regular screening

1. - 1 -
NUTSHELL COURSE
USPSTF CANCER SCREENING GUIDELINES
uspreventiveservicestaskforce.org
WHAT THE USPSTF GRADES MEAN?
CERVICAL CANCER SCREENING
Grade: A
Population: 21-65 y.
In immunocompromised patients (HIV, SLE, organ transplant patients on
immunosuppressants): Screening should be done at the onset of sexual intercourse, then
/6 months (x2), then/year (annually)
Screening
modality
and
frequency:
21-29: Cytology (Pap smear)/3 y.
30-65 y.:
 Cytology (Pap smear)/3y. (as above)
 Or, Cytology (Pap smear) + HPV testing/5 y. – "co-testing"
Notes: HPV infection is usually transient in women <30 y. As only persistent HPV infection is
likely to result in neoplasia, HPV testing in women <30 y. has low predictive value for
cervical cancer. HPV infection in older women is more likely to be persistent
USPSTF doesn't recommend screening in the following:
 <21 y. (regardless of sexual history)
 >65 y. who have had adequate prior screening and aren't at high risk
 Hysterectomy with removal of the cervix with no history of high-grade precancerous
or cervical Cancer
COLORECTAL CANCER SCREENING
Grade: A
Population: 50-75 y.
Screening
modality and
frequency:
Preferred (direct colon visualization -- prevention and early detection)
 Colonoscopy /10 y.
 CTC/ virtual colonoscopy
 Flexible sigmoidoscopy /5y.
 DCBE

2. - 2 -
NUTSHELL COURSE
Alternative (stool-based tests - - early detection only)
 Guaiac fecal occult blood test (gFOBT)/y.
 Fecal immunochemical tests (FIT)/y.
 Stool DNA tests (sDNA)/1-3 y.
Notes: DRE is not recommended for screening of CRC
LUNG CANCER SCREENING
Grade: B
Population: 55-80 y. who have a 30 pack-year smoking history and currently smoke or have quit
smoking within the past 15 y
Discontinue screening when the patient has not smoked for 15 y.
Screening
modality
and
frequency:
Low-dose CT/y.
Notes: Screening with CRX alone or plus sputum cytology have no effect on lung
cancer mortality
PROSTATE CANCER SCREENING
Grade: D
Population: Discuss to start screening at 50-75 y. (in average risk white men) and at age 40-45 y.
in black men, men with positive family history, and with BRCA1 mutation
Screening
modality
and
frequency:
PSA /2-4 years
Notes: PSA-based screening of prostate cancer usually detects asymptomatic cases who will not
either progress or will progress so slowly (overdiagnosis)
BREAST CANCER SCREENING
Grade: B
Population: 50-74 y.
Decision to start in 40-49 should be individualized as the net benefit is small (while
positive)
No recommendation for screening in women >75 y.
Screening
modality
and
frequency:
Conventional Mammorgaphy /2 years (biennial)
Notes: There is insufficient evidence to recommend 1o
screening with DBT (digital breast
tomosynthesis) or adjunctive screening with breast US, MRI, DBT, or other methods in
women who have dense breasts
Screening for BRCA1 or BRCA 2 mutation in women with family history of breast, ovarian,
tubal or peritoneal cancer is USPSTF grade "B"

3. - 3 -
NUTSHELL COURSE
OTHER USPSTF SCREENING GUIDELINES
ABDOMINAL AORTIC ANEURYSM (AAA)
Grade: B
Population: 65-75 y. men who have ever smoked (i.e., have smoked >100 cigarettes during
lifetime)
Screening
modality
and
frequency:
Abdominal US (one-time screening)
Notes: Screening for AAA can be offered in men ages 65-75 who have never smoked but have
a 1st
degree relative who required repair of an AAA or died from a ruptured AAA
Screening for AAA in women ages 65-75 y. is USPSTF grade "I"
DM is associated with a reduced risk of AAA
ABNORMAL BLOOD GLUCOSE
& TYPE 2 DM
Grade: B
Population: >40. without risk factors for DM
Consider earlier screening in people with >1 of the following risk factors for DM ;
 BMI >25 kg/m2
 Family history of DM in a 1st
degree relative
 Habitual physical inactivity
 History of delivering a baby weighing >4.1 kg (9 lb) or of gestational DM
 Hypertension (BP ≥140/90 mmHg)
 Dyslipidemia (HDL ≤35 mg/dL &/TG ≥250 mg/dL)
 Previous A1C ≥5.7 %, impaired glucose tolerance or impaired fasting glucose
 PCOS
 History of vascular disease
 Certain ethnic groups (African Americans, Asian Americans, American Indians,
Alaskan Natives, Hispanics or Latinos, Native Hawaiians or Pacific Islanders)
Screening
modality
and
frequency:
Hemoglobin A1c, fasting plasma glucose or 2-h 75 g oral glucose tolerance test
 /3 y. (evidence is limited)
 Dx of abnormal blood glucose or type 2 DM should be confirmed with repeated
testing (the same test on a different day is preferred)
 Refer or offer patients with abnormal blood glucose to intensive behavioral
counseling to promote healthful diet and physical activity
Notes: Routine screening for type 1 DM isn't recommended

