Recommended Screening Tests for Primary Care
Primary care screening should include cancer screening, cardiovascular risk assessment, diabetes screening, and age-appropriate preventive services based on established guidelines to reduce morbidity and mortality.
Cancer Screening
- Breast Cancer: Annual mammography beginning at age 40 for women 1
- Cervical Cancer: Pap test every 3 years, or Pap test with HPV DNA testing every 5 years for women with three normal test results in a row 1, 2
- Colorectal Cancer: Begin screening at age 50 with one of the following options 2:
- Prostate Cancer: For men 55-69 years, screening should be based on shared decision-making due to uncertainty in the balance of benefits and harms 2, 3
- Lung Cancer: Annual screening with low-dose CT for adults 55-80 years with ≥30 pack-year smoking history who currently smoke or have quit within the past 15 years 3
- Abdominal Aortic Aneurysm: One-time screening ultrasonography for men 65-75 years who have ever smoked 3
Cardiovascular Risk Assessment
- Blood Pressure: Regular screening for all adults 1, 4
- Lipid Profile: Screen adults 40-75 years for total cholesterol, HDL, LDL, and triglycerides 1, 3
- Aspirin Therapy: Consider for cardiovascular disease prevention based on individual risk assessment 4
Metabolic Screening
- Diabetes Screening: Fasting glucose or hemoglobin A1C for adults, with more frequent screening for those with BMI ≥30 kg/m² 1, 5
- Comprehensive Metabolic Panel (CMP): To assess kidney function, liver function, and electrolyte balance 1
- Thyroid Function: TSH test to screen for thyroid disorders, particularly in women 1
Additional Recommended Screenings
- Complete Blood Count (CBC): To screen for anemia, infection, and blood disorders 1
- Urinalysis: To screen for kidney disease and urinary tract infections 1
- Depression and Anxiety Screening: Using standardized screening tools 1
- Sexually Transmitted Infection (STI) Screening: For syphilis, gonorrhea, and chlamydia when indicated by risk factors 1
- Visual Acuity: The USPSTF found insufficient evidence to assess the balance of benefits and harms of screening for impaired visual acuity in older adults 2
Immunizations
- Tetanus and Diphtheria: Update according to Advisory Committee on Immunization Practices guidelines 4, 3
- Pneumococcal Vaccine: For adults 65 years and older 4
- Influenza Vaccine: Annual vaccination 4
Screening Considerations by Age and Risk
- Adults under 40: Focus on lifestyle counseling, blood pressure, STI screening based on risk factors 1
- Adults 40-49: Add lipid screening, diabetes screening, and mammography for women 1
- Adults 50-64: Add colorectal cancer screening, consider lung cancer screening based on smoking history 2, 3
- Adults 65+: Continue appropriate screenings based on life expectancy exceeding 5 years 4
Common Pitfalls to Avoid
- Over-screening: Single-panel gFOBT in the medical office using a stool sample collected during a digital rectal examination is not recommended due to very low sensitivity 2
- Under-screening: Less than 50% of primary care practices have reminder systems for breast or cervical cancer screening 2
- Inconsistent adherence: Approximately 40% of primary care settings show inconsistent adherence to screening guidelines 1
- Age-inappropriate screening: Cancer screening provides no survival benefit unless life expectancy exceeds 5 years 4
System Factors for Improving Screening Rates
- Implement reminder systems to alert patients when they are due for screening 2
- Reduce organizational interfaces required to complete screening 2
- Promote continuity in patient information, management, and therapy 2
- Address access barriers including insurance coverage and geographic distance 2
General health checks have been shown to improve chronic disease recognition and treatment, risk factor control, preventive service uptake, and patient-reported outcomes, though they have not been associated with reduced mortality or cardiovascular events 6.