These guidelines have been created for the general population who do not currently have symptoms or disease. If you have a pre-existing medical condition like heart disease, asthma, or diabetes, recommendations for certain tests may vary. Please work with your doctor to determine how often certain tests should be performed to maintain your health. These guidelines generally follow nationally recommended guidelines and are not an indication of your coverage.

For more information:
Services
Recommendation
Preventive Health Exam
(includes history, physical exam,
height and weight, risk assessment)		 Age 19-40, every 5 yrs; 41-50 every 3 yrs; 51- 59, every 2 yrs; 60+ every 1-2 yrs
Blood Pressure Age 18-64, at least every 2 yrs (A); age 65+, every 1-2 yrs (Important Notes)
Hearing At age 65 and older, your doctor may ask you about your hearing
Vision Starting at age 65, your doctor may perform a vision test
Screenings
Recommendation
Abdominal Aortic Aneurysm Between ages 65-75, a one-time screening by ultra-son for men who have ever smoked  (B)   (Important Notes)
Colon Cancer Beginning at age 50, every 3-5 years (A); after age 80, at physician and patient discretion (Important Notes)
Diabetes (Type II) All adults with hypertension and hyperlipidemia should be screened for Type II diabetes (B)
Lipid Screening Men and women should complete a fasting lipid profile every 5 years, beginning at age 20
Obesity Screening Discuss body mass index (BMI) with your doctor at preventive health exams (B)    (Important Notes)
STD Testing High risk individuals; testing for Chlamydia, HIV, Syphilis, Gonorrhea (A, B) (Important Notes)
Tuberculosis Infection
(tuberculin skin testing - PPD test) 		Screen high risk – all ages (A) (Important Notes)
Breast Cancer (women) Breast Self-Exam (BSE) Monthly (I) (Important Notes)

Mammography/Clinical Breast Exam beginning at age 40 every 1-2 years (B);
Age 70+ discuss with your doctor (Important Notes)
Cervical Cancer Screening (women)
(pap smear) 		Beginning at age 21 or within 3 years of onset of sexual activity, every 3 years (A) (Important Notes)
Osteoporosis Screening At age 60, routine screening for women at increased risk for osteoporatic fractures (B); at age 65+ routine screening for all women (B). (Important Notes)
Prostate Cancer (men) Beginning at age 50, discuss PSA (prostate specific antigen test) and DRE (digital rectal exam) (I) (Important Notes)
Immunizations
Recommendation
Hepatitis A Determine status; immunize if necessary (Important Notes)
Hepatitis B Determine status; immunize if necessary (Important Notes)
Influenza Annually, beginning at age 50 (at physician discretion) (Important Notes)
Measles / Mump / Rubella All adults born in 1957 or later and other adults consider to be "at risk."   (Important Notes)
Pneumococcus
(pneumonia)		 All adults age 65 and over (Important Notes)
Tetanus-Diphtheria Every 10 years
Varicella (chickenpox) Determine status; immunize if necessary (Important Notes)
Counseling
Recommendation
Advance Directives Your doctor will ask and advise concerning your future health care wishes (Important Notes)
Alcohol use All adults (B)
Calcium Talk to your doctor about how much calcium you get each day, and if a calcium supplement is right for you. (Important Notes)
Dental Health Visit a dental care provider on a regular basis, floss daily, brush teeth daily with a toothpaste that contains flouride, and use mouth rinse to prevent plaque.
Diet Eat a balanced diet (B)   (Important Notes)
Folate Women who are planning to or capable of becoming pregnant are encouraged to take daily multivitamins with folic acid to reduce the risk of neural tube defects.
Hormone Replacement Therapy The routine use of estrogen and progestin for the prevention of chronic conditions in postmenopausal women is NOT recommended.   (D)
Mental health Depression screening / counseling; suicide risk assessment (B)
Physical activity All ages
Smoking cessation All persons who use tobacco. Talk to your doctor about whether nicotene replacement therapy is right for you. (A) (Important Notes)

Strength of Recommendations:

A  =  strongly recommended (there is good evidence that the service improves important health outcomes)

B  =  recommended (there is at least fair evidence that the service improves health outcomes)

C = no recommendation (there is only fair evidence that the service can improve health outcomes.

