Primary Prevention (Prevention of Disease/Injury)
Individual actions (healthy individuals): Eat a nutritious diet, exercise, use seatbelts and helmets
Gun safety: Use safety locks for guns; keep guns out of reach of children/teens National programs: Federal health-promotion/disease-prevention programs include
immunizations, the Occupational Safety and Health Administration (OSHA)’s job safety laws, and Environmental Protection Agency (EPA) laws.
Programs promote a healthy lifestyle for youth (healthy diet, exercise, etc.) Building a youth center in an urban high-crime area or a Habitat for Humanity
(shelter).
Aspirin prophylaxis for primary prevention of CVD and colon cancer in adults aged 50 to 59 years who have a 10% risk or higher.
Secondary Prevention (Early Detection of a Disease to Minimize Bodily Damage)
Screening tests (Pap smears, mammograms, CBC for anemia, etc.)
Screening for depression (interviewing a patient about feelings of sadness, hopelessness) Screening for sexually transmitted infections (STIs; asking about sexual history,
partners, signs and symptoms)
Screening for alcohol abuse (interviewing a patient using the CAGE questionnaire) Testing for hepatitis C virus infection in a person with risk factors
Having a person with a history of MI, TIA, or stroke take an aspirin or statin daily (to prevent a future stroke or MI)
Tertiary Prevention (Prevention of Disease Progression,
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Rehabilitation, Support Groups, Education on Equipment)
Support groups: Alcoholics Anonymous (AA), breast cancer support groups, HIV support groups
Education for patients with preexisting disease (i.e., diabetes, hypertension): Avoidance of drug interactions, proper use of wheelchair or medical equipment, others
Rehabilitation: Cardiac rehabilitation, physical therapy (PT), occupational therapy (OT)
Treatment of a person with hepatitis C virus infection
Treatment of a person who has already had a heart attack with daily aspirin (to prevent another heart attack)
U.S. PREVENTIVE SERVICES TASK FORCE
Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer (April 2016)
Age 50 to 59 years with equal or more than 10% risk (10-year cardiovascular disease risk)
Initiate low-dose aspirin use for primary prevention of cardiovascular and colorectal cancer (in patients who are not at increased risk for bleeding) with life expectancy of at least 10 years and who are willing to take low-dose aspirin daily for at least 10 years)
Breast Cancer (January 2016)
Baseline mammogram: Start at age 50 years and repeat every 2 years until the age of 74 years
Age 75 years or older: Insufficient evidence for routine mammogram
Does not apply to women with known genetic mutations (BRCA1 or BRCA2), familial breast cancer, history chest radiation at a young age or previously diagnosed with high- risk breast lesion who may benefit from starting screening in their 40s
Note *
Age 40 to 49 years (individualize based on risk factors, if done). The American Cancer Society recommends starting routine screening at age 40 years.
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*U.S. Preventive Services Task Force (USPSTF) Recommendation Statement (January 2016).
Cervical Cancer (Table 4.1)
Table 4.1 Cervical Cancer Screening
Age Group Recommendations for Pap/Liquid Cytology
Age 20 years or younger Do not screen (even if sexually active with multiple partners).
Cervical cancer is rare before age 21 years.
Age 21 to 65 years Baseline at age 21 years. Screen every 3 years.
Age 30 to 65 years Another option starting at age 30 years is to screen with combination of cytology plus human papillomavirus (HPV) testing every 5 years.
Had hysterectomy with removal of cervix If hysterectomy with cervical removal was not due to cervical intraepithelial neoplasia (CIN grade 2) or cervical cancer, then can stop screening.
Women older than 65 years who had adequate prior screening
Do not screen if history of adequate prior screening and is otherwise not at high risk for cervical cancer.
Source: USPSTF (2012).
Notes *
These recommendations do not apply to women who are immunocompromised (i.e., HIV infection), had in utero exposure to diethylstilbestrol (DES), or have a diagnosis of high-grade precancerous cervical lesion or cervical cancer.
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*USPSTF Screening Recommendations for Cervical Cancer (July 2015).
Colorectal Cancer (June 2016)
Baseline: Starting at age 50 years until the age of 75 (older age is the most common risk factor)
Age 76 to 85 years: Against routine screening but “there may be considerations”;
individualize screening as needed
Older than age 85 years: Screening for colorectal cancer bot recommended
Notes
These three methods are all acceptable for colorectal cancer. The screening intervals of each method differ:
High-sensitivity fecal occult blood test (gFOBT) for three consecutive stool samples annually (high-sensitivity version such as Hemoccult SENSA superior to older Hemoccult II test)
Flexible sigmoidoscopy or CT colonography every 5 years Colonoscopy every 10 years
Lipid Disorders
Total lipid profile after a 9-hour (minimum) fast
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The USPSTF recommends the use of low- to moderate-dose statin when all of the following criteria area met:
• Aged 40 to 74 years
• The patient has one or more CVD risk factors (i.e., dyslipidemia, DM, hypertension, smoking)
• The patient has a calculated 10-year risk of a cardiovascular event of 10% or greater
• Age 76 years and older without history of heart attack or stroke (insufficient evidence)
Lung Cancer (June 2013)
Screening for persons who smoke (30 pack-years) or have quit in the past 15 years Age 55 to 80 years: Annual screening with low-dose CT (LDCT)
Discontinue screening once 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
Prostate Cancer (May 2012)
This topic is being updated in 2016. The USPSTF recommends against prostate- specific antigen (PSA) screening for prostate cancer. The recommendation “applies to men in the general U.S. population, regardless of age.”
