Routine Disease Screening
Harrison’s Manual of Medicine 19th edition provides 600+ internal medicine topics in a rapid-access format. Download Harrison’s App to iPhone, iPad, and Android smartphone and tablet. Explore these free sample topics:
-- The first section of this topic is shown below --
A primary goal of health care is to prevent disease or to detect it early enough that interventions will be more effective. In general, screening is most effective when applied to relatively common disorders that carry a large disease burden and have a long latency period. Early detection of disease has the potential to reduce both morbidity and mortality; however, screening asymptomatic individuals carries some risk. False-positive results can lead to unnecessary laboratory tests and invasive procedures and can increase pt anxiety. Several measurements have been derived to better assess the potential gain from screening and prevention interventions:
- Number of subjects needed to be screened to alter the outcome in one individual
- Absolute impact of screening on disease (e.g., lives saved per thousand screened)
- Relative impact of screening on disease outcome (e.g., the % reduction in deaths)
- The cost per year of life saved
- The increase in average life expectancy for a population
As part of a routine health care examination, history should include medication use, allergies, vaccination history, dietary history, use of alcohol and tobacco, sexual practices, safety practices (seat belt and helmet use, gun possession), and a thorough family history. Routine measurements should include assessments of height, weight, body-mass index, and blood pressure. Screening should also be considered for domestic violence and depression.
Counseling by health care providers should be performed at health care visits. Tobacco and alcohol use, diet, and exercise represent the vast majority of factors that influence preventable deaths. While behavioral changes are frequently difficult to achieve, it should be emphasized that studies show even brief (<5 min) tobacco counseling by physicians results in a significant rate of long-term smoking cessation. Instruction about self-examination (e.g., skin, breast, testicular) should also be provided during preventative visits.
The top causes of age-specific mortality and corresponding preventative strategies are listed in Table 201-1. Formal recommendations from the U.S. Preventive Services Task Force are listed in Table 201-2.
|Age Group||Leading Causes of Age-Specific Mortality||Screening Prevention Interventions to Consider for Each Specific Population|
As above plus consider the following:
As above plus consider the following:
|Test or Disorder||Population,a Years||Frequency|
|Abdominal aortic aneurysm (ultrasound)||Men 65–75 who have ever smoked||Once|
|Human papillomavirus (HPV)||Up to age 26||If not done prior|
|Measles, mumps, rubella (MMR)||Women, childbearing age||One dose|
|Tetanus-diphtheria (Td)||>18||Every 10 years|
|Varicella (VZV)||Susceptibles only, >18||Two doses|
|Blood pressure, height and weight||>18||Periodically|
|Breast cancer (mammography and clinical breast examination)a||Women 50–75||Every 2 years|
|Cervical cancerc||Women 21–65||Every 3 years|
|Pap smear||Women 30–65||Every 5 years if|
|Pap smear and HPV testing||HPV negative|
|Chlamydia/Gonorrhea||Sexually active women <25||Unknown|
|Cholesterol||Men >35||Every 5 years|
|Women >45||Every 5 years|
|Colorectal cancera fecal occult blood and/or sigmoidoscopy or colonoscopy||50–75|
|Every 5 years|
|Every 10 years|
|Diabetes||>45 or earlier, if there are additional risk factors||Every 3 years|
|Hepatitis C||Adults born between 1945–1965||Once|
|Intimate partner violence||Women of childbearing age||Unknown|
|Obesity (BMI)||All adults||Unknown|
|Osteoporosis||Women >65; >60 at risk||Unknown|
In addition to the general recommendations applicable to all persons, screening for specific diseases and preventive measures need to be individualized based on family history, travel history, or occupational history. For example, when there is a significant family history of breast, colon, or prostate cancer, it is prudent to initiate screening about 10 years before the age at which the youngest family member developed cancer.
Specific recommendations for disease prevention can also be found in subsequent chapters on “Cardiovascular Disease Prevention” (Chap. 202), “Prevention and Early Detection of Cancer” (Chap. 203), “Smoking Cessation” (Chap. 204), and “Women’s Health” (Chap. 205).