Recommendations for preventive services

E. RODNEY HORNBAKE MD

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The following recommendations are based on the best available evidence. These recommendations are for screening apparently healthy people and do not apply to those for whom some of these tests may be recommended for diagnosis of suspected diseases.

	RECOMMENDATION
Colon and Rectal Cancer Screening	Strongly recommended (very strong evidence of benefit) for all adults between 50 and 75 and at a younger age for those at high risk. Some patients over 75 also benefit. Much less strong is evidence that one method of screening is superior to others. Colonoscopy is probably the best method due to increased accuracy, reduced frequency and because of the opportunity it affords to remove pre-cancerous polyps. Other methods can be used.
Mammography	Recommended every 1-2 years for women over 40. The benefit is greatest for women over 50.
Cervical Cancer Screening (PAP)	Recommended at least every 3 years for women who are sexually active and who have a cervix. Women over 65 who have had multiple normal pap smears and are not at high risk can discontinue PAP testing.
Prostate Cancer Screening (digital rectal exam and PSA test)	Annual screening for men between 50 and 75 is recommended by the United States Preventive Services Task Force
Bone Density Testing	Women over 65 should be screened for osteoporosis.Women under age 65 and men at any age with risk factors for osteoporosis should be screened.
Tuberculin skin test (Tuberculosis screening)	Screening of asymptomatic adults at high risk including people with AIDS, contact with known TB cases, immigrants from areas with high rates of TB, residents of institutions including nursing homes and in certain US communities with high incidence of TB.;
Cholesterol ;	The National Cholesterol Education Project recommends that every adult over 20 have a cholesterol level (lipid profile) at least every 5 years.
Influenza vaccine	Annually in October and November for all adults over 50 and for all adults with chronic such as asthma, COPD, heart disease
Pneumococcal vaccine	Adults over 65 should receive a single dose of this vaccine. Other adults without a functioning spleen and other conditions before age 65. Repeat immunization is sometimes given but consensus is lacking around this practice.
Hepatitis A vaccine	This vaccine is recommended for certain international travelers, people who engage in risky sex, those who self inject intravenous drugs, recipients of certain blood products, and those with chronic liver disease.
Hepatitis B vaccine	This vaccine is now routinely given to children. It is recommended for adults who are at high risk including health care workers, those who self inject intravenous drugs, people who engage in risky sex and those who live with someone with chronic hepatitis B.
Meningococcal vaccine	This vaccine is recommended for college students living in a dormitory, those who lack a functional spleen and those traveling to areas where meningococcal disease is common.
Tetanus and Diphtheria vaccine	Recommended every 10 years after initial childhood immunizations. Pertussis (whooping cough) should be included once between age 18 and 65.
Chickenpox Vaccine	Adults who have never had chickenpox should be tested for immunity and immunized if not immune.
Shingles Vaccine	Recommended for most adults over age 60 (administered once)