AAFP Screening Guidelines

Question 1

Illicit Drug Use

Answer 1

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening adolescents, adults, and pregnant women for illicit drug use.

Question 2

Second Hand Smoke

Answer 2

The AAFP strongly recommends to counsel smoking parents with children in the house regarding the harmful effects of smoking and children’s health.

Question 3

Vitamin D Deficiency

Answer 3

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for Vitamin D Deficiency.

Question 4

Gonococcal Infection in Neonates, Ocular Topical Medication

Answer 4

The AAFP strongly recommends prophylactic ocular topical medication for all newborns against gonococcal ophthalmia neonatorum.

Question 5

Sickle Cell Disease, Newborns

Answer 5

The AAFP recommends screening for sickle cell disease in all newborns.

Question 6

Iron deficiency Anemia, Children

Answer 6

The AAFP concludes that the evidence is insufficient to recommend for or against routine screening for iron deficiency anemia in asymptomatic children aged 6 to 12 months.

Question 7

Lead Poisoning, Children

Answer 7

The AAFP concludes that evidence is insufficient to recommend for or against routine screening for elevated blood lead levels in asymptomatic children aged 1 to 5 years who are at increased risk.

Question 8

Ovarian Cancer/BRCA Mutation Testing

Answer 8

The AAFP recommends that women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing.

The AAFP recommends against routine referral for genetic counseling or routine BRCA testing for women whose family history is not associated with increased risk for deleterious mutations in BRCA1/2.

Question 9

Skin Cancer, Screening

Answer 9

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of using a whole-body skin exam by a PCP or patient skin self-exam for the early detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer in the adult general population.

Question 10

Rh (D) Incompatibility, Pregnant Women

Answer 10

The AAFP strongly recommends Rh (D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care.

The AAFP recommends repeated Rh (D) antibody testing for all unsensitized Rh (D)-negative women at 24-28 weeks’ gestation. (

Question 11

Diabetes, Gestational

Answer 11

The AAFP recommends screening for gestational diabetes mellitus in asymptomatic pregnant women after 24 weeks of gestation.

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for GDM in asymptomatic pregnant women before 24 weeks of gestation.

Question 12

Genital Herpes Simplex Virus Infection, NonPregnant Adolescents and Adults

Answer 12

The AAFP recommends against routine serological screening for HSV in asymptomatic adolescents and adults.

Question 13

Genital Herpes Simplex Virus Infection, Pregnant Women

Answer 13

The AAFP recommends against routine serological screening for HSV in asymptomatic pregnant women at any time during pregnancy to prevent neonatal HSV infection.

Question 14

Depression, Adults

Answer 14

The AAFP recommends screening adults for depression when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up. [“Staff-assisted depression care supports” refers to clinical staff that assist the PCP by providing some direct depression care and/or coordination, case management, or mental health treatment.]

The AAFP recommends against routinely screening adults for depression when staff-assisted depression care supports are not in place. There may be considerations that support screening for depression in an individual patient.

Question 15

Lipid Disorders, Adults

Answer 15

The AAFP recommends screening men aged 35 and older for lipid disorders.

The AAFP recommends screening men 20-35 and women 20 and older for lipid disorders if they are at increased risk for CAD.

The AAFP makes no recommendation for or against routine screening for lipid disorders in men aged 20 to 35, or in women aged 20 and older who are not at increased risk for CAD.

Question 16

Speech and Language Delay in Preschool Children

Answer 16

The AAFP concludes that the evidence is insufficient to recommend for or against routine use of brief, formal screening instruments in primary care to detect speech and language delay in children up to 5 years of age.

Question 17

Breastfeeding, Structured Education and Counseling

Answer 17

The AAFP recommends interventions during pregnancy and after birth to promote and support breastfeeding.

Question 18

Thyroid Dysfunction Screening, Adults

Answer 18

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for thyroid dysfunction in nonpregnant, asymptomatic adults.

