Table Of Contents
Cancer Prevention
| Age | USPSTF Recommendations | Management | |
| Breast Cancer | 50-74 | Mammogram | Surgery and radiation tx – Local treatments used to remove, destroy, or control the cancer cells in a specific area Chemotherapy and hormone therapy – Systemic treatments used to destroy or control cancer cells all over the body. |
| Cervical Cancer | 21-65 | Pap Smears (cytology) q 3y (21-65) Cytology + HPV q 5y (30-65) | Radiation, Chemotherapy and Surgery. Some combined tx Radiation or chemotherapy – used to treat cancer that spread beyond the pelvis (Stage IV) or cancer that has recurred |
| Colon Cancer | 50-75 | FOBT – annually Flexible sigmoidoscopy – every 5 yrs with FOBT every 3 yrs Colonoscopy every 10 years | Surgery and chemotherapy |
| Lung Cancer | 55-80 | Low dose CT 30 pack-yr hx Or quit within past 15 yrs | Non-small cell lung cancer – surgery, chemotherapy, radiation therapy, targeted therapy, or a combination Small cell lung cancer – Surgical resection, radiation therapy and chemotherapy |
| Prostate Cancer | Against digital examination or PSA | Observation or Active Surveillance Surgery Radiation Therapy Cryotherapy Hormone Therapy Chemotherapy | |
| Rectal Cancer | lowest 6 in. of the large bowel | radiation therapy |
| Age | Screening | Management | |
| Abdominal Aortic Aneurysm | men 65-75 who smoking history | Abdominal US once | Open abdominal surgery (removing the damaged section of the aorta, replacing it with a synthetic tube (graft)) Endovascular repair. |
| BMI | 18 Yo or older | BMI = kg (weight)/ m^2 (height) BMI = lbs/in^2 | BMI > 30 should be referred for intensive multicomponent behavioral intervention |
| Hyperglycemia | HbA1c at least 2x per year | Lifestyle modification | |
| Hypertension | measure BP at every visit | Lifestyle mod if BP > 120/80 Medication if BP > 140/90 | |
| Hyperlipidemia | Men > 35 and women >35 Adults > 20 at increased risk for cardiovascular disease | measure fasting lipids at least annually | Statin if LDL > 100 |
| Nephropathy | measure urine microalbumin annually | ACEi or ARBs | |
| Retinopathy | annual dilated eye exam | Laser photocoagulation | |
| Neuropathy | annual foot exam | Pregabalin, duloxetine | |
| Gastroparesis | none | Metoclopramide, erythromycin | |
| Erectile dysfunction | none | PDE inhibitor (sildenafil) |
Vaccines
| Age/Population | Frequency | |
| Hepatitis A Vaccines | Chronic liver disease, use of clotting factors, occupational exposure, IV drug users, homosexual men, travel to endemic areas | 2 doses for long-lasting protection Given at least 6 months apart. 12 – 23 months old. Older children and adolescents after 23 months. |
| Hepatitis B Vaccines | High risk exposure: health care workers, exposure to blood products, dialysis patients, IV drug users, multiple sexual partners or recent STD, homosexual activity, diabetes not previously immunized | 1st Shot – Any Time (newborns receive at the delivery room) 2nd Shot – At least one month (or 28 days) after the 1st shot. 3rd Shot – At least 4 months (16 weeks) after the 1st shot (and at least 2 months after the 2nd shot). |
| Influenza Vaccines | 6 months and > | Annually |
| Meningococcal vaccine | High risk groups: college/dormitory residents and military recruits, complement deficiency, asplenia, travel to countries where endemic | 1 primary dose – MenACWY vaccines (Menactra or Menveo) at 11 – 12 Yo. 1 booster dose at 16 Yo Min. interval between doses is at least 8 weeks. |
| Pneumococcal Vaccines | All adults > 65 | PCV13 (Prevnar13) PPSV23 (Pneumovax23): all > 65 PCV13 65 or > (no prev dose) PPSV23 at least 1 year later |
| Shingles Vaccines | 50 and > | 2 doses of Shingrix 2 to 6 months apart Shingrix – strong protection against shingles and PHN, preferred over zostavax |
| Pertussis | Adults 19-65 | Tdap vaccine No Td past 10 years No Tdap as adult Healthcare workers, childcare providers,close contact infants < 1 year |
| Varicella Vaccines | No hx of immunization Seronegative on testing At risk for exposure | 2 doses 1st dose – 12-18 months 2nd dose – 4-6 Yo Older children and adults 2 shots, with 4-8 weeks between the 1st and 2nd shots. |
Vaccines during Pregnancy
| Safe | Wait until after pregnancy |
| Tdap Influenza IV Hep A, if at risk Hep B, if at risk Meningococcal, if indicated Pneumococcal polysaccharide, if indicated | MMR Varicella HPV Influenza LAV |
Smoking
- Smoking Cessation Treatment:
- First-line agents – reliably increase long term smoking abstinence rates
- Buproprion (Zyban, Welbutrin) – Rx
- Varenicline (Chantix) – Rx
- Nicotine Gum – OTC
- Nicotine Inhaler – Rx
- Nicotine lozenge
- Nicotine Nasal Spray – Rx
- Nicotine Patch – OTC
- Second-line agents: (Neither FDA approved for this use)
- Clonidine 0.1-0.75 mg/day (transdermal or oral)
- Nortriptyline
- Psychosocial Therapy
- Behavioral Therapy
- Telephone quit line
- First-line agents – reliably increase long term smoking abstinence rates
