Comprehensive Adult-Gerontology Primary Care Screening and Vaccination Guidelines
CANCER SCREENING
Colorectal Cancer
Screen all adults starting at age 45 through age 75 years 1. Multiple strategies are acceptable:
- Colonoscopy every 10 years
- FIT (fecal immunochemical test) annually
- sDNA-FIT (stool DNA + FIT) every 1-3 years
- CT colonography every 5 years
- Flexible sigmoidoscopy every 5 years (with or without annual FIT)
For ages 76-85: Individualize based on prior screening history, life expectancy, and patient preferences. Adults with no prior screening may benefit; those with adequate prior screening likely do not need continued screening 1.
Critical implementation point: Benefits only accrue with adherence to screening intervals and follow-up colonoscopy after abnormal results. Stool-based tests require repeated testing at recommended intervals 1.
Special consideration for Black adults: While some organizations recommend earlier screening specifically for Black adults, USPSTF recommends age 45 for everyone. However, clinicians should ensure Black patients receive screening given their higher colorectal cancer incidence and mortality 1.
Breast Cancer
Screen with mammography every 2 years from age 40 to 74 years 2. This represents the most recent 2024 update lowering the starting age from 50 to 40 years.
For age 75+: Insufficient evidence to recommend for or against screening 2.
Dense breast tissue: Insufficient evidence to recommend supplemental screening with ultrasound or MRI in women with dense breasts on otherwise negative mammography 2.
CARDIOVASCULAR SCREENING
Hypertension
Screen all adults age 18 years and older with office blood pressure measurement 3.
Critical diagnostic step: Obtain blood pressure measurements outside the clinical setting for diagnostic confirmation before starting treatment 3. This can include:
- Ambulatory blood pressure monitoring (ABPM)
- Home blood pressure monitoring
This is an A-grade recommendation with high certainty of substantial net benefit 3.
INFECTIOUS DISEASE SCREENING
Hepatitis C Virus (HCV)
Screen all adults aged 18 to 79 years once for HCV infection 4. This universal screening recommendation reflects the 3.8-fold increase in acute HCV cases over the past decade due to injection drug use 4.
HIV
Screen all adolescents and adults aged 15 to 65 years for HIV infection 5.
Younger adolescents (<15 years) and older adults (>65 years): Screen if at increased risk 5.
All pregnant persons: Screen for HIV, including those who present in labor or delivery with unknown HIV status 5.
This is an A-grade recommendation. Early identification and treatment substantially reduces AIDS-related events, death, and transmission to sexual partners. In pregnancy, treatment dramatically reduces mother-to-child transmission 5.
Anxiety Disorders
Screen all adults aged 19-64 years for anxiety disorders, including pregnant and postpartum persons 6.
Adults 65 years and older: Insufficient evidence to recommend for or against screening 6.
VACCINATIONS
Annual Vaccinations
Influenza vaccine: Administer annually to all adults using inactivated (IIV), recombinant (RIV), or live attenuated (LAIV) formulations 7.
Tetanus, Diphtheria, Pertussis
Give one dose of Tdap, then Td or Tdap booster every 10 years 7.
Age-Specific Vaccinations
Ages 19-26 years:
- HPV vaccine: 2 or 3 doses depending on age at initial vaccination 7
- MMR: 1 or 2 doses if born in 1957 or later 7
- Varicella: 2 doses if born in 1980 or later 7
Ages 27-45 years:
- HPV vaccine: May be given through age 45 based on shared clinical decision-making 7
Ages 50-64 years:
- Varicella: 2 doses if no prior immunity 7
Age 65+ years:
- Zoster (shingles): 2 doses of recombinant zoster vaccine (RZV/Shingrix) - preferred OR 1 dose of live zoster vaccine (ZVL) 7
- Pneumococcal PCV13: Shared clinical decision-making for immunocompetent adults. Consider for nursing home residents, those in settings with low pediatric PCV13 uptake, or those with chronic conditions (heart, lung, liver disease, diabetes, smoking) 7
- Pneumococcal PPSV23: All adults 65+ should receive 1 dose 7
Pneumococcal Vaccination Nuances
For immunocompetent adults 65+, PPSV23 is universally recommended, while PCV13 involves shared decision-making. Higher-risk groups who may benefit more from PCV13 include nursing home residents and those with multiple chronic conditions 7.
KEY IMPLEMENTATION PITFALLS
- Colorectal screening: Stool-based tests only work with repeated adherence to intervals; one-time testing is inadequate 1
- Hypertension diagnosis: Never diagnose based solely on office readings; always confirm with out-of-office measurements 3
- Breast cancer screening: The 2024 update lowered starting age to 40; ensure you're not using outdated age 50 threshold 2
- HCV screening: Now universal for ages 18-79, not risk-based 4
- Zoster vaccine: Recombinant (RZV/Shingrix) requires 2 doses and is preferred over the older live vaccine 7