Question 19

Neural tube defects, Prevention, Folic Acid Supplementation, Women

Answer 19

The AAFP recommends that all women planning or capable of pregnancy take a daily supplement containing 0.43 to 0.8 mg (400 to 800 µg) of folic acid.

Question 20

Chronic Obstructive Pulmonary Disease, Adults

Answer 20

The AAFP recommends against screening asymptomatic adults for COPD using spirometry.

Question 21

Falls Prevention in Older Adults

Answer 21

The AAFP recommends exercise/PT and vitamin D supplementation in community-dwelling adults aged 65 years or older who are at increased risk for falls

The AAFP does not recommend automatically performing an in-depth multifactorial risk assessment in conjunction with comprehensive management of identified risks to prevent falls in community-dwelling adults aged 65 years or older because the likelihood of benefit is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of the circumstances of prior falls, co-morbid medical conditions, and patient values.

Question 22

Immunizations, Adults

Answer 22

The AAFP recommends immunizing all adults using the AAFP recommendations unless contraindicated

Question 23

Illicit or Nonmedical Drug Use, in Children and Adolescents

Answer 23

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care–based behavioral interventions to prevent or reduce illicit drug or nonmedical pharmaceutical use in children and adolescents. This recommendation applies to children and adolescents who have not already been diagnosed with a substance use disorder.

Question 24

Tobacco Use, Adults

Answer 24

The AAFP recommends that clinicians screen all adults for tobacco use and provide tobacco cessation interventions for those who use tobacco products.

Question 25

Abdominal Aortic Aneurysm, Men

Answer 25

The AAFP recommends one-time screening for AAA by ultrasonography in men ages 65 to 75 years who have ever smoked.

The AAFP recommends that clinicians selectively offer screening for AAA in men ages 65 to 75 years who have never smoked rather than routinely screening all men in this group

Question 26

Breast Cancer, Digital Mammography or MRI

Answer 26

The AAFP concludes that current evidence is insufficient to assess benefits and harms of either digital mammography or MRI instead of film screen mammography as screening modalities for breast cancer.

Question 27

Hearing Loss Sensorineural (SNHL)

Answer 27

The AAFP recommends screening for hearing loss in all newborn infants.

Question 28

Sexually Transmitted Infections

Answer 28

The AAFP recommends intensive behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of behavioral counseling to prevent STIs in non-sexually active adolescents and in adults not at increased risk for STIs.

Question 29

Venous Thromboembolism, Genomic Testing

Answer 29

The AAFP recommends against routine testing for Factor V Leiden and/or prothrombin 2012G (PT) in asymptomatic adult family members of patients with venous thromboembolism, for the purpose of considering primary prophylactic anticoagulation. This recommendation does not extend to patients with other risk factors for thrombosis such as contraception use.

Question 30

Alcohol Misuse, Adolescents

Answer 30

The AAFP recognizes the avoidance of alcohol products by adolescents aged 12 to 17 years is desirable. The effectiveness of the physician’s advice and counseling in this area is uncertain.

Question 31

Idiopathic Scoliosis in Adolescents

Answer 31

The AAFP recommends against the routine screening of asymptomatic adolescents for idiopathic scoliosis.

Question 32

Motor Vehicle Occupant Restraints

Answer 32

The AAFP recognizes the use of motor vehicle occupant restraints is desirable to prevent motor vehicle occupant injuries. The effectiveness of physician’s advice and counseling in this is area is uncertain.

Question 33

Breast Cancer, Mammography

(for women with average risk)

Answer 33

The AAFP recommends biennial (every two years) screening mammography for women between ages 50-74.

The AAFP concludes that the current evidence is insufficient to assess the benefits and harms of screening mammography in women aged 75 years and older.

Question 34

Breast Cancer, Self BSE

Answer 34

The AAFP recommends against clinicians teaching women Breast Self-Examination (BSE)

Question 35

Ovarian cancer

Answer 35

The AAFP recommends against screening for ovarian cancer in women.

Question 36

Cervical Cancer

Answer 36

The AAFP recommends screening for cervical cancer in women 21-65 with cytology every 3 years or, for women 30-60 who want to lengthen the screening interval, screening with cytology and HPV testing every 5 years.

