Summary of Basic Health Maintenance/Screening

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Life Habits Screening
Cancer Screening
Hepatitis Screening
STD Screening of Asymptomatic Patients
Immunizations
Hyperlipidemia

Life Habits Screening

Screen	Criteria	Action
Diet/Exercise Nicotine addiction Drug/alcohol use Sexual Health Mental Health Domestic violence	All Patients Yearly	Identify issues, discuss, refer as appropriate: Dietician will see patients for evaluation and BIA every six months or, when clinically indicated, provider may refer patient for consult. Provider may refer to smoking cessation counselors, social workers, or psychiatry.

Cancer Screening

Screen	Criteria	Action
Breast Cancer	Women/age dependent AND MTF transgender, if on estrogen therapy	Age 40-49: controversial whether to screen with mammography (yearly or biannual) Age 50+: screen every 1-2 years with mammography Insufficient data to recommend clinical breast exam
Cervical Cancer	All women	PAP smears to begin at onset of sexual activity or age 21 years old If negative X 2 at six month interval, then yearly See Cervical Cancer guideline for management of specific abnormality
Prostate Cancer	Family hx of prostate CA or African/American heritage: Age≥45 All other men≥50	Counsel interested men about potential benefits and harms of early detection and treatment; consider digital rectal exam and PSA
Colorectal Cancer	Low risk: Age≥50 Medium risk : Age≥40 High risk *: Age≥40 or 10 yrs before youngest family case (whichever comes first)	Annual FOBT, q5yr sigmoidoscopy, q5yr sigmoidoscopy+annual FOBT, or every 10yr colonoscopy Same screening as above but begin at 40yo Every 5yr colonoscopy

* Patients with one first degree relative age>60 or two second degree relatives (grandparent, aunt or uncle) diagnosed with colon cancer

** Patients with a first degree relative (parent, sibling, or child) with colon cancer or an adenomatous polyp diagnosed at age<60 or two first degree relatives diagnosed with colorectal cancer at any age

Hepatitis Screening

Screen

Criteria

Action

Hepatitis A

All patients

If HAV Ab negative, schedule vaccine series

Hepatitis B

All patients

If HBC core and surface Ab negative, schedule vaccine series

If HBV Sag+ schedule q6months RUQ U/S, AFP

Hepatitis C

All patients

If Ab+ and PCR negative; repeat PCRx1

If PCR +; refer for biopsy and treatment if appropriate;

Check genotype and quantitative PCR on tx candidates

If no tx; q 3months LFTs

If cirrhosis, no tx but q 6months U/S and AFP

STD Screening of Asymptomatic Patients

Group	Criteria	Action
MSM	Sexually active in last year	Annual RPR
	Oral sex in last year	Annual pharyngeal gonorrhea cultures
	Receptive anal intercourse	Annual rectal GC/CT
	High risk MSM*	Q3-6 month RPR, rectal C/CT+pharyngeal GC
Women	Sexually active in last year	Cervical GC/CT nucleic acid amplification test (NAT) or urine NAT for GC/CT; screening interval based on risk assessment of woman

*MSM with anonymous or multiple partners , users of crystal methamphetamine or inhaled nitrites ("poppers"), or men whose sex partners participate in these activities.

Immunizations

Criteria

Action

All patients

Pneumovax baseline and q5years

Annual influenza

Diphtheria/tetanus every ten years (3 dose series, if not given in childhood)

PPD: on intake or annual if at risk (homeless or communal living)

MMR: for patients with medical/exposure indications; if titers negative give two doses at least 28 days apart (if CD4≤200 withhold MMR or other measles containing vaccine)

Hyperlipidemia

Criteria	Action
Age≥35 or soon to initiate HAART	Check lipid panel See lipid section in guidelines for management of specific abnormalities

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