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:
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:
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:
ü Crohn’s disease
ü Ulcerative colitis
ü Personal history of either adenomatous polyp or colon cancer
ü Strong family history
Prostate Cancer Screening:
ü PIN (prostatic intraepithelial neoplasia)
ü Strong family history
ü African American race
Tobacco Use:
Lipid Screening:
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:
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:
ü Family history
ü Coronary artery disease
ü Cerebrovascular disease
ü Hypertension
ü Hypercholesterolemia
ü Claudication
Immunizations:
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.
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.
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.
Other Adult Immunizations:
http://mayoweb.mayo,edu/nurs-ambulatory/immunizations-adult.html
or CDC website at:
http://www.cdc.gov/nip/menus/vaccines.htm#Schedules