1.2 General Screening Recommendations in Adults
| Depends on presence of risk factorsa | |||
Combination HIV-1/2 immuoassay (this detects both HIV antigen and antibody) | ||||
Only in patients with risk factors for dyslipidemia (see the “Dyslipidemia” section below) | ||||
Breast cancerb | ||||
Colon cancerc | ||||
Digital rectal examination and prostate-specific antigen (PSA) | ||||
All patients with ≥ 30 pack-year smoking historyd | ||||
Female patients with risk factors for osteoporosise | ||||
a Risk factors for STD: men who have sex with men, contact with sex workers, illicit drug use, a new partner in the last 3 months, incarceration, and previous history of STD. Also, consider screening for other STDs -HIV, HBV, HCV, and syphilis. | ||||
b At age 40, all women can be offered screening mammography. At age 50, all women should begin screening. | ||||
c Patients with family history of colon cancer in any first-degree relative before age 60, or in two or more first-degree relatives at any age should begin screening at age 40, or 10 years before the youngest case in the family, whichever comes earlier. See Chapter 9, Gastroenterology, colon cancer section for further details. | ||||
d How to calculate pack-years? Multiply the number of packs of cigarettes smoked per day by the number of years the person has smoked. For example, smoking 1 packet per day for 30 years is equal to 1 x 30 = 30 pack-year smoking history. | ||||
e Risk factors for osteoporosis: family history, smoking, alcohol abuse, chronic steroid use, chronic anticonvulsant use, low body weight, and previous history of pathological fractures. | ||||
Patient’s age is very important for screening purposes.
Is chlamydia screening recommended for a 27-year-old sexually active female patient with no risk factors? The answer is no.
Generally, preventive screening is stopped at the age of 70 to 80 years, or if life expectancy is less than 10 years.
Do not screen a patient just because he/she requests it. Know the indications above.
Additional screening
All adults should be screened for depression, alcohol misuse, hypertension, obesity, and smoking at regular intervals.
Smoking cessation: patients who want to quit smoking, nicotine replacement therapy is recommended; use combination of nicotine patch plus gum, inhaler, or lozenges. Bupropion or varenicline (which decreases the urge to smoke) can also be considered.
1 Varenicline is associated with higher rates of cardiovascular events. Avoid this in patients with cardiac conditions. Also, both varenicline and bupropion comes with black-box warning of increased risk of suicide. Consider this risk in patients with psychiatric conditions.
1.3 Preventive Management of Dyslipidemia
Start screening for dyslipidemia from 20 years of age, if patient has any of the following risk factor:
Family history of dyslipidemia.
Multiple risk factors for atherosclerotic cardiovascular disease (ASCVD) (e.g., smoking and hypertension).
Family history of coronary artery disease (CAD) in a male relative < 50 years or female relative < 60 years—termed as premature CAD.
If none of the above is present, begin screening for dyslipidemia at the age of 35 years in male and 45 years in females.
When to initiate statin therapy ?
a If patient has any of following medical history, it is defined as Clinical ASCVD
b The boards will not ask you what is high- or moderate-intensity dose for each statin (Just FYI- high intensity dose of atorvastatin is 40–80 mg).
c Benefits of statin therapy may be less clear in the following patients: age < 45 or > 75, or with low-density lipoprotein (LDL) levels of <70 mg/dL.
d ASCVD score is a composite number calculated using following risk factors: age, gender, hypertension (controlled or uncontrolled), diabetes mellitus, race, cigarette smoking, and high-density lipoprotein. A 10-year risk score is used for dyslipidemia management. (The boards will not ask you to calculate ASCVD score, or what conditions are factored in 10-year ASCVD risk-score will be provided in the question itself).
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