Adult Preventive Screening

Key considerations: Missed colorectal cancer screening, Undiagnosed hypertension, Undiagnosed diabetes

Cannot miss

history: Complete medical, family, and social history, medication review, immunization status; exam: Vital signs including BP, BMI, age-appropriate physical exam; labs: Lipid panel (adults >35M or >45F), fasting glucose or HbA1c (if overweight/obese every 3 years), TSH if symptoms, HIV (ages 15-65 at least once), Hepatitis C (born 1945-1965); imaging: Mammogram q1-2yr ages 40-74, low-dose CT annually ages 50-80 with 20 pack-year smoking history, colonoscopy q10yr or FIT annually starting age 45; Cervical: Pap q3yr ages 21-65 or Pap+HPV q5yr ages 30-65; DEXA for women >=65; bedside: PHQ-2/PHQ-9 depression screening, AUDIT-C alcohol screening, GAD-7 anxiety, fall risk assessment (>65)

immediate: Not applicable; general: Counsel on results, arrange follow-up for abnormals; Document screening in chart; Immunizations: influenza annually, Tdap/Td, pneumococcal (>=65), shingles (>=50), COVID; Lifestyle counseling: diet, exercise, weight management, smoking cessation

admit: Not applicable; discharge: Outpatient management; consults: Specialty referral for abnormal screening results

USPSTF grade A and B recommendations are covered without cost-sharing under the ACA — use this to counsel patients who cite cost as a barrier
Prostate cancer screening (PSA): shared decision-making ages 55-69 per USPSTF — not routine
Lung cancer screening criteria: age 50-80, 20 pack-year history, currently smoke or quit within 15 years