood, loss of interest/pleasure, change in sleep, appetite, weight, psychomotor, loss of energy or concentration, thoughts of worthlessness, guilt, death, or suicide HIV NYC is a high prevalence area, screen all patients Domestic Violence SAFE: Stress/safety Afraid/abused Friends/family Emergency plan Seatbelts Bike Helmets Drunk Driving STD counseling	For High Risk Patients ASA for primary prevention (2009) 75-100mg daily Male 45-79 (CV prev) F 55-79 (CVAprev) “if benefit outweighs risk” Pt >80 “I” depends on risk profile PPD recent TB infection, HIV, IVDU, silicosis, prior TB on CXR, underweight, DM, CRI/HD, gastrectomy, jejunoileal bypass, renal/cardiac transplant, head and neck Ca GC/Chlamydia Women <25 years old or high risk sexual behavior Syphillis MSM, high risk sexual behavior, commercial sex workers, h/o correctional facilities Hep B screen pregnant women; pts born outside of US Rubella Screen women of childbearing age: hx of vaccination or serology
				Lipids High risk >20 years DM, CAD or PAD, early family CV disease, tobacco, HTN, BMI >30
21		Women >21 years Pap at least every 3 years. Can extend screening interval if 3 normal paps or negative HPV testing. If TAH, no need for Pap unless TAH due to malignancy, in that case pt should continue with GYN surveillance f/u.
35				Men >35 years
40	Breast Cancer Women 50-74 years q 2yrs (B) USPSTF2009 Screening >75 (I) CBE >40 (I) Self Exam (D) High Risk or pt preference: >40 yrs old(C) For High Risk consider: BRAC 1,2 testing if first degree relatives with breast or ovarian CA, or men with breast CA in family, also consider medical or surgical prophylaxis
			Colorectal Cancer (Earlier if HNPCC, familial polyposis, UC, early family history of colon CA)
45				High risk Women >45 years Test total Cholesterol and HDL (calculated LDL) every 3-5 years		If HTN, high cholesterol >45 years Fasting blood glucose > 126, Glucose tolerance test >200 after 2 hours		Prostate Cancer USPSTF:found insufficient evidence to assess risk/benefit of screening. Pt should be informed about the test, risk/benefit, Consider family hx, race, sx, and pt preference. If pt interested, yearly with PSA and DRE begin at age 50 (40-45 for those at higher risk). No screening recommended after age 75 or if life exp. <10yrs
50			Women, Men > 50 years Colonoscopy every 10 years or Sigmoidoscopy every 5 years or ANNUAL FOBTx3
60							Osteoporosis High risk > 60 years low BMI, white or Asian, h/o fracture, FH of osteoporotic fracture, falls, sedentary, smoking, excessive etoh or caffeine use, low Ca or vit D intake
65		If history of normal Paps, STOP screening at 65			AAA Men >65 yr past/present smokers Abd US, if >5.5cm, surgery		Women > 65 years DEXA scan- interval determined clinically. See fracture calculator on medicineclinic.org
75			If hx of nl testing, consider stopping screening at 75, can stop for all at 85
85