Recommended Preventive Screening 2011 updated 9/14/11 M Hamm (original QI Project Team Garan, Hamm, Gedmintas)

Age
21		Cervical Cancer 3 years after sexually active or>21		Lipids High risk >20 years DM, CAD or PAD, earlyfamily CV disease, tobacco, HTN, BMI >30		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 DOVE 59060 Seatbelts Bike Helmets Drunk Driving STD counseling	For High Risk Patients 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/ChlamydiaWomen <25 years old or high risk sexual behavior Syphillis MSM, high risk sexual behavior, commercial sex workers, h/o correctional facilities Hep B screenpregnant women Rubella Screenwomen of childbearing age:hx of vaccination or serology ASA for primary prevention of CV events for patients with 10 year CHD risk >6%: 75 mg ASA daily
		21-30yo q2yrs if normal 31-65yo q3yrif 3 normal paps and negative HPV testing. If TAH, no need for Pap unless TAH for invasive cervical Ca or DES
35				Men>35 years
40	Breast Cancer mammography > 40 years if high risk or per pt preference							Prostate Cancer 40-45 for high risk
			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		USPSTF: insufficient evidence to assess risks,benefits of prostate cancer screening.Discus risk/benefit, family hx, race, sx, and pt preference. Yearly with PSA and DRE begin at age 50 No screening recommended after age 75 or if life exp. <10yrs
50	> 50 years old mammoq2 yrs USPSTF evidence insufficient for clinical breast exams if mammo is available Evidence against self breast exam High Risk women: 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		Women, Men > 50 years Colonoscopy every 10 years or Sigmoidoscopy every 5 years or ANNUAL FOBT
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, can stop screening at 65			AAA Men >65 yr past/present smokers Abd US, if >5.5cm, surgery		Women avg risk > 65 years DEXA scan- interval determined clinically. See FRAX calculator to risk stratify
75	No evidence for mammo after age 75		If history of normal testing, STOP screening at 75, stop for all at 85
85