The AAFP recommends against screening for cervical cancer in women

The AAFP recommends against screening for cervical cancer with HPV testing, alone or in combination with cytology, in women

The AAFP recommends against screening for cervical cancer in women >65 who have had adequate prior screening and are not otherwise at high risk for cervical cancer.

The AAFP recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and who do not have a history CIN grade 2 or 3 or cervical cancer.

Question 37

Bacteriuria, Asymptomatic, Pregnant Women

Answer 37

The AAFP recommends screening for asymptomatic bacteriuria with urine culture for pregnant women at 12 to 16 weeks’ gestation or at the first prenatal visit, if later.

Question 38

Colorectal Cancer, Adults

Answer 38

The AAFP recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonscopy, in adults, beginning at age 50 years and continuing until age 75. The risk and benefits of these screening methods vary.

The AAFP recommends against routine screening for colorectal cancer in adults 76-85. There may be considerations that support colorectal caner screening in an individual patient.

The AAFP recommends against screening for colorectal cancer in adults >85.

The AAFP concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic colongraphy and fecal DNA testing as screening modalities for colorectal cancer.

Question 39

Alcohol Misuse, Adults

Answer 39

The AAFP recommends that clinicians screen adults aged 18 years or older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse.

Question 40

Tobacco Use, Counseling, Children and Adolescents

Answer 40

The AAFP recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents.

Question 41

Maltreatment, Children

Answer 41

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care interventions to prevent child maltreatment. This recommendation applies to children who do not have signs or symptoms of maltreatment.

Question 42

Oral Cancer, Adults

Answer 42

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral cancer in asymptomatic adults.

Question 43

Chlamydia, Men

Answer 43

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men.

Question 44

Vitamin D and Calcium Supplementation, Prevention of Fractures in Premenopausal Women or Men

Answer 44

The AAFP concludes that the current evidence is insufficient to assess the balance of the benefits and harms of combined vitamin D and calcium supplementation for the primary prevention of fractures in premenopausal women or in men.

Question 45

Osteoporosis, Women

Answer 45

The AAFP recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year old white woman who has no additional risk factors.

[A 65-year-old white woman with no other risk factors has a 9.3% 10-year risk for any osteoporotic fracture]

Question 46

Hyperbilirubinemia, Infants

Answer 46

The AAFP concludes that the evidence is insufficient to recommend screening infants for hyperbilirubinemia to prevent chronic bilirubin encephalopathy

Question 47

Syphilis, Pregnant Women

Answer 47

The AAFP recommends that clinicians screen all pregnant women for syphilis infection

Question 48

Colorectal Cancer, Chemo Prevention

Answer 48

The AAFP recommends against the routine use of ASA and NSAIDs to prevent colorectal cancer in individuals at average risk for colorectal cancer.

Question 49

Insulin Dependent Diabetes Mellitus

Answer 49

The AAFP recommends against the use of immune marker screening for insulin dependent diabetes mellitus in asymptomatic persons

Question 50

Visual Impairment, Children

Answer 50

The AAFP recommends vision screening for all children at least once between the ages of 3 and 5 years to detect the presence of amblyopia or its risk factors.

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of vision screening for children of age.

Question 51

Bacteriuria, Asymptomatic, Men and NonPregnant Women

Answer 51

The AAFP recommends against screening for asymptomatic bacteriuria in men and nonpregnant women.

Question 52

Obesity, Children and adolescents

Answer 52

The AAFP recommends that clinicians screen children aged 6 years and older for obesity and offer them or refer them to comprehensive, intensive behavioral interventions to promote improvement in weight status.

Question 53

Breast Cancer, Prevention Medication

(for women at increased risk)

Answer 53

The AAFP recommends that clinicians engage in shared, informed decision making with women who are at increased risk for breast cancer about medications to reduce their risk. For 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.

