Ø  These are average risk recommendations based on the USPSTF, ICSI, ACS, and other recommendations and, in particular, the Mayo Model of Care.

Ø  Some of the factors that increase risk for patients are listed so providers can potentially modify screening or early detection testing based on individual patient risk factor profile, in addition to considering subspecialty referral.

Ø  These guidelines are for asymptomatic patients.  Patients with symptoms should be investigated as appropriate.

Ø  Strong family history is defined as one or more first degree relatives with the condition in question, unless otherwise specified (see lipid screening guidelines).

Ø  Screening could be considered beyond the upper age limit if life expectancy is greater than 10 years.

Breast Cancer Screening:

• Annual mammogram and breast examination for female patients age 40-75 years.
• Breast self-examination optional
• Increased risk:

ü  Personal history of breast cancer

ü  Personal or family history of BRCA1 and BRCA2 mutations

ü  >20% lifetime risk

ü  Radiation to chest ages 10-30

ü  Atypical ductal hyperplasia

ü  Atypical lobular hyperplasia

ü  Lobular carcinoma in situ

ü  Gail Model 5-year risk > 1.66%

ü  Strong family history

Cervical Cancer Screening:

• Cervical cytology (Pap test) at age 21, or 3 years after first vaginal intercourse, whichever comes first.  Annual cervical cytology until age 30.
• For women 30 and older with prior 3 consecutive Paps negative, screen with cervical cytology alone every 2-3 years.  Alternatively, screen with high-risk HPV DNA test along with cervical cytology; if both are negative, screen no sooner than 3 years.
• May discontinue cervical cancer screening at age 70 if 3 negative cytology tests within the previous 10 years and no new risks.
• Women who had a hysterectomy with removal of the cervix for a benign condition (and no history of cervical dysplasia) do not need Pap smears.
• Increased risk warranting more frequent screening:

ü  History of cervical cancer

ü  Infection with high-risk HPV type

ü  HIV infection

ü  Recent change in sexual partner

ü  Multiple sexual partners

ü  History of sexually transmitted disease

ü  Diethylstilbesterol (DES) exposure in utero

Colorectal Cancer Screening:

• Age 50-80 years
• Multiple test options. Ordering of test left to the provider.
• Colonoscopy every 10 years is preferred.
• CT colonography every 5 years especially for patients who cannot safely be taken off warfarin (Coumadin) or clopidogrel (Plavix).
• Other options are recommended by some groups
• Increased risk:

ü  Crohn’s disease

ü  Ulcerative colitis

ü  Personal history of either adenomatous polyp or colon cancer

ü  Strong family history

Prostate Cancer Screening:

• Age 50-70 years
• PSA screen and DRE every year
• Increased risk:

ü  PIN (prostatic intraepithelial neoplasia)

ü  Strong family history

ü  African American race

Tobacco Use:

• Screen all patients for tobacco use
• Provide educational material to patients using tobacco that outline resources to help quit

Lipid Screening:

• Every 5 years for men and women age 20-75 years
• Increased risk:

ü  Family or personal history of CAD, stroke, diabetes mellitus, prior lipid abnormality

v  For coronary artery disease (CAD), family history is defined as first degree male relative with CAD <55 years or first degree female with CAD <65 years

Osteoporosis Screening:

• One time bone density measurement for postmenopausal women
• DEXA scan is preferred screening test
• Increased risk:

ü  Smoking

ü  Excessive alcohol intake (more than 2 drinks per day)

ü  Hypogonadism (estrogen deficiency in women or testosterone deficiency in men)

ü  Thin body habitus (weight <55 kg or BMI <29 kg/m²)

ü  Caucasian or Asian race

ü  Personal or family history of hip fracture or osteoporosis

ü  Diet deficient in calcium or vitamin D without adequate supplementation

ü  Increased likelihood of falling

ü  Long-term treatment of glucocorticoid hormones

ü  Rheumatoid arthritis

ü  Men over 70 years

Abdominal Aortic Aneurysm Screening:

• One time abdominal ultrasound for men age 65-75 years who have ever smoked
• Increased risk (for men and women):

ü  Family history

ü  Coronary artery disease

ü  Cerebrovascular disease

ü  Hypertension

ü  Hypercholesterolemia

ü  Claudication

Immunizations:

• Influenza vaccine offered every year for patients age 50 years and above
• Increased risk:

ü  Influenza vaccine every year for all adult patients with chronic lung or heart disease, diabetes mellitus, chronic alcoholism, cirrhosis, HIV infection, multiple myeloma, chronic prednisone use, organ transplantation, hemoglobinopathies, chronic tobacco abuse, renal disease, and health care workers.

• Pneumococcal vaccine offered once for patients age 65 years and above.
• A booster is recommended if initial vaccination was given at less than 65 years and was >5 years ago.
• A booster at 5 years is also recommended for patients at increased risk.
• Increased risk:

ü  Patients with chronic lung or heart disease, diabetes mellitus, chronic alcoholism, CSF leak, asplenia, renal disease, chronic tobacco abuse, cirrhosis, HIV infection, multiple myeloma, chronic prednisone use, and organ transplantation should receive Pneumococcal vaccine at an earlier age.

• A tetanus booster should be offered every 10 years
• Patients under age 65 who are due for a tetanus vaccine booster should receive a one-time Tdap (tetanus, diphtheria, and pertussis) vaccine (Adacel).
• Increased risk (for pertussis):

ü  Adults who have contact with infants, such as health care workers, parents, or child care providers, or any woman planning to become pregnant, should receive a Tdap vaccination if their most recent tetanus booster was more than 2 years ago.

• Human papillomavirus (HPV) vaccine (Gardisil) should be offered to all females ages 9-26 years unless contraindicated.
• Herpes zoster vaccine (Zostavax) should be offered to adults age 60 years or older unless contraindicated.

Other Adult Immunizations:

• Vaccinations for varicella, hepatitis A, hepatitis B, and MMR are applicable for certain age groups and for adults with risk factors.  Please refer to Mayo Adult Immunization website at:

http://mayoweb.mayo,edu/nurs-ambulatory/immunizations-adult.html

or CDC website at:

http://www.cdc.gov/nip/menus/vaccines.htm#Schedules