1.3 Preventive Health, Immunization & Well-Patient Screening
Key Takeaways
- USPSTF cancer screening guidelines recommend biennial mammography for women aged 40–74, and cervical cancer screening for women aged 21–65 (cytology every 3 years for 21–29; cytology every 3 years or hrHPV co-testing/alone every 5 years for 30–65).
- USPSTF colorectal cancer screening is recommended for adults aged 45–75 (colonoscopy every 10 years or FIT annually); annual low-dose CT lung cancer screening is indicated for adults aged 50–80 with a >=20 pack-year smoking history who currently smoke or quit within 15 years.
- Cardiovascular primary prevention includes one-time abdominal aortic aneurysm (AAA) ultrasound for men aged 65–75 who ever smoked, and primary statin therapy for adults aged 40–75 with >=1 risk factor and 10-year ASCVD risk >=10%.
- Adult immunizations include annual influenza vaccine, pneumococcal vaccination (PCV20 or PCV15+PPSV23) for adults >=65 or with risk factors, 2-dose Recombinant Zoster Vaccine for adults >=50, and Tdap booster every 10 years (and during every pregnancy at 27–36 weeks).
- Osteoporosis DEXA bone density screening is recommended for all women aged >=65 (or younger postmenopausal women with elevated FRAX risk); a T-score <= -2.5 defines osteoporosis.
Last updated: July 2026
Evidence-Based Preventive Health Screening
Preventive medicine focuses on reducing disease incidence (primary prevention) and detecting asymptomatic disease early to improve clinical outcomes (secondary prevention). The United States Preventive Services Task Force (USPSTF) assigns letter grades (A, B, C, D, I) to preventive interventions. Grade A and B recommendations are high-yield standards tested extensively on the USMLE Step 2 CK.
USPSTF Cancer Screening Recommendations
| Malignancy | Target Population | Screening Modality & Interval | Discontinuation Criteria |
|---|---|---|---|
| Breast Cancer | Women aged 40–74 years | Biennial (every 2 years) screening mammography | Age >=75 years, or life expectancy <10 years |
| Cervical Cancer | Women aged 21–65 years | 21–29 yrs: Cervical cytology (Pap) every 3 years.<br>30–65 yrs: Cytology every 3 yrs, OR hrHPV co-testing every 5 yrs, OR hrHPV alone every 5 yrs. | Age >65 yrs with adequate prior negative screening; hysterectomy with cervix removal for benign disease |
| Colorectal Cancer | Adults aged 45–75 years | Colonoscopy every 10 yrs, OR FIT (Fecal Immunochemical Test) annually, OR sDNA-FIT (Cologuard) every 1–3 yrs, OR CT colonography every 5 yrs. | Age 76–85 yrs (individualized based on health status); discontinue at age >85 yrs |
| Lung Cancer | Adults aged 50–80 years with >=20 pack-year smoking history | Annual low-dose computed tomography (LDCT) of the chest | Quit smoking >=15 years ago, or develops health problem limiting life expectancy/surgical candidacy |
| Prostate Cancer | Men aged 55–69 years | Individualized PSA-based screening (Grade C recommendation) | Age >=70 years |
Cardiovascular and Metabolic Risk Screening
Cardiovascular disease and diabetes mellitus screening enables early pharmacological and lifestyle interventions to prevent target organ damage.
Screening Parameters & Indications
| Disease Entity | Target Population | Screening Parameter / Modality | Clinical Thresholds & Action |
|---|---|---|---|
| Abdominal Aortic Aneurysm (AAA) | Men aged 65–75 years who have ever smoked (>=100 cigarettes lifetime) | One-time abdominal ultrasound | Repair considered if AAA diameter >=5.5 cm or expanding >0.5 cm in 6 months |
| Hypertension (HTN) | Adults aged >=18 years | Office blood pressure measurement (confirm with out-of-office ABPM/HBPM) | BP >=130/80 mmHg defines stage 1 HTN (ACC/AHA guidelines) |
| Type 2 Diabetes Mellitus | Adults aged 35–70 years who are overweight/obese (BMI >=25 kg/m²; >=23 in Asian Americans) | Fasting plasma glucose, HbA1c, or 2-hour oral glucose tolerance test (OGTT) | Fasting glucose >=126 mg/dL, HbA1c >=6.5%, or 2-hr OGTT >=200 mg/dL establishes T2DM diagnosis |
| Lipid Screening / Statin Therapy | Adults aged 40–75 years without history of CVD | Fasting lipid panel; calculate 10-year ASCVD risk score | Initiate moderate-intensity statin if patient has >=1 CVD risk factor (HTN, DM, smoking, dyslipidemia) AND 10-yr ASCVD risk >=10% |
| Osteoporosis | Women aged >=65 years (or postmenopausal women <65 with elevated FRAX risk) | Dual-energy X-ray absorptiometry (DEXA) scan at femoral neck/lumbar spine | T-score <= -2.5 defines osteoporosis; T-score between -1.0 and -2.49 defines osteopenia |
Adult Immunization Schedules and Special Populations
Vaccination is a cornerstone of primary prevention. ACIP guidelines establish routine schedules and high-risk indications.
Summary of High-Yield Adult Vaccines
| Vaccine | Target Population & Schedule | Special Risk Groups & Contraindications |
|---|---|---|
| Influenza | Annual dose for all individuals >=6 months of age | Inactivated (IIV) or Recombinant (RIV) for age >=65; Live Attenuated (LAIV, intranasal) is contra-indicated in immunocompromised, pregnant, or age >=50 |
| Pneumococcal | Adults >=65 years, or adults 19–64 years with risk factors (chronic heart/lung/liver disease, DM, smoking, alcoholism, asplenia, immunocompromise) | Option A: Single dose of PCV20 alone.<br>Option B: PCV15 followed by PPSV23 >=1 year later (>=8 weeks later for asplenia/immunocompromise) |
| Varicella-Zoster (Shingrix) | Recombinant Zoster Vaccine (RZV) 2-dose series for adults >=50 years (given 2–6 months apart) | Indicated regardless of prior herpes zoster episode or prior live zoster (Zostavax) vaccination; non-live vaccine safe in immunocompromised |
| Tetanus, Diphtheria, Pertussis | Tdap single dose once for all adults, then Td or Tdap booster every 10 years | Administer 1 dose of Tdap during EVERY pregnancy between 27 and 36 weeks gestation (regardless of prior Tdap history) |
| Human Papillomavirus (HPV) | Routine at age 11–12; catch-up through age 26 years for all adults (shared decision-making for ages 27–45) | 2-dose series if started before age 15; 3-dose series (0, 1–2, 6 months) if started at age >=15 or in immunocompromised patients |
| Hepatitis B | All adults aged 19–59 years (and adults >=60 with risk factors) | 3-dose series (Engerix-B, Recombivax HB) or 2-dose series (Heplisav-B); screen for HBsAg, anti-HBs, anti-HBc in high-risk patients |
Behavioral Health & Well-Patient Screening Algorithm
[ Routine Adult Well-Patient Visit ]
|
+--------------------------+--------------------------+
| |
[ Depression Screening: PHQ-2 ] [ Alcohol Screening: AUDIT-C / CAGE ]
(Little interest + Feeling down) (Frequency, quantity, binge drinking)
| |
+-----+-----+ +-----+-----+
| | | |
[ Negative ] [ Positive (>=1) ] [ Negative ] [ Positive (>=3 M, >=2 F) ]
| | | |
Continue Administer **PHQ-9** Continue Administer full **AUDIT**
routine - Score >=10: Major Depression routine - Brief behavioral counseling
care - Assess suicidal ideation care - Pharmacotherapy if AUD
(Naltrexone, Acamprosate)
Clinical Management Rules
- Universal Depression Screening: USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women, using the PHQ-2 followed by the PHQ-9.
- Unhealthy Alcohol Use: Screen all adults >=18 years using AUDIT-C or single-question screening ("How many times in the past year have you had 5 [for men] or 4 [for women] or more drinks in a day?"). Provide brief behavioral counseling interventions to patients engaging in risky or hazardous drinking.
Test Your Knowledge
A 55-year-old male with a 30 pack-year cigarette smoking history who currently smokes 1 pack per day presents for a routine preventive health maintenance visit. He has no cough, shortness of breath, or weight loss. Which preventive screening intervention is recommended by the USPSTF for this patient?
A
B
C
D
Test Your Knowledge
A 67-year-old postmenopausal woman with no history of prior fractures presents for a well-woman examination. Physical examination is unremarkable. Dual-energy X-ray absorptiometry (DEXA) screening demonstrates a T-score of -2.7 at the femoral neck. Which of the following is the correct diagnosis and initial management plan?
A
B
C
D