The 'well-woman' screening guidelines

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Pap smears & annual pelvic exam

• USPSTF and ASCCP recommend cytology screening every 3 years from ages 21 to 29

• From ages 30 to 64, screening can be cytologic every 3 years or cytology with high-risk HPV testing every 5 years (co-testing) 

• Pap testing can be discontinued at age 65 for those who have had previous negative smears

• The same Pap smear screening guidelines should be followed in women who had the HPV vaccine

• Women under 21 may need testing for STIs but that does not include a Pap smear or HPV testing

For more on well-woman exams: Key points for today’s ‘well-woman’ exam: A guide for ob/gyns

NEXT: Testing for HIV

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Testing for HIV

• CDC recommends HIV testing all patients aged 13 to 64 

• Testing should be performed annually on high-risk patients

• High-risk populations include injection-drug users and their sex partners, individuals who exchange sex for money or drugs, sex partners of HIV-infected individuals, and heterosexuals if they or their sex partners have had ≥ 1 sex partner since their most recent HIV test

NEXT: Testing for STIs

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Testing for STIs

• Annual testing for chlamydia and gonorrhea is recommended in sexually active women < 25, and those older who have a new partner, multiple partners or a partner with a STD

• Type-specific HSV testing should be considered in patients who present for STI evaluation 

• Hepatitis C testing should be done on women born between 1945 and 1965 and patients who are at high risk, including individuals on immunosuppressive therapy or hemodialysis or who are HIV-positive

NEXT: Colorectal cancer screening

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Colorectal cancer screening

• ACS recommends screening average-risk patients at age 45 

• Options include colonoscopy every 10 years, computed tomographic colonography or sigmoidoscopy every 5 years, take-home high-sensitivity guaiac-based FOBT or FIT annually, and multitargeted stool-DNA testing every 3 years 

• A positive result on a non-colonoscopy test should trigger colonoscopy 

NEXT: Breast cancer screening

Breast cancer screening

• USPSTF recommends mammography every 2 years for women > 50

• USPSTF does not recommend biannual screening for women aged 40 to 49 but ACP does

• For high-risk women, ACS recommends annual screening with mammography and MRI beginning at age 30 

• ACP recommends mammography every 2 years in patients with life expectancy ≥ 10 years

• After age 75, according to ACP, the decision to continue screening should be based on a patient’s health status

• ACP recommends limiting use of MRI to patients at high risk or to determine disease extent after diagnosis

NEXT: Hypertension, CVD, diabetes

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Hypertension, CVD, diabetes

• The AHA-approved cut-off for diagnosis of hypertension is now 130/80 mg/Hg

• The risk calculator (cvriskcalculator.com) should be used instead of LDL levels to determine whether use of statins is warranted

• To determine need for statins in patients with a 10-year risk of 5% to 20%, coronary artery calcium scoring is recommended by the Society for Cardiovascular Computed Tomography

• Screening for diabetes should be done after pregnancy and in patients who have hypertension, hyperlipidemia or obesity (aged 40-70)

• For patients aged ≥ 45, a baseline fasting blood sugar and repeat screening at least every 3 years thereafter are recommended

• Annual screening is recommended for patients who are overweight or have risk factors for diabetes

NEXT: Osteoporosis screening

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Osteoporosis screening

• BMD should be performed in women > 65 with no risk factors for osteoporosis

• Follow-up testing should be done every 2 to 5 years, depending on risk

• FRAX guidelines should be used to evaluate 10-year risk of fracture