Question 54

Pancreatic Cancer, Adult

Answer 54

The AAFP recommends against routine screening for pancreatic cancer in asymptomatic adults using abdominal palpation, ultrasonography, or serologic markers. (

Question 55

Breast Cancer, Clinical Examination (CBE)

Answer 55

The AAFP concludes that the current evidence is insufficient to assess the benefits and harms of CBE for women aged 40 years and older.

Question 56

Thyroid Cancer

Answer 56

The AAFP recommends against the use of ultrasound screening for thyroid cancer in asymptomatic persons.

Question 57

Peripheral Arterial Disease

Answer 57

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for peripheral artery disease (PAD) and cardiovascular disease (CVD) risk assessment with the ankle– brachial index (ABI) in adults

Question 58

HIV Infection, Pregnant Women

Answer 58

The AAFP recommends that clinicians screen all pregnant women for HIV, including those who present in labor whose HIV status is unknown.

Question 59

Skin Cancer, Behavioral Counseling

Answer 59

The AAFP recommends counseling children, adolescents, and young adults ages 10 to 24 years who have fair skin about minimizing their exposure to ultraviolet radiation to reduce risk of skin cancer.

Question 60

Visual Difficulties, Adults

Answer 60

The AAFP concludes that the current evidence is insufficient to assess the balance of benefit and harms of screening for visual acuity for the improvement of outcomes in older adults.

Question 61

Dysplasia (Developmental) of the Hip in Infants

Answer 61

The AAFP concludes that the evidence is insufficient to recommend routine screening for developmental dysplasia of the hip in infants as a means to prevent adverse outcomes.

Question 62

Behavior Counseling, Healthful Diet and Physical Activity for Cardiovascular Disease

Answer 62

The AAFP recommends offering or referring adults who are overweight or obese and have additional CVD risk factors to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD.

Question 63

Bladder Cancer, Adults

Answer 63

The AAFP concludes that the evidence is insufficient to assess the balance of benefits and harms of screening for bladder cancer in asymptomatic adults.

Question 64

Glaucoma, Adults

Answer 64

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for primary open-angle glaucoma in adults.

Question 65

Syphilis, non-pregnant adults

Answer 65

The AAFP strongly recommends that clinicians screen persons at increased risk for syphilis infection

The AAFP recommends against routine screening of asymptomatic persons who are not at increased risk for syphilis infection

Question 66

Hearing, Screening Loss in Older Adults

Answer 66

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for hearing loss in asymptomatic adults 50 years and older.

Clinical Considerations: This recommendation applies to adults age 50 years and older who show no signs or symptoms of hearing loss.

Question 67

Hypertension, Adults

Answer 67

The AAFP recommends screening for high blood pressure in adults aged 18 and older.

Question 68

Coronary Heart Disease, Adults

Answer 68

The AAFP recommends against screening with resting or exercise EKG for the prediction of CAD events in asymptomatic adults at low risk for CAD events.

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening with resting or exercise ECG for the prediction of CAD events in asymptomatic adults at intermediate or high risk for CAD events.

Question 69

Obesity, Adults (Screening for and Management)

Answer 69

The AAFP recommends screening all adults for obesity. Clinicians should offer or refer patients with a BMI of 30 or higher to intensive, multicomponent behavioral interventions.

Question 70

Hemochromatosis

Answer 70

The AAFP recommends against routine genetic screening for hereditary hemochromatosis in the asymptomatic general population.

Question 71

Phenylketonuria, Newborn

Answer 71

The AAFP recommends ordering screening test for PKU in neonates

Question 72

Depression, Children and Adolescents

Answer 72

The AAFP recommends screening of adolescents (12-18 y.o.) for major depressive disorder when systems are in place to ensure accurate diagnosis, psychotherapy (CBT or interpersonal), and follow-up.

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening of children (7-11 years of age)

Question 73

Immunization, Children and Adolescent, Catch-up

Answer 73

The AAFP recommends immunizing children 0-18 who are between doses for vaccinations with the AAFP recommendation unless contraindicated.

Question 74

Hepatitis B Virus Infection, Pregnant Women

Answer 74

The AAFP recommends screening for HBV in pregnant women at their first prenatal visit.

