The 2015 Primrose Preventive Screening Guidelines: Recommendations with good evidence are presented in boldface; those with fair evidence are presented in italic text; consensus recommendations are presented in plain text. These recommendations are intended for primary care prevention and screening. Additional testing or physical examination, as required, for pre-existing conditions and presenting complaints might be warranted.
| MANEUVER | RECOMMENDATIONS | ||
|---|---|---|---|
| AGE 21–49 Y | AGE 50–64 Y | AGE ≥ 65 Y | |
| History and counseling | |||
| • Substances | Smoking14 Alcohol15,16: ≤ 10 drinks/wk for women, ≤ 15 drinks/wk for men Other substances17 | Smoking Alcohol: ≤ 10 drinks/wk for women, ≤ 15 drinks/wk for men Other substances | Smoking Alcohol: ≤ 10 drinks/wk for women, ≤ 15 drinks/wk for men Other substances |
| • Physical activity | 150 min/wk moderate or vigorous intensity18 (cannot say more than a few words without pausing for breath) | 150 min/wk moderate or vigorous intensity (cannot say more than a few words without pausing for breath) | 150 min/wk moderate or vigorous intensity (cannot say more than a few words without pausing for breath) |
| • Diet and nutrition | Fruit, vegetables, whole grains, healthy fat, ≤ 2000 mg/d of salt19 | Fruit, vegetables, whole grains, healthy fat, ≤ 2000 mg/d of salt | Fruit, vegetables, whole grains, healthy fat, ≤ 2000 mg/d of salt |
| • Sun exposure | Protective clothing, sunscreen20 | Protective clothing, sunscreen | Protective clothing, sunscreen |
| • Sexual activity | Safe sex and STI counseling21 (Screen for chlamydia and gonorrhea annually until age 25 y if sexually active and beyond age 25 y if high risk) | Safe sex and STI counseling if high risk | Safe sex and STI counseling if high risk |
| • Advance directives | Discuss once22 | ||
| • Supplements | Vitamin D: 400–2000 IU/d23 Calcium: 1000 mg/d from diet24; 1500–2000 mg/d if pregnant or lactating25 | Vitamin D: 1000–2000 IU/d Calcium: 1200 mg/d mainly from diet | Vitamin D: 1000–2000 IU/d Calcium: 1200 mg/d mainly from diet |
| • Physical examination* | BP,26 height, weight, BMI,27 WC28 If obese (30 kg/m2 ≤ BMI < 40 kg/m2) offer or refer to structured behavioural interventions aimed at weight loss | BP, height, weight, BMI, WC If obese (30 kg/m2 ≤ BMI < 40 kg/m2) offer or refer to structured behavioural interventions aimed at weight loss | BP, height, weight, BMI, WC If obese (30 kg/m2 ≤ BMI < 40 kg/m2) offer or refer to structured behavioural interventions aimed at weight loss |
| Investigations and screening tests | |||
| • Cognitive | Screen if a family member is concerned29; memory complaints should be evaluated and followed to assess progression | ||
| • Falls | Ask about trips or falls in past year or fear of falling30 | ||
| • STI | Gonorrhea and chlamydia31 VDRL, HIV, and HBV if high risk | Gonorrhea and chlamydia VDRL, HIV, and HBV if high risk | Gonorrhea and chlamydia VDRL, HIV, and HBV if high risk |
| • Diabetes† | Assess HbA1c level if FINDRISC score > 1432 | Assess HbA1c level if FINDRISC score > 14 | Assess HbA1c level if FINDRISC score > 14 |
| • Lipid levels‡ | Risk assessment32 Screen men ≥ 40 y | Risk assessment Screen women ≥ 50 y or menopausal | Risk assessment |
| • Vision | 19–40 y every 10 y33; 41–49 y every 5 y unless high risk (African American, high myopia, diabetes, or hypertension) | 50–55 y every 5 y; 56–64 y every 3 y unless high risk (African American, high myopia, diabetes, or hypertension) | Annually |
| • Colon cancer | FIT or FOBT every 2 y or flexible sigmoidoscopy every 10 y34 | FIT or FOBT every 2 y or flexible sigmoidoscopy every 10 y until 75 y | |
| • Osteoporosis | Screen based on risk factors | Screen women and men once > 65 y35 | |
| • Immunizations§ | Td, Tdap, HPV, MMR Pneumococcal, influenza, varicella, polio, meningococcal conjugate36–38 | Td, Tdap, pneumococcal influenza, herpes zoster, varicella, polio | Td, Tdap, pneumococcal, influenza, herpes zoster, varicella, polio |
| Women | |||
| • Family planning | Folic acid: 0.4–1 mg/d at childbearing age39 Rubella serology40 | ||
| • Cervical cancer | Start at age 25 y if sexually active,‖ every 3 y if results are normal41 | Every 3 y if results are normal | Every 3 y if results are normal; stop at age 69 y if 3 normal results in past 10 y |
| • Breast cancer | Mammogram every 2 y42 | Mammogram every 2 y; stop at age 75 y | |
| Men | |||
| • AAA screen | Abdominal ultrasound once at age 65–75 y in patients who have ever smoked43 | ||
AAA—abdominal aortic aneurysm; BMI—body mass index; BP—blood pressure; CVD—cardiovascular disease; FINDRISC—Finnish Diabetes Risk Score; FIT— fecal immunochemical test; FOBT—fecal occult blood test; HbA1c—hemoglobin A1c; HBV—hepatitis B virus; HPV—human papillomavirus; MMR—measles-mumps-rubella; STI—sexually transmitted infection; Td—tetanus and diphtheria; Tdap—tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis; VDRL—Venereal Disease Research Laboratory; WC—waist circumference.