D = does not recommend/recommends against  (there is at least fair evidence that the service is ineffective or that its harms outweigh its benefits.)

I   = inconclusive (evidence is insufficient to recommend for or against routinely providing the service)

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Important Notes:

Services

Blood Pressure

Adults should receive blood pressure measurements at least every 2 years if their last diastolic and systolic blood pressure readings were below 85 and 140 mm Hg, respectively (A).  Because the risk of high blood pressure increases with age, measurements are recommended every 1-2 years for those 65 and older. 

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Screenings

Abdominal Aortic Aneurysm

  • One-time screening by ultrasonography is recommended in men aged 65 to 75 who have ever smoked [*at least 100 cigarettes in person’s lifetime] (B). 
  • There is no recommendation for or against screening for AAA in men aged 65 to 75 who have never smoked (C). 
  • The USPSTF recommends against routine screening for AAA in women (D). 

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Colon Cancer

Your doctor should review the limitations and risks of the available options with you. These include:

  • Colonoscopy
  • Double Contrast Barium Enema
  • Sigmoidoscopy
  • Fecal Occult Blood Test

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Lipid Screening

  • Routine cholesterol testing should begin in young adulthood (≥20 years of age).
  • Lipid profile test should include total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.  

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Obesity Screening

  • Obese patients should consider programs that offer intensive counseling and behavior modification for optimum weight loss.

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Tuberculosis Infection (tuberculin skin test)

Screening for tuberculous infection by tuberculin skin testing is recommended for all persons at increased risk of developing tuberculosis (TB) (A).

“High risk” includes:

  • Persons infected with HIV, close contacts of persons with known or suspected TB (including health care workers), persons with medical risk factors associated with TB, and residents of long-term care facilities
  • Immigrants from countries with high TB prevalence (most countries in Africa, Asia, and Latin America), medically underserved low-income populations (including high-risk racial or ethnic minority populations)
  • Alcoholics and injection drug user

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Breast Cancer (women)

  • A breast self-examination (BSE) is a simple procedure to help a woman detect breast lumps.
  • Breast self-exams should not replace regular mammograms (if you are have them).
  • For women ages 40 to 69: routine screening for breast cancer every 1-2 years with mammography alone, or mammography and annual clinical breast examination is recommended (B).

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Cervical Cancer Screening (pap smear)

  • Screening with cervical cytology (pap smears) reduces incidence of cervical cancer.
  • Indirect evidence suggests most of the benefit can be obtained by beginning screening within 3 years of onset of sexual activity or age 21 (whichever comes first) and screening at least every 3 years (A).
  • After age 65, talk to your doctor about whether a pap smear is needed (D).

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STD Testing

Chlamydia Infection

  • Routinely screen all sexually active women aged 25 years and younger and other asymptomatic women at increased risk for infection. (A).
  • Age is the most important risk marker. Women under the age of 25 account for the majority of cases. The number of cases is highest in the 15-19 age group.
  • Other risk factors include being unmarried, African-American, having a prior history of sexually transmitted disease (STD), having new or multiple sexual partners, having cervical ectopy, and using barrier contraceptives inconsistently.
  • Re-screening after 6-12 months may be right for previously infected women, because of the high rate of re-infection.

HIV

High risk individuals include:

  • Men who have engaged in sex with other men, men and women who have had multiple sexual partners
  • Men and women who use or have ever used injection drugs and/or have shared drug equipment
  • Men and women receiving blood transfusion or organ transplant during 1978-1985
  • Men and women seeking treatment for any STD (sexually transmitted disease)
  • Men and women who exchanged sex for money or drugs, and their sexual partners

Syphilis

  • Screening persons at increased risk for syphilis infection and pregnant women is strongly recommended (A).
  • Persons at increased risk because of high-risk sexual activities include commercial sex workers, persons who exchange sex for drugs, those with other sexually transmitted diseases (STDs) including HIV, and contacts of persons with active syphilis.

Gonorrhea

  • Routine screening for gonorrhea is recommended for asymptomatic women at high risk of infection (B).
  • High-risk groups include commercial sex workers (prostitutes), persons with a history of repeated episodes of gonorrhea, and young women (under age 25) with two or more sex partners in the last year. There is insufficient evidence to recommend for or against screening high-risk men for gonorrhea (C).  