Question 75

Testicular Cancer

Answer 75

The AAFP recommends against screening for testicular cancer in asymptomatic adolescent or adult males

Question 76

Dental Caries, in Children from Birth through Age 5 Year

Answer 76

The AAFP recommends that PCPs prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride.

The AAFP recommends that PCPs apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption.

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening examinations for dental caries performed by PCPs in children from birth to age 5 years.

Question 77

Gonorrhea, Women

Answer 77

The AAFP recommends screening for chlamydia and gonorrhea in sexually active women age 24 years and younger and in older women who are at increased risk for infection.

Question 78

Prostate Cancer

Answer 78

The AAFP recommends against PSA-based screening for prostate cancer.

Question 79

Preeclampsia, Low-Dose Aspirin

Answer 79

The AAFP recommends the use of low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation in women who are at high risk for preeclampsia.

Question 80

Coronary Heart Disease Risk Assessment, Using Nontraditional Risk Factors

Answer 80

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of using the nontraditional risk factors discussed in this statement to screen asymptomatic men and women with no history of CAD to prevent CAD events.

[The nontraditional risk factors included in this recommendation are high-sensitivity C-reactive protein, ankle-brachial index, leukocyte count, fasting blood glucose level, periodontal disease, carotid intima-media thickness , coronary artery calcification score on electron-beam computed tomography, homocysteine level, and lipoprotein(a) level.]

Question 81

Iron deficiency Anemia, Pregnant Women

Answer 81

The AAFP recommends routine screening for iron deficiency anemia in asymptomatic pregnant women.

Question 82

Cardiovascular Disease, Aspirin for the Prevention of

Answer 82

The AAFP recommends the use of aspirin for men age 45 -79 and women 55-79 when the potential benefit due to a reduction in MI outweighs the potential harm due to an increase in gastrointestinal hemorrhage.

The AAFP recommends the use of aspirin for women age 55-79 when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage.

The AAFP concludes that the evidence is insufficient to assess the benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older

Question 83

Hepatitis B Virus Chronic Infection

Answer 83

The AAFP recommends against routinely screening the general asymptomatic population for chronic HBV infection.

Question 84

Vitamin, Mineral, and Multivitamin Supplements for the Primary Prevention of CVD and Cancer

Answer 84

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of the use of multivitamins for the prevention of CVD or cancer.

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of the use of single- or paired-nutrient supplements (with the exception of beta-carotene and vitamin E) for the prevention of CVD or cancer.

The AAFP recommends against the use of beta-carotene or vitamin E supplements for the prevention of CVD or cancer.

Question 85

Bacterial Vaginosis, Pregnant Women

Answer 85

The AAFP recommends against screening for bacterial vaginosis in asymptomatic pregnant women at low risk for preterm delivery.

Question 86

Hepatitis C Virus Infection, Adults

Answer 86

The AAFP recommends screening for HCV infection in persons at high risk for infection.

The AAFP also recommends offering one-time screening for HCV infection to adults born between 1945 and 1965.

Question 87

Gonorrhea, Men

Answer 87

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men.

Question 88

Tobacco Use, Pregnant Women

Answer 88

The AAFP recommends that clinicians screen all pregnant women about tobacco use and provide augmented, pregnancy-tailored counseling to those who smoke.

Question 89

Dementia, Adults

Answer 89

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment.

Question 90

Lipid Disorders, infants, children, adolescents, and young adults

Answer 90

The AAFP concludes that the evidence is insufficient to recommend for or against routine screening for lipid disorders in infants, children, adolescents, or young adults (up to age 20)

Question 91

Hypertension, Children and Adolescents

Answer 91

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for primary hypertension in asymptomatic children and adolescents to prevent subsequent cardiovascular disease in childhood or adulthood.

Question 92

Chlamydia, Women

Answer 92

The AAFP recommends screening for chlamydia and gonorrhea in sexually active women age 24 years and younger and in older women at increased risk for infection

Question 93

Carotid Artery Stenosis, Adults

Answer 93

The AAFP recommends against screening for asymptomatic carotid artery stenosis in general adult populations.

