Health Screening and Health Promotion part 2 - LEIK Flashcards
Lipid Disorders - total lipid profile
Total lipid profile after a 9-hour (minimum) fast
Lipid Disorders -
The USPSTF recommends the use of low- to moderate-dose statin when all of the
following criteria area met:
- Aged 40 to 74 years
- The patient has one or more CVD risk factors (i.e., dyslipidemia, DM, hypertension, smoking)
- The patient has a calculated 10-year risk of a cardiovascular event of 10% or greater
- Age 76 years and older without history of heart attack or stroke (insufficient evidence)
Lung Cancer (June 2013) Screening
Screening for persons who smoke (30 pack-years) or have quit in the past 15 years
Age 55 to 80 years: Annual screening with low-dose CT (LDCT)
Discontinue screening once person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery
Prostate Cancer
Screening
Begin at age 50
Prostate Cancer
Screening
Discuss pros / cons of testing via DRE or PSA blood test
Prostate Cancer
Screening
AA or father with prostate cx before age 65, start
discussion at age 45
Ovarian Cancer (September 2012) Screening
Grade D: Routine screening is not recommended.
Ovarian Cancer (September 2012) Screening
Very high-risk women with BRCA1/BRCA2 mutations: Refer to specialists.
Ovarian Cancer (September 2012) Screening
If ovarian cancer screening is done, transvaginal ultrasound with serum cancer antigen (CA-125)
is ordered.
Ovarian Cancer (September 2012) Screening
The screening starts at age 30 years (or 5–10 years before earliest age of first diagnosis of ovarian cancer in family).
Ovarian Cancer (September 2012) Screening
• Some experts recommend bilateral salpingo-oophorectomy (BSO) between age 35 to 40 years (after childbearing is complete).
Ovarian Cancer (September 2012) Screening
BSO has a significant effect in reducing
ovarian cancer risk in at-risk women.
Ovarian Cancer (September 2012) Screening
High-risk women: Refer for genetic counseling.
Ovarian Cancer (September 2012) Screening
Look for family history of having two or more first- to second-degree relatives with a history of ovarian cancer or a combination of ovarian cancer;
women of Ashkenazi Jewish ethnicity with first-degree
relative (or second-degree relatives on the same side of the family) with breast or ovarian cancer.
Ovarian Cancer (September 2012) Screening - TVUS (transvaginal ultrasound)
TVUS (transvaginal ultrasound) is a test that uses sound waves to look at the uterus, fallopian tubes, and ovaries by putting an ultrasound wand into the vagina. It can help find a mass (tumor) in the ovary, but it can’t actually tell if a mass is cancer or benign. When it is used for screening, most of the masses found are not cancer.
Ovarian Cancer (September 2012) Screening - CA-125 blood test
The CA-125 blood test measures the amount of a protein called CA-125 in the blood. Many women with ovarian cancer have high levels of CA-125. This test can be useful as a tumor marker to help guide treatment in women known to have ovarian cancer, because a high level often goes down if treatment is working. But checking CA-125 levels has not been found to be as useful as a screening test for ovarian cancer. The problem with using this test for ovarian cancer screening is that high levels of CA-125 is more often caused by common conditions such as endometriosis and pelvic inflammatory disease. Also, not everyone who has ovarian cancer has a high CA-125 level. When someone who is not known to have ovarian cancer has an abnormal CA-125 level, the doctor might repeat the test (to make sure the result is correct) and may consider ordering a transvaginal ultrasound test.
Skin Cancer Counseling
Recommended for children, adolescents, and young adults (ages 10–24 years) with fair skin
Skin Cancer Counseling
Education includes avoidance of sunlight from 10 a.m. to 4 p.m., use of SPF 15 or higher sunblock, protective clothing, wide-brim hats
Routine screening is not recommended by the USPSTF for the following conditions:
Ovarian cancer Oral cancer Testicular cancer (adolescents or adult males;
Abdominal aortic aneurysm (AAA;
June 2014)
Men at age 65 to 75 years who have
smoked
Abdominal aortic aneurysm (AAA;
June 2014)
One-time screening with ultrasonography in men ages
65 to 75 years who have smoked; individualize for
men who never smoked
Blood pressure in adults
hypertension; October 2015
Start at age 18 years or older
Requires at least 2 readings on 2 separate occasions
Blood pressure in adults
hypertension; October 2015
Recommends obtaining measurements outside of
clinical setting for diagnostic confirmation before starting
treatment
Depression
General adult population
Include pregnant and postpartum women;
PHQ-2: 2 questions (+) screen =
PHQ-9 (more comprehensive)
Diabetes mellitus (DM) type 2 (October 2015)
Age 40 to 70 years if overweight or
obese
Diabetes mellitus (DM) type 2 (October 2015)
Applies to adults in primary care settings who are not
“high risk”; DM patients with risk factors (certain
ethnicities, PCOS, GDM, etc.) can undergo screening at
younger age
Blood Glucose
Begin at age 45
Blood Glucose
Normal results: repeat q3yr
Blood Glucose
CONSIDER TESTING IN
BMI >25 / >23 (Asians) AND 1 of the following
1st degree relative w/DM
AA/Latino/NA/Asian/PI
Women w/PCOS
Acanthosis
Hx of CVD
HTN >140/90
HDL <35 and/or trig >250
Physical Inactivity
Blood Glucose
Prediabetes
Prediabetes A1C >5.7: annual
Blood Glucose
GDM
GDM: lifelong test at least q3yr
Latent tuberculosis (September 2016) Asymptomatic adults
Screen asymptomatic adults who are at increased risk for infection
Lung cancer (December 2013) smoking
Low-dose computed tomography (LDCT) if currently smokes with 30-pack-year history or quit in
the previous 15 years
Obesity
start at age 6-18 years
Obesity
Offer or refer for intensive behavioral interventions
Sexually transmitted infections (STIs;
September 2014)
Start at the onset of sexual activity
Sexually transmitted infections (STIs;
September 2014)
High-intensity behavioral counseling for sexually active
adolescents and adults who are at high risk for STIs
Skin Cancer
Routine screening is not recommended;
individualize recommendation
Osteoporosis
Begin at age >65
Osteoporosis
BMD (Bone Mineral Density):
osteoporosis risk [T-score]
FRAX tool: 10-yr risk of fracture
Osteoporosis
May start earlier if a younger woman has a fracture risk equal or greater than that of a 65-year-old White woman
(i.e., chronic steroids)
RISK FACTORS
Breast Cancer
Older age: Age 50 years or older (most common risk factor)
Previous history of breast cancer
Two or more first-degree relatives with breast cancer
Early menarche, late menopause, nulliparity (longer exposure to estrogen)
Obesity (adipose tissue can synthesize small amounts of estrogen)
RISK FACTORS
Cervical Cancer
Multiple sex partners (defined as greater than four lifetime partners)
Younger age onset of sex (immature cervix easier to infect)
Immunosuppression and smoking
RISK FACTORS
Colorectal Cancer
History of familial polyposis (multiple polyps on colon)
First-degree relative with colon cancer
Crohn’s disease (ulcerative colitis)
RISK FACTORS
Prostate Cancer
Age 50 years or older
African ancestry
First-degree relative with prostate cancer
RISK FACTORS
Sexually Transmitted Infections (STIs) or Sexually
Transmitted Diseases (STDs)
Multiple sexual partners Earlier age onset of sex New partners (defined as <3 months) History of STD Homelessness