4. - 4 -
NUTSHELL COURSE
ASYMPTOMATIC BACTEURIA IN ADULTS
Grade: A
Population: 12-16 weeks of gestation (or at the 1st
prenatal visit, if later)
Screening
modality
and
frequency:
Urine culture.
Frequency of subsequent urine testing during pregnancy is uncertain
Notes Asymptomatic bacteruria during pregnancy may lead to maternal UTI and LBW
Screening for asymptomatic bacteruria in men and non-pregnant women in not
recommended (Rx can lead to bacterial resistance)
CHLAMYDIA & GONORRHEA
Grade: B
Population: Sexually active females aged ≤24 y. and older women at high risk for infection (e.g., HIV
infection, prior chlamydial or gonorrheal infection [within the last 12 months], new or
multiple sex partners, inconsistent use of barrier methods, sex under the influence of
drugs)
Screening
modality
and
frequency:
Nucleic acid amplification test (NAAT) on urine or from vaginal swabs taken without
pelvic examination
 >1/year (not well established)
Notes Highest infection rates of chlamydia and gonorrhea infections is in women ages 20-24 y.
Screening of chlamydia and gonorrhea in men is USPSTF grade "I"
All pregnant women can be screened for genital chlamydia (regardless of age) at the 1st
prenatal visit
GESTATIONAL DM (GDM)
rade: B
Population: 24-28 weeks of gestation
Screening
modality
and
frequency:
1-step approach;
75-g glucose load is administered after fasting glucose and plasma glucose levels are
evaluated after 1 and 2 hours.
GDM is diagnosed if 1 glucose value falls at or above the specified glucose threshold.
2-step approach;

5. - 5 -
NUTSHELL COURSE
Notes Screening for GDM <24 weeks of gestation is not recommended (grade I)
Other methods of screening for GDM include fasting plasma glucose & screening based
on risk factors
HIV INFECTION
Grade: A
Population: Pregnant women (including those who present in labor)
15-65 y. (universal screening)
Younger adolescents and older adults at high risk can also be screened, e.g.;
 Men who have sex with men
 IVDA
 Those who acquired or request testing for other STDs
Screening
modality
Conventional methods: Reactive immunoassay, followed by confirmatory Western blot
or immunofluorescent assay
Rapid HIV testing on blood or oral fluid specimens: Confirm with conventional methods
Combination methods: For p24 antigen and HIV antibodies and qualitative HIV-1 RNA
Notes Test patients with suspected acute HIV infection with combination methods
OTHERS
Grade (A)  HTN in adults >18 y.
 Syphilis infection in pregnancy, non-pregnant adolescents and adults
Grade (B)  BRCA-related cancer in women who have family history of breast, ovarian, tubal or peritoneal
cancer
 Depression in adolescents and adults >12 y. (including pregnant and postpartum women)
 Hepatitis C infection in adults
 Intimate partner violence in women of childbearing age
 Latent TB in high risk adults
 Obesity in children and adults
 Osteoporosis in women >65 y.
 Visual impairment in children ages 3-5 y.
Grade (D)  Bacterial vaginosis in asymptomatic pregnant women at high risk of PTL
 Carotid stenosis in general adult population
 COPD
 Genital herpes in adolescents, adults and pregnant women
 Lead poisoning in children or pregnant woman at average risk
 Ovarian cancer
 Pancreatic cancer
 Testicular cancer in adolescents and adults
Grade(I)  Autism spectrum disorder (ASD)
 Bacterial vaginosis in asymptomatic pregnant women at low risk of PTL
 Bladder cancer in asymptomatic adults
 Child maltreatment
 CKD
 Cognitive impairment in older adults
 Development hip dysyplsia
 Hearing loss in older adults > 50y.
 HTN in children and adolescents <18 y.
 Illicit drug use in adolescents, adults and pregnant women
 Impaired visual acuity in older adults 65 y.
 Iron deficiency anemia in children or pregnant women
 Lipid disorders in children or adolescents <20 y.

6. - 6 -
NUTSHELL COURSE
 Open-angle glaucoma in adults
 Osteoporosis in men
 Peripheral arterial disease (PVD)
 Skin cancer
 Speech and language delay in children <5 y.
 Suicide risk in adolescents, adults and older adults
 Vitamin D deficiency in adults >18 y.
SUMMARY
FOOTNOTES
Screening may be updated or changed over time, I used the following sources to prepare these
notes and you can return to them if you anything is changed;
-