So you know that we’re right
in the wheel house of family
medicine where we’re talking
about adult health maintenance.
This is something that really
falls on us many times
to do all of these health
and we’ll go over guidelines today
that keep your patients well,
and these will be some of
the questions in terms of
when to initiate certain types of testing
or screening or preventive medicine
and therefore I hope it’s
really helpful to you.
And we’ll start with a case again.
So I’ve got a healthy 29-year-old woman.
She’s here for an annual
which is part of the recommendations for
health maintenance services for this patient.
Is it A. Depression screening, B.
C. HPV vaccine, or D.
The answer is depression screening.
So as you may recall,
depression screening is
recommended for adults
broadly when the practice has the
ability to follow up patients
and treat depression
Whereas, chlamydia screening
routinely for women stops at age 26,
our patient is 29 years old.
HPV vaccine, again, stops at age
26, our patient is 29 years old,
and she’s too young for the
pneumococcal vaccine, as well.
So what else do we recommend for younger
adults in terms of health maintenance?
Well, you should have a blood pressure
check at least every two years,
a cholesterol screening at least every
five years beginning at age 20 years old,
a diabetes screen based on anyone
with a family history of diabetes,
from a racial or ethnic
minority group, or with obesity.
That’s a pretty big group that
needs diabetes screening,
a lot of times I’ll do that
with the cholesterol screening.
Depression screening, I already mentioned.
Cervical cancer screening is recommended
between ages 21 to 65 years of age.
Now, with cytology alone, the screening
can be done every three years.
Combined testing with cytology and human
papilloma virus testing that’s negative,
that can be assigned that the
woman only needs every five years
for a cycle for her
cervical cancer screening.
HIV testing is recommended
for everybody at least once,
obviously more frequently among
patients with high-risk behaviors,
IV drug abuse, sex workers.
And chlamydia screening, I mentioned,
through age 25 among women.
How about vaccines?
Influenza vaccine is
recommended essentially for --
It’s very easy now if you remember the
vaccine recommendations for influenza
from our Centers for
Everyone who’s at average risk,
who is six months or older, should
receive annual influenza vaccine --
easy, same thing with the
Tdap vaccine every 10 years,
and, as I mentioned, HPV
vaccine through age 26.
So what to add during
ages 40 to 49 years?
You want to at least consider
mammography for women.
The interval could be
every one to two years.
And we’re going to spend time
in an upcoming discussion
talking about breast cancer
But one thing to realize is
that the routine self-breast
examination done at home
is not recommended.
You can also think about prostate cancer
screening for high-risk patients,
African-Americans, and those with a
family history of prostate cancer.
We will also be discussing prostate
cancer screening as its own topic
in another discussion about general
cancer screening among adults.
Now when the patient is 50 years old,
mammography should be considered
every one to two years until age 75,
but you can consider extending that
if the patient’s life expectancy
is at least 10 years,
as many women’s lives are now
getting longer and longer.
Bone mineral density testing with a
DEXA test should be initiated at age 65.
This is relatively new as a guideline,
but there is a reservoir
of hepatitis C out there
that many, many patients
did not know that they had
and therefore it’s recommended to screen
persons between age 1945 and 1965
one time only for hepatitis C.
And the routine administration of pneumococcal
vaccine now begins at age 65 years
with the PCV13 or 13-valent
followed by the 23-valent
vaccine about six months later.
Other vaccines, remember, herpes
zoster vaccine at age 60.
So colorectal cancer, we have a
separate discussion on that coming up,
but just understand there are
multiple modalities that you can use.
Certainly, in Europe, fecal occult
blood test is the preferred method
for broad screening for average risk
patients for colorectal cancer.
And it’s worth thinking at least
about screening for prostate cancer
beginning at age 50, but it
remains a controversial area.
So that’s a really brief tour of
health maintenance and preventive care
with some of the milestones.
I think every one of those
slides contained material
that could well be on the examination
and it’s just worth knowing
some of those age cutoffs
and some of those
Hope it was helpful.