05-24-2006, 08:25 PM
SCREENING RECOMMENDATIONS:
Cholesterol:
All men aged 35 and older and all women aged 45 and older should be screened routinely for lipid disorders.
Younger adults”men aged 20-35 and women aged 20-45”should be screened if they have other risk factors for heart disease. These risk factors include tobacco use, diabetes, a family history of premature heart disease (<50 yrs in men, <60 yrs in women) or high cholesterol, or high blood pressure.
Clinicians should measure HDL in addition to measuring total cholesterol or LDL. There is insufficient evidence to recommend for or against measuring triglycerides.
The optimal frequency of screening has not yet been determined, but every five years seems reasonable. Longer intervals may be appropriate in persons with normal cholesterol and no risk factors for CAD.
Children > 2 yrs age:
If a family member has a total cholesterol > 240, order random cholesterol
If the measured random cholesterol < 170, repeat in 5 yrs: if >200, order fasting lipid profile.
If a family member has a H/O premature CAD, order FLP directly.
Hypertension:
Screening of all adults is recommended at least every two years. Hypertension currently is defined as blood pressure >140/90, though this is more an arbitrary cutoff level than a biological one. In fact, cardiovascular mortality begins to increase at systolic pressures >110 mm Hg, and diastolic pressures > 70 mm Hg.
Hypertension should be diagnosed using an average of more than one reading taken at each of three separate visits. Once confirmed:
Patients should be counseled concerning physical activity, dietary sodium intake, weight loss, and alcohol intake.
Risk factors for CAD such as elevated cholesterol and smoking should be assessed.
Decisions on beginning drug therapy should be based on the level of blood pressure elevation, patient's age, concomitant disease, risk factors, and evidence of target-organ damage.
All patients should be counseled concerning physical activity and weight control as primary prevention of hypertension.
Aged 18 years - Normal: recheck in 2 years
Prehypertension: recheck in 1 year (SBP > 130 or DBP > 85)
Breast Cancer:
Screening women 50 to 75 years of age with mammography significantly decreases the death rate from breast cancer. There is some controversy surrounding the screening of women between the ages of 40 and 49 because early studies showed no improvement in survival rates. However, several studies now show a significant reduction in mortality rates in women in this age group who receive mammograms.
There is not enough evidence to prove the effectiveness of clinical breast exams (CBE), but most groups recommend annual CBE beginning at age 40.
There is no evidence of benefit in screening women over the age of 75, but each case should be considered on an individual basis.
There is insufficient evidence to recommend for or against teaching breast self-examination.
Women aged 20“39 years - CBE every 3 years.
Women aged 40 years - Mammography and CBE yearly.
Colorectal Cancer:
Screening for colorectal cancer is recommended for all persons aged 50 and older with fecal occult blood testing (FOBT) and/or flexible sigmoidoscopy.
There is not enough evidence to determine whether FOBT or sigmoidoscopy is the more effective screening tool, or whether there is an advantage in combining the two methods.
FOBT should be done on an annual basis, with the patient following the recommended guidelines for dietary restrictions, collection, and storage.
The optimal frequency of performing flexible sigmoidoscopy is not known, but most experts recommend screening every three to five years.
High-risk patients (i.e., familial polyposis, HNPCC, ulcerative colitis, adenomatous polyps, or colon cancer) should have earlier and more frequent screening.
Digital rectal examination (DRE) has poor sensitivity and specificity as a screening test, and although it is recommended by a number of organizations the USPSTF found insufficient evidence to recommend for or against DRE as a screening tool for colorectal cancer.
- Colonoscopy is the preferred method of screening for colon cancer.
- Average-risk persons should undergo colonoscopy at age 50, and if normal, every 10 years. If a polyp is found, the colonoscopy should be repeated after 3 years.
- When there is a family history of colon cancer, screening should begin at age 40 or ten years prior to the age of the family member. The earlier date is respected. Follow-up examinations for persons with family histories of colon cancer should occur at 5-year intervals. (First-degree relative with colon cancer or adenomatous polyps at age < 60 years, or 2 first-degree relatives with colorectal cancer at any time.)
- First-degree relative with colorectal cancer or adenomatous polyps at age 60 years, or 2 second-degree relatives with colorectal cancer - Follow average risk recommendations, but begin at age 40 years.
- 1 second-degree or third-degree relative with colorectal cancer - Follow average risk recommendations
- When there are multiple family members, screening colonoscopy should be performed at age 25 and every 1 to 2 years (characteristic of persons with hereditary nonpolyposis colorectal cancer (Lynch syndrome).
