What should be included in a primary care preventive screening schedule?

Primary Care Preventive Screening Schedule

A comprehensive primary care preventive screening schedule should include age- and sex-specific cancer screenings, cardiovascular risk assessment, metabolic screening, immunizations, and behavioral health assessments, with the specific tests and intervals determined by patient age, sex, and risk factors. 1

Cancer Screening

Breast Cancer

• Women should begin annual mammography at age 40 according to the American Cancer Society 1
• The USPSTF recommends biennial screening mammography for women aged 50 to 74 years, with individualized decision-making for women aged 40-49 years 2
• Women aged 60-69 years derive the greatest mortality benefit from screening 2

Cervical Cancer

• Begin Pap testing at age 21 or when sexually active 2
• After three consecutive normal annual Pap tests, screen every 3 years 2
• For women aged 30-65 years, Pap test with HPV DNA testing every 5 years is an acceptable alternative 2, 1
• Discontinue regular testing after age 65 if prior results have been consistently normal 2

Colorectal Cancer

• Begin screening at age 50 for average-risk adults 2, 1
• Recommended options include: 2, 1
  • Annual high-sensitivity fecal occult blood test (FOBT) or fecal immunochemical test (FIT)
  • Colonoscopy every 10 years
  • Flexible sigmoidoscopy every 5 years
  • CT colonography every 5 years
• Continue screening until at least age 75 for those with life expectancy >10 years 3

Prostate Cancer

• For men aged 55-69 years, engage in shared decision-making regarding PSA testing 1
• Begin discussions at age 50 for average-risk men with at least 10-year life expectancy 2
• Begin at age 45 for high-risk men (African-American or family history) 2
• The USPSTF and Canadian Task Force do not recommend routine screening for the general population 2

Lung Cancer

• Screen adults aged 55-80 years with annual low-dose CT if they have ≥30 pack-year smoking history and currently smoke or quit within the past 15 years 2, 4
• Screening requires access to high-volume, high-quality screening and treatment centers 2

Cardiovascular Risk Assessment

• Measure blood pressure annually in all adults 1, 3
• Screen adults aged 40-75 years for lipid panel (total cholesterol, HDL, LDL, triglycerides) 1
• Use ACC/AHA risk calculator to guide statin therapy decisions 3

Metabolic Screening

Diabetes

• Screen with fasting glucose or hemoglobin A1C in adults aged 40-75 years 1, 3
• Screen more frequently in adults with BMI ≥30 kg/m² 1

Thyroid

• Screen with TSH test, particularly in women 1

Comprehensive Metabolic Panel

• Perform CMP to assess kidney function, liver function, and electrolyte balance 1

Additional Recommended Screenings

Hematologic

• Complete Blood Count (CBC) to screen for anemia, infection, and blood disorders 1

Urinary

• Urinalysis to screen for kidney disease and urinary tract infections 1

Behavioral Health

• Screen for depression and anxiety using standardized screening tools 1, 3
• Assess alcohol use 3

Sexually Transmitted Infections

• Screen for syphilis, gonorrhea, and chlamydia when indicated by risk factors 1

Cognitive Function (Age ≥65)

• Screen using validated tools such as the Montreal Cognitive Assessment (MoCA) 3

Immunizations

• Annual influenza vaccination for all adults 3
• Pneumococcal vaccination as appropriate for age 3
• Tetanus-diphtheria booster every 10 years 5

Cancer-Related Checkup

• Perform cancer-related checkup every 3 years for ages 20-39, annually for age 40 and older 2
• Include health counseling on tobacco, sun exposure, diet, nutrition, and risk factors 2
• Examine thyroid, oral cavity, skin, lymph nodes, ovaries (women), and testicles (men) 2

System Factors to Improve Screening Rates

Common pitfall: Relying solely on opportunistic screening during acute care visits results in poor preventive care delivery 2

To maximize screening effectiveness: 1

• Implement reminder systems to alert patients when screenings are due
• Reduce organizational barriers to completing screening
• Promote continuity in patient information and management
• Address access barriers including insurance coverage and geographic distance

Critical consideration: A recommendation from a healthcare professional is among the strongest predictors of screening utilization 2. Regular preventive health examinations provide the best opportunity for comprehensive screening 2.