WC measurements should be as follows:
< 94 cm in men and < 80 cm in women of European, sub-Saharan African, Eastern Mediterranean, or Middle Eastern (Arab) descent;
< 90 cm in men and < 80 cm in women of South Asian, Japanese, or Chinese descent; and
<102 cm in men and < 88 cm in women are currently used for all other backgrounds for clinical purposes, but prevalence should be given using both European and North American cutoff points to allow better comparisons in future epidemiologic studies of populations of Europid descent.
From late middle age until ≥ 80 y there is a decline in the volume of subcutaneous fat and a redistribution of fat from subcutaneous to visceral depots. This might make WC risk factors less valid in older patients.
FINDRISC rates diabetes risk within the next 10 y:
0–14 points = low to moderate risk (1%–17% chance of developing diabetes within 10 y); recommend not screening for type 2 diabetes.
15–20 points = high risk (33% chance of developing diabetes within 10 y); recommend screening every 3–5 y with assessment of HbA1c.
≥ 21 points = very high risk (50% chance of developing diabetes within 10 y); recommend annual screening with assessment of HbA1c.
Risk assessment: use the Framingham score (multiplied by 2 if there is a family history) or use a cardiovascular age calculator (www.cvage.ca).
If the Framingham risk score is < 5%, screen every 3–5 y; ≥ 5% repeat screening annually.
Screen men ≥ 40 y and women ≥ 50 y or postmenopausal (consider earlier in ethnic groups at increased risk such as South Asian or First Nations patients) or all patients with any of the following, regardless of age: current smoker, diabetes, arterial hypertension, family history of premature CVD, family history of hyperlipidemia, erectile dysfunction, chronic kidney disease, inflammatory disease, HIV, chronic obstructive pulmonary disease, clinical evidence of atherosclerosis or abdominal aneurysm, clinical manifestation of hyperlipidemia, or obesity (BMI > 27 kg/m2).
Framingham risk score only validated to age 74 y.
The following are the routine adult immunizations for individuals with low risk.
Td: primary series for previously unimmunized adults; booster dose every 10 y.
Pertussis: 1 dose of acellular pertussis–containing vaccine (Tdap) in adulthood; adults who will be in close contact with infants should be immunized as early as possible.
HPV: bivalent (HPV2) or quadrivalent (HPV4) vaccine for women ≤ 26 y; HPV4 vaccine for men ≤ 26 y. Can be given at > 27 y if high risk of exposure.
Measles and mumps: 1 dose for susceptible adults born in or after 1970; consider patients born before 1970 to be immune.
Rubella: 2 doses for travelers, postsecondary students, military personnel, and health care workers; if vaccine is indicated, pregnant women should be immunized after delivery.
Herpes zoster: 1 dose in those ≥ 60 y; those 50–59 years of age can be given 1 dose, but immunity wanes after 5 y.
Influenza: encouraged for adults; recommended for those ≥ 65 y.
Pneumococcal 23-valent polysaccharide: 1 dose for those ≥ 65 y.
Polio: primary series for previously unimmunized adults when a primary series of tetanus and diphtheria toxoid–containing vaccine is being given or with routine tetanus and diphtheria toxoid–containing vaccine booster doses.
Varicella: 2 doses in susceptible adults ≤ 49 y; if patients previously received 1 dose they should receive a second dose; 2 doses in adults ≥ 50 y who are known to be seronegative.
Meningococcal conjugate: 1 dose in adults ≤ 24 y not immunized in adolescence.
↵‖ Sexual activity includes intercourse and digital or oral sexual activity involving the genital area with a partner of either sex.