- Colonoscopy is recommended 1 year after a hemicolectomy for colon cancer to verify the absence of recurrence and the presence of new lesions.
- African American aged 45 years - Screen with colonoscopy as first-line method.
- Colonoscopies are recommended every 1-2 years in patients with extensive UC and Crohn™s colitis beginning 8-10 yrs after diagnosis.
Cervical Cancer:
- Regular Pap smear screening is recommended every year in all women with a cervix at 18 (21) years of age or within 3 years after first sexual intercourse.
- Annual Pap smear until age 30. At age 30, if 3 consecutive normal results, may screen every 2“3 years. Continue to screen annually if risk factors present.
- Women with Hx cervical cancer, DES exposure, HIV infection, or weakened immune system should continue to have annual screening as long as in good health.
- Patients on tamoxifen should undergo annual gynaecological exam with complete history and Pap smear.
- Patients who underwent treatment for biopsy-confirmed CIN II/III should be screened using a cytological test with or without colposcopy every 4 to 6 months. After 3 consecutive negative results, they should be screened annually using a cytologic test.
- There is no evidence that screening annually leads to a better outcome than screening every three years, but screening schedules for individual patients should be determined with consideration of that patient's risk factors for cervical cancer.
Pap smears probably can be discontinued after age 65 if the patient has received regular screening prior to that time and if all of the patient's smears have been normal.
- Screening after hysterectomy is not necessary unless cancer was the reason for the surgery.
Chlamydial infection:
- Routine screening should be done for chlamydial infection in all women aged 25 yrs and younger and in other asymptomatic women at increased risk for this infection.
- High risk- New male sex partners or 2 or more partners during preceding year, inconsistent use of barrier methods, history of prior STD, African-American race, cervical ectopy.
Prostate Cancer:
The USPSTF recommends against routine screening for prostate cancer with DRE, prostate specific antigen (PSA), or transrectal ultrasound. The ACS and the American Urological Association recommend annual DRE beginning at age 40, and PSA measurement beginning at age 50 (age 40 for African American men), but there is no evidence that screening for prostate cancer results in reduced morbidity or mortality.
The prevalence of prostate cancer found incidentally at autopsy in men ages 70 to 79 is reported to be as high as 66%, and although millions of men will have prostate cancer when they die, only a small percentage will die from their cancer. There currently is no good screening method to distinguish between aggressive and indolent cancers, and screening can in fact expose patients to potential complications of treatment such as incontinence, impotence, and even death.
If screening is to be performed, the patient should be informed of the potential benefits and risks of screening.
If screening is performed, the best approach is DRE and PSA in men > 50yrs of age with a life expectancy of >ten years.
Anemia:
Screen high-risk children for anemia between 9 and 12 months, 6 months later, and annually from 2 to 5 years.
Screen all non-pregnant women beginning in adolescence every 5“10 years until menopause.
Screen all women with hemoglobin or hematocrit at first prenatal visit.
High risk children - Includes infants living in poverty, blacks, Native Americans and Alaska Natives, immigrants from developing countries, preterm and low birthweight infants, and infants whose principal dietary intake is unfortified cow's milk.
Endometrial cancer:
All women at high risk for endometrial cancer - Annual screening at age 35 years with endometrial biopsy.
High-risk women are those known to carry hereditary nonpolyposis colorectal cancer“associated genetic mutations, or at high risk to carry mutation, or who are from families with suspected autosomal dominant predisposition to colon cancer.
Liver Cancer:
Surveillance with abdominal ultrasound and AFP every 6 months should be considered for high-risk groups.
High risk - All persons with established cirrhosis with HBV, HCV, or hemochromatosis; males with cirrhosis due to alcohol or primary biliary cirrhosis.
Hepatitis B:
Screen all women with HBsAg at first prenatal visit. Repeat in third trimester if woman is initially HBsAg negative and engages in high-risk behavior.
HIV:
People at increased risk - Strongly recommends screening.
Pregnant women - Universal testing with patient notification of all pregnant women (ie, testing is routinely performed unless patient actively refuses). Consent to testing should be in writing. Retest high-risk women at 36 weeks' gestation.
Infants born to high-risk mothers - Recommends (not strongly) screening
Syphilis:
Pregnant women - Screen all pregnant women with nontreponemal test (eg, RPR or VDRL) at first prenatal visit; repeat in third trimester and at delivery for women at high risk of acquiring infection during pregnancy.
High-risk persons - Screen high-risk persons with routine serologic test (eg, RPR or VDRL).