Question 94

Kidney Disease, Chronic Screening

Answer 94

The AAFP concludes that the evidence is insufficient to assess the balance of benefits and harms for routine screening for CKD in asymptomatic adults. Common tests considered for CKD screening include creatinine-derived estimates of GFR and urine testing for albumin.

Question 95

Congenital Hypothyroidism

Answer 95

The AAFP recommends screening for congenital hypothyroidism in newborns.

Question 96

Cardiovascular Disease, Genomic Testing

Answer 96

The AAFP recommends against genomics profiling to assess risk for cardiovascular disease. The net health benefit from the use of any genomic tests for the assessment of cardiovascular disease risk is negligible and there is no evidence that they lead to improved patient management or increased risk reduction.

Question 97

Lung Cancer

Answer 97

The AAFP concludes that the evidence is insufficient to recommend for or against screening for lung cancer with CT in persons at high risk for lung cancer based on age and smoking history.

Question 98

Diabetes, Type 2, Adults

Answer 98

The AAFP recommends screening for type 2 diabetes in asymptomatic adults with sustained BP > 135/80 mm Hg (either treated or untreated).

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for type 2 diabetes in asymptomatic adults with BP of 135/80 mm Hg or lower.

Question 99

Suicide, Screening

Answer 99

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for suicide risk in adolescents, adults, and older adults in primary care.

Question 100

Abdominal Aortic Aneurysm, Women

Answer 100

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA in women ages 65 to 75 years who have ever smoked.

The AAFP recommends against routine screening for AAA in women who have never smoked.

Question 101

Immunization, Children and Adolescent

Answer 101

The AAFP recommends immunizing all children 0-18 using the AAFP recommendations unless contraindicated

Question 102

Breast Cancer/BRCA Mutation Testing

Answer 102

The AAFP recommends that PCPs screen women who have family members with breast, ovarian, tubal, or peritoneal cancer with screening tools designed to identify a family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes (BRCA1 or BRCA2). Women with positive screening results should receive genetic counseling and, if indicated after counseling, BRCA testing.

The AAFP recommends against routine genetic counseling or BRCA testing for women whose family history is not associated with an increased risk for potentially harmful mutations in the BRCA1 or BRCA2 genes.

Question 103

Abuse, Intimate Partner Violence of Elderly and Vulnerable Adults

Answer 103

The AAFP recommends that clinicians screen women of childbearing age for intimate partner violence and provide or refer women who screen positive to intervention services. This recommendation applies to women who do not have signs or symptoms of abuse

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening all elderly and vulnerable adults for abuse and neglect

Question 104

Vitamin D and Calcium Supplementation, Prevention of Fractures in Noninstitutionalized Postmenopausal Women

Answer 104

The AAFP concludes that the current evidence is insufficient to assess the balance of the benefits and harms of daily supplementation with >400 IU of vitamin D3 and 1,000 mg of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women.

The AAFP recommends against daily supplementation with ≤400 IU of vitamin D3 and 1,000 mg of calcium carbonate for the primary prevention of fractures in noninstitutionalized postmenopausal women.

Question 105

Hemoglobinopathies, Newborns

Answer 105

The AAFP strongly recommends ordering screening tests for PKU, hemoglobinopathies, and thyroid function abnormalities in neonates.

Question 106

Low Back Pain, Adults

Answer 106

The AAFP concludes that the evidence is insufficient to recommend for or against routine use of interventions to prevent low back pain in adults in primary care settings.

Question 107

Hormone Replacement Therapy

Answer 107

The AAFP recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women.

The AAFP recommends against the use of estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy.

[This recommendation applies to postmenopausal women who are considering hormone therapy for the primary prevention of chronic medical conditions. This recommendation does not apply to women younger than age 50 years who have undergone surgical menopause. This recommendation does not consider the use of hormone therapy for the management of menopausal symptoms, such as hot flashes or vaginal dryness.]

