Preventive Medicine

United States Preventive Services Task Force (USPSTF)
Preventive medicine:
Cervical cancer screening:
Elsebey notes 1
Breast cancer screening:
• If there’re risk factors, mammography should be recommended at the age of 40.
• The AAFP recommends women who are at increased risk for breast cancer and at low risk for
adverse medication effects, clinicians should offer to prescribe risk-reducing medications such
as tamoxifen or raloxifene. Never offer if no risk.
Elsebey notes 2
Colon cancer screening:
• The AAFP recommends offering genetic testing for Lynch syndrome to patients newly diagnosed
with colorectal cancer to reduce morbidity and mortality in relatives. Genetic testing should be
offered to first degree relatives of those found to have Lynch syndrome, and those positive for
Lynch syndrome should be offered earlier and more frequent screening for colorectal cancer.
• The most common extracolonic malignancy associated with Lynch syndrome is endometrial
cancer. Affected individuals have a ∼ 40% lifetime risk (depending on the type of mutation) of
developing endometrial cancer, with most cases occurring in premenopausal women.
Hysterectomy with bilateral salpingo-oophorectomy at the end of childbearing age (∼ 40 years) is
recommended for women with Lynch syndrome.
Elsebey notes 3
Lung cancer screening:
Prostate cancer screening:
Bladder cancer screening:
Abdominal aortic aneurysm screening:

• Abdominal ultrasonography is used to screen for abdominal aortic aneurysm. This screening
measure is recommended only in men 65–75 years of age, who have a smoking history.
• There is no abdominal aortic aneurysm screening recommended for women.
Elsebey notes 4
Osteoporosis screening:
DEXA (dual-energy X-ray absorptiometry) should be recommended to be done every 2 years for
women ≥ 65 years and men ≥ 70 years.
• A T-score 1 to 2.5 standard deviations below normal is osteopenia.
• A T-score > 2.5 standard deviations below normal is osteoporosis.
Diabetes mellites:
Elsebey notes 5
Hypertension:
Blood pressure testing is indicated for all patients above the age of 18 at every visit. Screening
adults should be every 2 years.
Hyperlipidaemia:
Lipid screening is recommended every 5 years for all patients above 20 years of age with diabetes,
hypertension, coronary artery disease, or the equivalents of coronary disease such as:
Carotid disease
Peripheral vascular disease
Aortic disease
Smoking Cessation:
All patients should:

Be asked, “Do you smoke?”
Be advised to stop smoking.
Attempt: Find out who really wants to stop.
Be assisted: Prescribe a method of aiding nicotine dependence.
Arrange to meet with the patient again to find out if they have set a quit date and have really
managed to stop.
Varenicline is the most effective medical means of stopping smoking. Both varenicline and
bupropion are more effective than nicotine patches and gum.
Elsebey notes 6
Alcoholism (Alcohol Dependence):
Alcoholism is a “self-diagnosed” disease. Alcoholism is not defined as an amount of alcohol used. It is
not defined as alcohol use leading to loss of employment. Many alcoholics still maintain their jobs.
Ask:
C: Do they feel the need to cut down the amount they are drinking?
A: Do they feel angry when asked about their drinking?
G: Do they feel guilty about the amount they drink?
E: Do they feel the need for a morning eye-opener?
The CAGE questions are excellent at helping patients recognize they are alcohol dependent.
Intimate Partner Violence (Domestic violence):

All patients should be asked about the possibility of intimate partner violence. Patients will most
often not volunteer this information. You cannot report this form of injury without the consent of
the patient
Elsebey notes 7
Vaccination:
Hepatitis A vaccine:
Postexposure prophylaxis for hepatitis A:

Hepatitis A virus vaccine: Adults < age 40 and children > age 1 months.
Hepatitis immune globulin: Children < 12 months, Adults > 40 years, and immunocompromised
individuals (e.g, advanced AIDS, chronic liver disease, or immunocompromised)
Elsebey notes 8
HBV screening:
Hepatitis B vaccine:
Post-exposure prophylaxis:
Elsebey notes 9
Hepatitis C:
Postexposure Prophylaxis: Hepatitis C

There is no postexposure prophylaxis for hepatitis C.
HIV:
Everyone age 15–65 should be tested regardless of risk factors. The interval between tests is
unclear.
HIV exposure:
Elsebey notes 10
Traveler’s vaccination
Elsebey notes 11
Adult vaccination:
Elsebey notes 12
Influneza vaccine:
Elsebey notes 13
Pneumococcal vaccine:
Elsebey notes 14
Tetanus /Acellular Pertussis:
Elsebey notes 15
Meningococcal Vaccine:
Varicella-Zoster vaccine:
Yellow fever:
Elsebey notes 16
Human Papilloma Virus (HPV) Vaccine:
Chlamydia screening:
Athlete:
Elsebey notes 17

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United States Preventive Services Task Force (USPSTF)

Cervical cancer screening:

• If there’re risk factors, mammography should be recommended at the age of 40.

Prostate cancer screening:

Bladder cancer screening:

Abdominal aortic aneurysm screening:

All patients should:

Intimate Partner Violence (Domestic violence):

Postexposure prophylaxis for hepatitis A:

Postexposure Prophylaxis: Hepatitis C

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