Screening in Adults Flashcards
What are the 10 major, general areas for screening in adults?
- Weight
- Blood Pressure
- Cholesterol
- Fasting blood glucose
- Cervical cancer screening
- Breast cancer screening
- Colorectal cancer screening
- Prostate cancer
- Skin cancer
- Oral hygeine / cancer
What are the guidelines for screening of weight?
Should be measured at least every few years. Unless more stringent measures are being undertaken in journey of weight-loss by patient.
High BMI is a major risk factor for many different health issues: CVD, DM, Arthritis, etc.
BMI goal = 20-25
BMI = weight / height (meters-squared)
Central obesity is strongly associated with metabolic syndrome –> DM
Goal waits measurements:
Men <88cm
Guidelines for Blood Pressure Screening
Should be recorded at least every 1-2 years in everyone >16yo
Control of BP results in decreased mortality from cerebrovacular accidents. And, to a lesser extent, risk fo heart disease, kidney failure and retinopathy
Guidelines for Cholesterol screening
All adults >45 yo should have 5-yearly total cholesterol blood tests (getting HDL measured gives extra info)
Reccommendations: total cholesterol should be <4.0 mmol/L
For most, dietary modification is sufficient to keep this undercontrol. For others, there are statins…
Guidelines for Fasting blood glucose screening
Should be screened every 3 years in everyone >40
To keep on track of potential metabolic syndrome / DMT2 development
Cervical cancer screening guidelines
Women aged 18-70 who have been sexually active should have a pap smear every 2 years
Women >70 who have never been screened should undergo 2 successive pap smear screenings (2 years apart) before screening can be safely ceased
Considerations towards the individual woman’s relative risk may cause pap smears to be conducted more regularly. However, they should never be more than 3 years apart
Pap smears should begin at 18yo, OR 2 years after first sexual experience - whichever occurs LATER
Risk factors for cervical cancer:
- All women who are or have been sexually active
- Early age at first sexual intercourse
- Multiple sexual partners
- Genital warts virus infection
- Cigarette smoking
- Those with LSIL and HSIL on pap smears (any abnormal past pap smear)
Breast carcinoma screening guidelines
Mammograms should be performed at least every 2 years in women aged 50-70yo
Not recommended at <40yo, due to difficulty differentiating malignant lesions from dense tissue
Women 40-49 yar may choose to have a mammogram
Genetic testing should be considered in those at high risk (e.g. first-degree relative with BC)
Mammography alone CAN NOT be used to exclude malignancy of palpable breast lumps, as it still carries a 10% false negative rate*
Guidelines for colorectal cancer screening
Depends on patient history. Important factors include:
FHx colorectal cancers or adenomas
Personal Hx of Inflammatory Bowel Disease or Rectal Bleeding
Rectal examination should be performed as part of screening patients for CRC
Faecal occult blood testing (FOBT) is reccommended every 2 years for adults >50yo –> even if without sx and with only average risk
Guidelines for CRC screening in patients with ‘positive’ risk hx
Positive hx of fhx CRC or adenomas, or personal hx of IBD or PR bleeding.
Gather:
Past history of colonic adenomas or large bowel cancers - including colonoscopy reports
Past/present hx of UC - including colonoscopy with biopsies
Incidence of familial polyposis, gardner syndrome - sigmoidoscopy or colonoscopy
*Consider prophylactic colectomy in some individuals
In addition to FOBT, 2-yearly colonoscopies are recommended for patients aged 25-30 years if there is a significant FHx colorectal cancer, or Hx of family members with CRC at <50yo, or family studies showing high genetic risk
Genetic testing should be considered in those at risk
Guidelines for prostate cancer screening
RACGP guidleines do not support routine PSA testing.
Up to discretion of GP, with consideration towards specific context of patient at hand.
Important to explain risks and benefits, as well as the common uncertainties of testing, and dangers associated with invasive follow-up to positive PSAs.
Guidelines for Oral Hygine/Cancer Screening
Annual oral cavity inspection in >40s
Important for identifying pre-malignant lesions in oral cavity
Incidence of oral cancer is highest amongst patients with hx of heavy smoking and/or drinking
Poor dental hygeine can result in poor nutrition, especially amongst the elderly