Question 108

Lead Poisoning, Pregnant Women

Answer 108

The AAFP recommends against routine screening for elevated blood levels in asymptomatic pregnant women.

Question 109

HIV Infection, Adolescents and Adults

Answer 109

The AAFP recommends that clinicians screen adolescents and adults ages 18-65 for HIV infection. Younger adolescents and older adults who are at increased risk should also be screened.

[The AAFP’s recommendation differs from USPSTF only on the age to initiate routine screening for HIV. The USPSTF recommends routine screening beginning at age 15 years]

Question 110

Healthful Diet and Physical Activity for Cardiovascular Disease

Answer 110

Although the correlation among healthful diet, physical activity, and the incidence of cardiovascular disease is strong, existing evidence indicates that the health benefit of initiating behavioral counseling in the primary care setting to promote a healthful diet and physical activity is small. Clinicians may choose to selectively counsel patients rather than incorporate counseling into the care of all adults in the general population. Considerations: General adult population without a known diagnosis of HTN, DM, HLD, or CVD. Issues to consider include other risk factors for cardiovascular disease, a patient’s readiness for change, social support and community resources that support behavioral change, and other health care and preventive service priorities.

Question 111

Hepatitis B Virus Infection, in Nonpregnant Adolescents and Adults

Answer 111

The AAFP recommends screening for HBV infection in persons at high risk for infection.

Question 112

Behavioral Counseling to Prevent Sexually Transmitted Infections

Answer 112

The AAFP recommends high-intensity behavioral counseling to prevent STIs for all sexually active adolescents and for adults at increased risk for STIs.

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of behavioral counseling to prevent STIs in non-sexually active adolescents and in adults not at increased risk for STIs.

Question 113

Colorectal cancer, genomic testing

Answer 113

The AAFP recommends offering genetic testing for Lynch syndrome to patients newly diagnosed with CRC 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.

Question 114

Osteoporosis, Men

Answer 114

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men.

Question 115

Pulmonary Chronic Obstructive Disease

Answer 115

The AAFP recommends against screening asymptomatic adults for COPD using spiromtery.

Question 116

Screenings that are strongly recommended

Answer 116

Gonococcal Infection in Neonates, Ocular Topical Medication

Hemoglobinopathies, Newborns

Rh (D) Incompatibility, Pregnant Women

Second hand smoke, exposure, children

Syphilis in pt’s at increased risk

Question 117

Recommended screenings

Answer 117

One-time screening for AAA by USG in men ages 65 to 75 years who have ever smoked

Women of childbearing age for intimate partner violence

Adults aged 18 years or older for alcohol misuse

Asymptomatic bacteriuria with urine culture for pregnant women at 12 to 16 weeks’ gestation or at the first prenatal visit

Offering or referring adults who are overweight or obese and have additional CVD risk factors to intensive behavioral counseling

High-intensity behavioral counseling to prevent STIs for all sexually active adolescents and for adults at increased risk

Biennial screening mammography for women between ages 50 and 74

Women who have family members with breast, ovarian, tubal, or peritoneal cancer with screening tools designed to identify a family history associated with an increased risk for BRCA1/BRCA2

Interventions during pregnancy and after birth to promote and support breastfeeding.

ASA for men age 45 to 79 years and women age 55 to 79 years

Cervical cancer in women age 21 to 65 years with cytology every 3 years or women age 30 to 65 years with cytology and HPV testing every 5 years

Chlamydia and gonorrhea in sexually active women age 24 years and younger and in older women who are at increased risk

CRC beginning at age 50 years and continuing until age 75 years

Offering genetic testing for Lynch syndrome to patients newly diagnosed with colorectal cancer

Congenital hypothyroidism in newborns

Prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride

Apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption

Screening adults for depression when staff-assisted depression care supports are in place

Screening adolescents 12-18 years of age for major depressive disorder when systems are in place