Cholesterol:
All men aged 35 and older and all women aged 45 and older should be screened routinely for lipid disorders.
Younger adults”men aged 20-35 and women aged 20-45”should be screened if they have other risk factors for heart disease. These risk factors include tobacco use, diabetes, a family history of premature heart disease (<50 yrs in men, <60 yrs in women) or high cholesterol, or high blood pressure.
Clinicians should measure HDL in addition to measuring total cholesterol or LDL. There is insufficient evidence to recommend for or against measuring triglycerides.
The optimal frequency of screening has not yet been determined, but every five years seems reasonable. Longer intervals may be appropriate in persons with normal cholesterol and no risk factors for CAD.
Children > 2 yrs age:
If a family member has a total cholesterol > 240, order random cholesterol
If the measured random cholesterol < 170, repeat in 5 yrs: if >200, order fasting lipid profile.
If a family member has a H/O premature CAD, order FLP directly.
Hypertension:
Screening of all adults is recommended at least every two years. Hypertension currently is defined as blood pressure >140/90, though this is more an arbitrary cutoff level than a biological one. In fact, cardiovascular mortality begins to increase at systolic pressures >110 mm Hg, and diastolic pressures > 70 mm Hg.
Hypertension should be diagnosed using an average of more than one reading taken at each of three separate visits. Once confirmed:
Patients should be counseled concerning physical activity, dietary sodium intake, weight loss, and alcohol intake.
Risk factors for CAD such as elevated cholesterol and smoking should be assessed.
Decisions on beginning drug therapy should be based on the level of blood pressure elevation, patient's age, concomitant disease, risk factors, and evidence of target-organ damage.
All patients should be counseled concerning physical activity and weight control as primary prevention of hypertension.
Aged 18 years - Normal: recheck in 2 years
Prehypertension: recheck in 1 year (SBP > 130 or DBP > 85)
Breast Cancer:
Screening women 50 to 75 years of age with mammography significantly decreases the death rate from breast cancer. There is some controversy surrounding the screening of women between the ages of 40 and 49 because early studies showed no improvement in survival rates. However, several studies now show a significant reduction in mortality rates in women in this age group who receive mammograms.
There is not enough evidence to prove the effectiveness of clinical breast exams (CBE), but most groups recommend annual CBE beginning at age 40.
There is no evidence of benefit in screening women over the age of 75, but each case should be considered on an individual basis.
There is insufficient evidence to recommend for or against teaching breast self-examination.
Women aged 20“39 years - CBE every 3 years.
Women aged 40 years - Mammography and CBE yearly.
Colorectal Cancer:
Screening for colorectal cancer is recommended for all persons aged 50 and older with fecal occult blood testing (FOBT) and/or flexible sigmoidoscopy.
There is not enough evidence to determine whether FOBT or sigmoidoscopy is the more effective screening tool, or whether there is an advantage in combining the two methods.
FOBT should be done on an annual basis, with the patient following the recommended guidelines for dietary restrictions, collection, and storage.
The optimal frequency of performing flexible sigmoidoscopy is not known, but most experts recommend screening every three to five years.
High-risk patients (i.e., familial polyposis, HNPCC, ulcerative colitis, adenomatous polyps, or colon cancer) should have earlier and more frequent screening.
Digital rectal examination (DRE) has poor sensitivity and specificity as a screening test, and although it is recommended by a number of organizations the USPSTF found insufficient evidence to recommend for or against DRE as a screening tool for colorectal cancer.
- Colonoscopy is the preferred method of screening for colon cancer.
- Average-risk persons should undergo colonoscopy at age 50, and if normal, every 10 years. If a polyp is found, the colonoscopy should be repeated after 3 years.
- When there is a family history of colon cancer, screening should begin at age 40 or ten years prior to the age of the family member. The earlier date is respected. Follow-up examinations for persons with family histories of colon cancer should occur at 5-year intervals. (First-degree relative with colon cancer or adenomatous polyps at age < 60 years, or 2 first-degree relatives with colorectal cancer at any time.)
- First-degree relative with colorectal cancer or adenomatous polyps at age 60 years, or 2 second-degree relatives with colorectal cancer - Follow average risk recommendations, but begin at age 40 years.
- 1 second-degree or third-degree relative with colorectal cancer - Follow average risk recommendations
- When there are multiple family members, screening colonoscopy should be performed at age 25 and every 1 to 2 years (characteristic of persons with hereditary nonpolyposis colorectal cancer (Lynch syndrome).