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Osteoporosis

Women aged 65 and older should be regularly screened for osteoporosis (B).  Routine screening should begin at age 60 for women at increased risk for osteoporotic fractures (B). 

Talk to your doctor about the risk factors for low bone mass, which can be affected by your:

  • Age
  • Activity level
  • Body size (body mass index [BMI])
  • Smoking
  • Alcohol use
  • Ethnicity (Caucasian and Asian women are at highest risk)
  • Family history
  • Calcium intake

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Prostate Cancer (men)

  • High-risk groups include African American men or any man having a first-degree relative who had prostate cancer at an early age.
  • Talk to your doctor about the potential benefits and harms of screening, diagnosis and treatment.

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Immunizations

Hepatitis A

Vaccination is recommended for:

  • Persons traveling to endemic or epidemic settings
  • Men who have sex with men
  • Illegal drug users
  • Persons with chronic liver disease including people with chronic Hep C and B
  • Persons with clotting factor disorders
  • Children and/or staff of child-care facilities where an incident of HAV has been reported (especially where children are in diapers)

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Hepatitis B

Vaccination is recommended for:

  • All adults at increased risk of occupational, environmental, social or family exposure
  • All unvaccinated adolescents
  • Hemodialysis patients
  • Recipients of clotting-factor concentrates
  • People who inject drugs
  • Household contacts and sex partners of those with HBV

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Influenza

Vaccination also is recommended for:

  • Persons > 6 mos. living with at- risk people
  • Persons 6 mos.-50 years of age with chronic cardiovascular, pulmonary or metabolic disorders, renal dysfunction, hemoglobinopathies and immunosuppression
  • Residents/employees of chronic care facilities
  • Women in 2nd or 3rd trimester of pregnancy
  • Health care providers in hospital & outpatient settings

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Measles / Mumps / Rubella

Vaccination also is recommended for:

  • Health care workers
  • College students
  • Women of childbearing age
  • HIV-infected persons without severe immunosuppression
  • International travelers
  • Special attention should be given to women born outside U.S. in 1957 or later.

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Pneumococcus (pneumonia)

Vaccination also is recommended for:

  • Persons 2-64 years of age with chronic cardiovascular or pulmonary disorders, liver disease, alcoholism, diabetes and CSF leaks & chronic renal disorders
  • Adults to age 64 with no spleen, no spleen function, or sickle cell
  • All immunocompromised/ immunosuppressed adults
  • Residents of long-term care facilities
  • Receiving a cochlear implant

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Tetanus-Diptheria

  • Completion of primary 3-dose immunization schedule followed by either single mid-life booster (age 50) or TD booster every 10 years

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Varicella (chickenpox)

  • Adults who have reliable histories of varicella are considered to be immune.
  • Those who do not have such histories are considered susceptible and should be tested to determine immune status. Over two-thirds of adults who do not have a reliable history of varicella are actually immune.
  • Priority should be given to vaccination of adults who are at high risk for exposure and transmitting disease, such as health care workers, teachers of young children, day-care employees, staff in institutional settings, family contacts of immunocompromised persons, non-pregnant women of childbearing age, international travelers.

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Counseling

Advance Directives

  • Advance Directives allow patients’ wishes to drive medical decision making in the event they are unable to communicate.

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Calcium

  • At least 1,200 mg/day calcium is required for most women. 
  • A dietary intake of 400-600 IU of vitamin D is recommended, either through sun exposure or through dietary intake. 

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Diet

  • Major diseases in which diet plays a role include coronary artery disease, some types of cancer, stroke, hypertension, obesity, osteoporosis, and non-insulin-dependent diabetes mullitus.

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Smoking Cessation

  • Tobacco kills more Americans each year than alcohol, drugs, and homicide/suicide combined.
  • The preventive counseling message consists of advising smokers to quit, asking how interested they are in quitting, and providing assistance and follow-up to those interested.

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Source: Rochester Health Commission Guidelines (effective 9/1/05)

Last Updated: November 30, 2005