Lancaster Physician Winter 2021 - 17

WINTER 2021

Y

ou take your car in every year to
get it inspected. You buy warranties on your major appliances
and vehicles. You buy mortgage
insurance to protect your homes and multiple other warranties. Don't you think it is
worth it to do everything you can to prevent
your own body from breaking down and
becoming another statistic? The human body
is by far the most sophisticated creation on
the planet and at the same time one of the
most neglected in terms of maintenance.
There is an awful lot we do not know
about our bodies, but, then again, we have
learned and are continually learning more
and more about what needs to be done to
maintain our health. We should pay more
attention to what science and the medical
profession has offered us to stay as healthy
as we can in spite of the myriad challenges
we face every day.

childhood vaccination status is up to date. If
not, there are catch-up protocols you should
discuss with your PCP.

This article presents a relatively simplistic
suggestion of what adults can do to keep
ourselves healthy in an extremely complex
world that is constantly throwing darts at
our very existence.

ROUTINE SCREENINGS
Cardiovascular health: Start at age 20 and
be assessed every three to five years to look
for modifiable risk factors like diet, smoking,
hypertension, dyslipidemia, obesity, physical
activity, diabetes mellitus (DM), and chronic
kidney disease.

The most important thing is to schedule
an appointment with a primary care provider (PCP) and discuss all of the options
available to you to lead a healthy life and to
also discuss the risks and benefits of all we
have to offer. Preventative services may vary
depending on a patient's age, gender, and
other risk factors, and they can be individualized based on personal preferences and
discussion with your PCP.
The following are adult guidelines for
routine screenings and vaccinations based
on a compilation of many professional organizations. Recommendations may vary and
are constantly changing as new information
becomes available, but the majority of those
presented here come from the United States
Preventive Services Task Force (USPSTF)
and the CDC. As with anything in medicine,
the decision to follow this advice, or not,
rests on the conversations between patients
and their providers. This article recognizes
the most common recommendations and
is not an all-inclusive list of adult screening
and preventative measures, and it assumes

Periodic visits should start around age 18
depending on one's general health and risk
factors and then continue every three years
until the age of 50 when yearly checkups
are encouraged. Of course, more frequent
visits might be needed depending on an
individual's health. These visits also provide
an opportunity to discuss patient concerns
and what is important to each patient and
to establish a physician-patient relationship.
They also allow time for discussing the risks
and benefits of screening. Studies show that
patients with established PCPs are more
likely to get preventative health services.
Screening should start at your first visit and
will depend on your age, gender, and other
risk factors.

Blood Pressure: Should be evaluated at
every visit and at least yearly at 40 years
of age.
Hyperlipidemia: Screening to start at
age 25 for males and 35 for females, though
the USPSTF suggests age 35 for males and
45 for females.
Diabetes mellitus: Screening recommended for all adults with a history of
hypertension or hyperlipidemia as well as
adults aged 40-70 with a BMI of >25 kg/m2.

50-80 with at least a 20-pack year smoking
history who currently smoke or have quit
<15 years ago. (Medicare recommends
screening from age 55-77 and a 30-pack
per year smoking history.)
Abdominal aortic aneurysm (AAA): A
screening ultrasound once for male smokers
aged 65-75 with a smoking history of at
least 100 cigarettes or a family history of a
first-degree relative with repair or rupture
of an AAA. There is insufficient evidence
for smoking women aged 65-75.
Hepatitis C: Screening for all patients
aged 18-79 once (may repeat if ongoing risk).
HIV: Screening once for people aged
15-65 if no risk; every three to five years
for individuals at slight risk and yearly for
high-risk patients. All pregnant women
should be screened.
Syphilis: Screening recommended for
high-risk patients.
Prostate Cancer: Prostatic specific
antigen (PSA) screening should be tailored
to each patient aged 55-69. Typically, no
screening after age 70. Earlier screening
may be indicated for those at higher risk
such as African Americans, family history
of prostate cancer in patients <65 years old,
and those at increased risk of BRCA 1 and
BRCA 2 mutations.
Mammogram: Every two years for women
aged 50-74 and individualized schedule for
women <50. Medicare recommends a baseline between the ages of 35-39 and annually
after age 40. The type of study recommended
depends on risk and breast density.

Colonoscopy: Screening for colon cancer
should start at age 50 and every 10 years until
the age of 75; also considered up to age 85 if
patient is healthy and has a life expectancy of
>10 years. Alternatives to this include fecal
occult blood test (FOBT) yearly, CologuardĀ®,
barium enema, or flexible sigmoidoscopy.

Cervical cancer: PAP tests are recommended every three years from ages 21-65
and not recommended if <21 or >65 years
old. An alternative is to do a PAP + HPV test
every five years in 30-65-year-old patients.
No more PAPs after a hysterectomy unless
there is a history of CIN 2 or CIN 3 or
cervical cancer.

Lung cancer: Screening CT of the lungs
should occur annually for smokers aged

Continued on page 18

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Lancaster Physician Winter 2021

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