- Colonoscopy is recommended 1 year after a hemicolectomy for colon cancer to verify the absence of recurrence and the presence of new lesions.
- African American aged 45 years - Screen with colonoscopy as first-line method.
- Colonoscopies are recommended every 1-2 years in patients with extensive UC and Crohn™s colitis beginning 8-10 yrs after diagnosis.
Cervical Cancer:
- Regular Pap smear screening is recommended every year in all women with a cervix at 18 (21) years of age or within 3 years after first sexual intercourse.
- Annual Pap smear until age 30. At age 30, if 3 consecutive normal results, may screen every 2“3 years. Continue to screen annually if risk factors present.
- Women with Hx cervical cancer, DES exposure, HIV infection, or weakened immune system should continue to have annual screening as long as in good health.
- Patients on tamoxifen should undergo annual gynaecological exam with complete history and Pap smear.
- Patients who underwent treatment for biopsy-confirmed CIN II/III should be screened using a cytological test with or without colposcopy every 4 to 6 months. After 3 consecutive negative results, they should be screened annually using a cytologic test.
- There is no evidence that screening annually leads to a better outcome than screening every three years, but screening schedules for individual patients should be determined with consideration of that patient's risk factors for cervical cancer.
Pap smears probably can be discontinued after age 65 if the patient has received regular screening prior to that time and if all of the patient's smears have been normal.
- Screening after hysterectomy is not necessary unless cancer was the reason for the surgery.
Chlamydial infection:
- Routine screening should be done for chlamydial infection in all women aged 25 yrs and younger and in other asymptomatic women at increased risk for this infection.
- High risk- New male sex partners or 2 or more partners during preceding year, inconsistent use of barrier methods, history of prior STD, African-American race, cervical ectopy.
Prostate Cancer:
The USPSTF recommends against routine screening for prostate cancer with DRE, prostate specific antigen (PSA), or transrectal ultrasound. The ACS and the American Urological Association recommend annual DRE beginning at age 40, and PSA measurement beginning at age 50 (age 40 for African American men), but there is no evidence that screening for prostate cancer results in reduced morbidity or mortality.
The prevalence of prostate cancer found incidentally at autopsy in men ages 70 to 79 is reported to be as high as 66%, and although millions of men will have prostate cancer when they die, only a small percentage will die from their cancer. There currently is no good screening method to distinguish between aggressive and indolent cancers, and screening can in fact expose patients to potential complications of treatment such as incontinence, impotence, and even death.
If screening is to be performed, the patient should be informed of the potential benefits and risks of screening.
If screening is performed, the best approach is DRE and PSA in men > 50yrs of age with a life expectancy of >ten years.
Anemia:
Screen high-risk children for anemia between 9 and 12 months, 6 months later, and annually from 2 to 5 years.
Screen all non-pregnant women beginning in adolescence every 5“10 years until menopause.
Screen all women with hemoglobin or hematocrit at first prenatal visit.
High risk children - Includes infants living in poverty, blacks, Native Americans and Alaska Natives, immigrants from developing countries, preterm and low birthweight infants, and infants whose principal dietary intake is unfortified cow's milk.
Endometrial cancer:
All women at high risk for endometrial cancer - Annual screening at age 35 years with endometrial biopsy.
High-risk women are those known to carry hereditary nonpolyposis colorectal cancer“associated genetic mutations, or at high risk to carry mutation, or who are from families with suspected autosomal dominant predisposition to colon cancer.
Liver Cancer:
Surveillance with abdominal ultrasound and AFP every 6 months should be considered for high-risk groups.
High risk - All persons with established cirrhosis with HBV, HCV, or hemochromatosis; males with cirrhosis due to alcohol or primary biliary cirrhosis.
Hepatitis B:
Screen all women with HBsAg at first prenatal visit. Repeat in third trimester if woman is initially HBsAg negative and engages in high-risk behavior.
HIV:
People at increased risk - Strongly recommends screening.
Pregnant women - Universal testing with patient notification of all pregnant women (ie, testing is routinely performed unless patient actively refuses). Consent to testing should be in writing. Retest high-risk women at 36 weeks' gestation.
Infants born to high-risk mothers - Recommends (not strongly) screening
Syphilis:
Pregnant women - Screen all pregnant women with nontreponemal test (eg, RPR or VDRL) at first prenatal visit; repeat in third trimester and at delivery for women at high risk of acquiring infection during pregnancy.
High-risk persons - Screen high-risk persons with routine serologic test (eg, RPR or VDRL).