Family Medicine

Cancer Prevention

AgeUSPSTF Recommendations Management
Breast Cancer 50-74MammogramSurgery 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 21-65Pap 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 50-75FOBT – annually
Flexible sigmoidoscopy – every 5 yrs with FOBT every 3 yrs
Colonoscopy every 10 years

Surgery and chemotherapy
Lung Cancer 55-80Low 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 CancerAgainst digital examination or PSAObservation or Active Surveillance
Radiation Therapy
Hormone Therapy 
Rectal Cancerlowest 6 in. of the large bowelradiation therapy
Abdominal Aortic Aneurysmmen 65-75 who smoking historyAbdominal US onceOpen abdominal surgery
(removing the damaged section of the aorta, replacing it with a synthetic tube (graft))

Endovascular repair.
BMI18 Yo or olderBMI = kg (weight)/ m^2 (height)
BMI = lbs/in^2
BMI > 30 should be referred for intensive multicomponent behavioral intervention
HyperglycemiaHbA1c at least 2x per yearLifestyle modification
Hypertensionmeasure BP at every visitLifestyle mod if BP > 120/80
Medication if BP > 140/90
HyperlipidemiaMen > 35 and women >35
Adults > 20 at increased risk for cardiovascular disease
measure fasting lipids at least annuallyStatin if LDL > 100
Nephropathymeasure urine microalbumin annuallyACEi or ARBs
Retinopathyannual dilated eye examLaser photocoagulation
Neuropathyannual foot examPregabalin, duloxetine
GastroparesisnoneMetoclopramide, erythromycin
Erectile dysfunctionnonePDE inhibitor (sildenafil)


Hepatitis A VaccinesChronic liver disease, use of clotting factors, occupational exposure, IV drug users, homosexual men, travel to endemic areas2 doses for long-lasting protection
Given at least 6 months apart.
12 – 23 months old.
Older children and adolescents after 23 months.
Hepatitis B VaccinesHigh 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 immunized1st 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 Vaccines6 months and >Annually
Meningococcal vaccineHigh risk groups: college/dormitory residents and military recruits, complement deficiency, asplenia, travel to countries where endemic1 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 VaccinesAll adults > 65PCV13 (Prevnar13)
PPSV23 (Pneumovax23): all > 65

PCV13 65 or > (no prev dose)
PPSV23 at least 1 year later
Shingles Vaccines50 and >2 doses of Shingrix 
2 to 6 months apart

Shingrix – strong protection against shingles and PHN, preferred over zostavax
PertussisAdults 19-65Tdap vaccine
No Td past 10 years
No Tdap as adult
Healthcare workers, childcare providers,close contact infants < 1 year
Varicella VaccinesNo 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

SafeWait until after pregnancy
Influenza IV
Hep A, if at risk
Hep B, if at risk
Meningococcal, if indicated
Pneumococcal polysaccharide, if indicated
Influenza LAV


  • 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

Metabolic syndrome