Grade D: The benefits of PSA-based screening for prostate cancer do not outweigh the disadvantages.
Ovarian Cancer (September 2012)
Grade D: Routine screening is not recommended.
Very high-risk women with BRCA1/BRCA2 mutations: Refer to specialists. If ovarian cancer screening is done, transvaginal ultrasound with serum cancer antigen (CA-125) is ordered. The screening starts at age 30 years (or 5–10 years before earliest age of first diagnosis of ovarian cancer in family).
• Some experts recommend bilateral salpingo-oophorectomy (BSO) between age 35 to 40 years (after childbearing is complete). BSO has a significant effect in reducing ovarian cancer risk in at-risk women.
High-risk women: Refer for genetic counseling. Look for family history of having two or more first- to second-degree relatives with a history of ovarian cancer or a
combination of ovarian cancer; women of Ashkenazi Jewish ethnicity with first-degree relative (or second-degree relatives on the same side of the family) with breast or ovarian cancer.
Skin Cancer Counseling
Recommended for children, adolescents, and young adults (ages 10–24 years) with fair skin
Education includes avoidance of sunlight from 10 a.m. to 4 p.m., use of SPF 15 or
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higher sunblock, protective clothing, wide-brim hats
Other
Routine screening is not recommended by the USPSTF for the following conditions:
Ovarian cancer Oral cancer Prostate cancer
Testicular cancer (adolescents or adult males; Table 4.2)
Table 4.2 USPSTF Health Screening Recommendations
Baseline Notes
Abdominal aortic aneurysm (AAA;
June 2014)
Men at age 65 to 75 years who have smoked
One-time screening with ultrasonography in men ages 65 to 75 years who have smoked; individualize for men who never smoked
Breast cancer (January 2016) Start at age 50 years Mammogram every 2 years (biennial) until age 74 years Age 75 years or older* Stop routine screening.
Individualize*
Breast self-exam (BSE) Against teaching BSE (Grade D recommendation)
Blood pressure in adults (hypertension;
October 2015)
Start at age 18 years or older Recommends obtaining measurements outside of clinical setting for diagnostic confirmation before starting treatment
Colon/colorectal cancer (June 2016) Start at age 50 years continue until age 75 years
High-sensitivity fetal occult blood test (FOBT; every year), or sigmoidoscopy (every 5 years), or colonoscopy (every 10 years)
Age 76 to 85 years Individualize*
Age older than 85 years Stop routine screening
Depression Adolescents (12–18 years) Start screening for major
depressive disorder starting at age 12 to 18 years
Depression (adults; January 2016) General adult population Include pregnant and
postpartum women; use Beck Depression Inventory Diabetes mellitus (DM) type 2
(October 2015)
Age 40 to 70 years if overweight or obese
Applies to adults in primary care settings who are not “high risk”; DM patients with risk factors (certain ethnicities, PCOS, GDM, etc.) can undergo screening at younger age
105 Latent tuberculosis (September 2016) Asymptomatic adults Screen asymptomatic adults who
are at increased risk for infection
Lung cancer (December 2013) Aged 55 to 80 years with history of smoking
Low-dose computed tomography (LDCT) if currently smokes with 30-pack-year history or quit in the previous 15 years
Obesity Start at age 6 to 18 years Offer or refer for intensive
behavioral interventions Sexually transmitted infections (STIs;
September 2014)
Start at the onset of sexual activity High-intensity behavioral counseling for sexually active adolescents and adults who are at high risk for STIs
Skin cancer(July 2016) Insufficient evidence Routine screening is not recommended; individualize recommendation
Osteoporosis (being updated) Start at age 65 years or older May start earlier if a younger woman has a fracture risk equal or greater than that of a 65-year-old White woman (i.e., chronic steroids) Ovarian cancer (September 2012) Against routine screening Do not screen for ovarian cancer
except high risk (as of September 2016) Pancreatic cancer (February 2014) Against routine screening
*Decision to screen is based on risk factors, life expectancy (>10 years), risk versus benefits.
FOBT, fecal occult blood test; GDM, gestational diabetes mellitus; PCOS, polycystic ovary syndrome.