Gestational diabetes mellitus in asymptomatic pregnant women after 24 weeks

Screening for type 2 diabetes in asymptomatic adults with BP> 135/80

Exercise/PT and vitamin D supplementation in community-dwelling adults aged 65 years or older who are at increased risk for falls

Hearing loss in all newborn infants

HBV in pregnant women at their first prenatal visit

HBV infection in persons at high risk for infection

HCV infection in persons at high risks for infection

Adolescents and adults ages 18 to 65 years for HIV infection

All pregnant women for HIV

High blood pressure in adults aged 18 and older

Immunizing all patients using the AAFP recommendations unless contraindicated

Iron deficiency anemia in asymptomatic pregnant women

Men aged 35 and older for lipid disorders

Men 20-35 or women > 20 for lipid disorders if they’re at increased risk

All women planning/capable of pregnancy take a daily supplement containing 400-800 µg of folate

All adults for obesity and referring those with BMI > 30 for interventions

Children aged 6 years and older for obesity and referral to intervention if obese

Osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year old white woman

Phenylketonuria in neonates

ASA 81mg as preventive medication after 12 weeks in women who are at high risk for preeclampsia

Repeat Rh (D) antibody testing for all unsensitized Rh (D)-negative women at 24-28 weeks

Intensive behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs

Counseling children, adolescents, and young adults ages 10-24 years who have fair skin about minimizing their exposure to UV radiation

All pregnant women for syphilis

All adults for tobacco use and provide tobacco cessation interventions

Provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents

Vision screening for all children at least once between the ages of 3 and 5 years

Question 118

Things we definitely shouldn’t screen for/do

(recommended against)

Answer 118

AAA in women who have never smoked

Asymptomatic bacteriuria in men and nonpregnant women

BV in asymptomatic pregnant women at low risk for preterm delivery

Teaching women Breast Self-Examination

Routine use of medications, such as tamoxifen or raloxifene, for risk reduction of primary breast cancer in women who are not at increased risk

Genetic counseling or BRCA testing for women whose family history is not associated with an increased risk

ASA for stroke prevention in women

Genomics profiling to assess risk for cardiovascular disease

Asymptomatic carotid artery stenosis

Cervical cancer in women younger than age 21 years

Cervical cancer in women > 65 years who have had adequate prior screening and are not otherwise at high risk

Cervical cancer in women who have had a hysterectomy with removal of the cervix and without history of HSIL

HPV testing, alone or in combination with cytology, in women

Asymptomatic adults for COPD using spirometry

CRC in adults age 76-85 years unless indicated or adults > 85

ASA/NSAIDs to prevent CRC in individuals at average risk

Resting or exercise EKG for the prediction of CAD events in asymptomatic adults at low risk

Serological screening for HSV in asymptomatic pregnant women or other adults

Genetic screening for hereditary hemochromatosis

Asymptomatic population for chronic HBV infection

Combo estrogen and progestin for the prevention of chronic conditions in postmenopausal women

Estrogen for the prevention of chronic conditions in postmenopausal women after hysterectomy

Asymptomatic adolescents for idiopathic scoliosis

Immune marker screening for IDDM

Elevated lead levels in asymptomatic children aged 1-5 years or pregnant women who are at average risk

Ovarian cancer

Pancreatic cancer

PSA for prostate CA

Hypercoagulable diseases in pt’s with family members with VTE

Persons who are not at increased risk for syphilis

Testicular cancer

Ultrasound screening for thyroid cancer

Beta-carotene or vitamin E for the prevention of CVD or cancer

≤400 IU of vitamin D3 and 1,000 mg of calcium carbonate for the primary prevention of fractures in noninstitutionalized postmenopausal women

Question 119

Things to screen/do for preggos

Answer 119

Asymptomatic bacteriuria with urine culture (12-16 weeks or first visit)

Gestational diabetes (after 24 weeks)

HBV (at first visit)

HIV

Iron deficiency anemia

Rh blood typing and antibody testing (at first visit)

Repeat Rh testing for Rh- moms (at 24-28 weeks)

Syphilis

Tobacco use + provide smoking cessation counseling to those ratchets who smoke