CORE: Adult Preventive Health
Goal: Understand adult male and female preventive health screening and vaccines.
Objectives:
Review USPSTF recommendations for adults
Share smartphrases for adult health maintenance visits
Brief overview of adult vaccination schedule
Particular focused discussion on PSA, breast cancer screening
Review colon cancer screening modalities
Female:
Pat A Nicolau (she/her/hers) is a 42 year old white woman who comes to your office to establish care and for complete physical examination. Her last Pap smear was 3 years ago, which she reports was “normal.” She denies a history of abnormal Pap smears.
At what age do you start performing screening pap smears? How often? Does she need a pap today? If so, how would you order it?
Do you perform a pelvic exam along with the remainder of your physical exam?
Pat has specific questions about breast cancer screening and wants to know when you recommend her first mammogram.
What additional questions would you ask?
What recommendations for screening mammography exist through various professional societies? (USPSTF, ACS, ACOG, American Society of Breast Surgeons)
How would you counsel her about her breast cancer risk?
She is currently sexually active with a new male partner over the last 6 months. She uses condoms occasionally. She is interested in routine STI testing today.
What would you consider for routine STI screening for this patient?
How would you counsel her on her contraceptive options? Including durations of time, side effects, contraindications? What if she wants to get pregnant in a year?
What are her options for emergency contraception?
Any other screening labs interested in performing today?
What are the other USPSTF A and B recommendations for this patient?
What vaccinations would you recommend for this patient/would want to make sure they are up to date on?
Male:
Patient XY is a 66 year old Black man who is well known to your practice but rarely comes into the office. He presents for an annual physical exam. You review his chart and note that he has no colon cancer screening on record. He smokes a pack of cigarettes daily for the last 50 years and enjoys the occasional Cuban cigar.
He is wondering if he should get that PSA test that all his male friends are talking about.
What are risk factors for prostate cancer?
What recommendations for prostate cancer screening exist through various professional societies?
What shared decision-making tools could you use to help him make a decision about prostate cancer screening?
What does his smoking put him at greater risk of? How does this change the USPSTF guidelines for this patient?
He has never been screened for colon cancer. What are the possible methods for colon cancer screening?
Any other screening labs interested in performing today?
What vaccinations would you recommend for this patient/want to make sure they were up to date on?
Recommended Resources:
ASCCP
USPSTF app
PSA recommendation for various societies
Healthlink practice - Health Decision tool