Age-Appropriate Screening Guidelines

As you encounter patients in a primary care setting, you play an important role in preventative medicine. Specifically, you must ensure that your patients are receiving appropriate screening given their age, gender, and risk factors. Especially after the implementation of the Affordable Care Act, preventive services have taken on an even greater importance.

 The main body that puts together guidelines in the United States is the U.S. Preventive Services Task Force, or USPSTF:

The U.S. Preventive Services Task Force is an independent panel of experts in primary care and prevention who systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. These reviews are published as U.S. Preventive Services Task Force recommendations on the Task Force Web site and/or in a peer-reviewed journal.

Often, the USPSTF guidelines are complemented by recommendations by specialty societies, such as the American Cancer Society or the American College Radiology. Be careful though: sometimes the guidelines may be contradictory, such as what age to start breast cancer screening with mammography. For a comprehensive list, visit the USPSTF website or download their app.

The selected guidelines below cover some of the most common recommendations:

Women

Age	Recommendation	Grade
Puberty - 24	Chlamydia/Gonorrhea if sexually active	B
21 - 65	Pap smear every 3 years (if combined with HPV testing, can be every 5 years after age 30)	A
40 - 49	Individual decision for screening mammogram based on relative benefits vs risks	C
50 - 74	Biennial screening mammography	B
50 - 75	1) Annual screening with fecal immunochemical test (FIT) 2) screening every 10 years with flexible sigmoidoscopy and annual screening with FIT 3) screening every 10 years with colonoscopy 4) screening every 5 years with CT colonography.	A
55 - 80	Low dose lung CT if one has a 30 pack-year smoking history, currently smokes or quit within the last 15 years.	B

Men

Age	Recommendation	Grade
50 - 75	1) Annual screening with fecal immunochemical test (FIT) 2) screening every 10 years with flexible sigmoidoscopy and annual screening with FIT 3) screening every 10 years with colonoscopy 4) screening every 5 years with CT colonography.	A
55 - 80	Low dose lung CT if one has a 30 pack-year smoking history, currently smokes or quit within the last 15 years.	B

Several interesting or unexpected exceptions to screening guidelines exist. For all, there is no specific recommended screening for skin cancer for the general population. That being said, one should still protect themselves from excessive skin exposure and follow up on any unusual skin findings. For men, the USPSTF recommends against screening for testicular and prostate cancer with PSA. For women, no screening for ovarian cancer exists presently. Women who have a strong family history of breast or gynecologic cancers should be screened for BRCA-1/2 and referred for genetic counseling if the tests are positive.

If there are other screening guidelines you feel should be included on here, please comment below or contact me. For more detailed information, check out Current Practice Guidelines in Primary Care for 2017: