The Medical Minute: Volume 1, Number 8

There are three levels of preventive care. The first is “primary prevention.” This approach focuses on preventing disease before it develops, including “preventing exposures to hazards that cause injury or disease, altering unhealthy or unsafe behaviors, and increasing resistance to disease or injury should exposure occur.” (Institute for Work & Health, n.d.).

“Secondary prevention” is directed toward reducing the impact of a disease or injury that has already occurred. This is achieved through medical screening, detection, and early intervention.

In “tertiary prevention,” an existing disease is managed to prevent complications or further damage. A great example of this approach is diabetes care, focusing on blood sugar control, and encouraging frequent exercise to prevent cardiovascular disease.

The U.S. Preventive Services Task Force (USPSTF) publishes recommendations about clinical preventive services. Its published list can be found on the USPSTF website. The following are some of the important preventive service recommendations one might expect during a primary care visit. Many of these recommendations are dependent on age and gender assigned at birth.

For Cis Women, Trans Men, and Others Assigned Female at Birth:

• Breast exam: A breast exam should be done at each annual physical exam. Women should be instructed on breast self-examination techniques as well.
• Cholesterol: Testing for cholesterol should begin at age 45. If there is a strong family history of diabetes or heart disease, screening may occur sooner (as early as age 20).
• Mammogram: In women with a low/average risk, screening is recommended every two years between the ages of 50 and 74. Earlier screening may be recommended in persons with a family or personal history.
• Osteoporosis: Bone density testing should begin around age 65. Certain medical conditions may lead to earlier testing.
• Pap smear: Pap smear is a screening for cervical cancer and should begin at age 21. Screenings should occur every three years until age 30 and then every five years until age 65.

For Cis Men, Trans Women, and Others Assigned Male at Birth:

• Abdominal Aortic Aneurysm: This is a one-time screening recommended for all men ages 65-75 who have ever smoked. The test is done with an abdominal ultrasound.
• Cholesterol: Testing for cholesterol should begin at age 35 for men. If there is a strong family history of diabetes or heart disease, screening may occur sooner (as early as age 20).
• Prostate cancer screening: The prostate-specific antigen (PSA) and digital rectal exam for prostate cancer are no longer recommended. Men should have a discussion with their primary care provider for recommendations. Screenings may be advised for men starting at age 50 or as early as age 40 for those with a strong family history.
• Testicular exam: Recommended at each annual physical examination. Men should be instructed on testicular self-exam.

For All:

• Blood Pressure: Screening for high blood pressure is an important aspect of cardiovascular health. Along with all other screening tests, blood pressure control can prevent cardiovascular damage.
• Colon cancer: Testing for colon cancer should begin at age 50. It may be required sooner depending on family history.
• Depression: Depression screening is recommended at each visit to a primary provider.
• Diabetes: Screening should occur for anyone who has a family history or risk factors for diabetes (i.e. overweight, high blood pressure, high cholesterol). Screening is best done with a fasting Hgb A1C test.
• Hepatitis C: All individuals born between 1945 and 1965 should have a one-time screening test for hepatitis C.
• Lung cancer: Screening by CT scan of the lungs is recommended for any person ages 55-80 who are current smokers or those with a strong history of smoking.
• Vaccinations: All adults should be vaccinated throughout their lifetime. The primary care provider will make recommendations regarding vaccinations based upon the patient’s age.

Be empowered to take control over your health through disease prevention. See your primary provider annually and get screening tests that will help you avoid or control disease. Exercise regularly, maintain a healthy weight, avoid smoking, and keep your alcohol intake moderate. You play a vital role in preventive care. Together with your primary care provider you can eliminate risk factors and ultimately change your health for the better.