1. Prevention and Screening Tests in the Elderly
Nick Butler

2. Geriatric syndrome screening
Areas of Prevention
Immunizations
Cancer
Cardiovascular
Metabolic
Infectious
Geriatric syndrome screening
Don’t screen for these

3. You have "outlived science.”
Jerry Jogerst MD

4. United States Preventative Services Task Force
U.S. Preventative Services Task Force.
Last Accessed 4/12/2017

5. Immunization
National Center for Immunization and Respiratory Diseases

6. Cancer Screening Colorectal cancer screening
USPSTF Grade A recommendation
Start at age 50 for average risk individuals
Stool-based testing (FIT, ect), direct visualization and serology test (SEPT9 DNA) are viable
76-85 yo have small benefit if previously screened
Consider 10 year prognosis when screening age >75
USPSTF does recommend ASA for colorectal cancer prevention in average-risk individuals

7. Cancer Screening Lung Cancer Screening USPSTF Grade B recommendation
Adults with > 30 pack-year hx
Current smoker or quit in past 15 yrs
Also supported by American Association of Thoracic Surgery, American Cancer Society, American College of Chest Physicians/ American Society of Clinical Oncology, Canadian Task Force on the Periodic Health Examination, National Comprehensive Cancer Network
Some differences in age to stop screening but otherwise similar.
Start screening age 55 with 30 pack/year averted 521 lung cancer deaths with 24 radiation induced lung cancer deaths

8. Cancer Screening Breast cancer screening USPSTF Grade B for age 50-74
Routine Mammography
Start age 50 in average risk individuals
Q 1-2 years but varies by society/group (USPSTF q2yr)
Screen to age 74.
ACOG, ACR, ACS recommends screening after 75 if patient thought reasonably healthy and candidate for treatment
BRCA only if family history has associated risk

9. Cancer Screening Prostate cancer screening
USPSTF recent change to grade C was grade D
No apparent improvement in all cause mortality
NNH:
1 in 5 underwent prostate biopsy for false-positive
1 in 34 developed ED by prostate cancer tx
1 in 56 developed urinary incontinence by tx
Controversial
Autopsy studies show 2/3 older men have asymptomatic prostate cancer
Inform and discuss risk and benefits with your patients
Quaas, Joshua. PSA Screening for prostate cancer. Am Fam Physician. May 2015

10. Cancer Screening Cervical cancer screening Grade A for women 21-65
Stop screening age 65 or post hysterectomy (benign disease)

11. Unhelpful or harmful screening
Ovarian cancer screening (D)
Pancreatic cancer screening (D)
Bladder cancer screening (I)
Whole body PET/CT for general cancer screening (D)
Colon cancer screening age > 85 (D)

12. Cardiovascular Screening
Blood pressure
USPSTF Grade A for yearly age > 18
Grade A for home monitoring

13. Cardiovascular Screen
Abdominal aortic aneurysm
USPSTF grade B
Men who have ever smoked
Men never smoked grade D
Women who have never smoked grade D
Women who have smoked grade I
Screen by abdominal ultrasonography
One time screening
Ever smoke = > 100 cigarettes in lifetime

14. Cardiovascular Screening
Lipid testing and treatment
Lipid testing every 5 years, more often if risk factors
USPSTF Grade B for statins in primary prevention with atherosclerotic cardiovascular disease (ASCVD) risk > 10%
USPSTF Grade C for statins in primary prevention with ASCVD %

15. Unhelpful or Harmful screening
Carotid Artery Stenosis (D)
EKG for heart disease in low risk adults (D)
Vit E or B-carotene for CAD prevention (D)
CAD screening with non-traditional risk factors (I)
PAD asymptomatic assessment with ABI (I)

16. Metabolic screening Diabetes Mellitus Grade B
40-70 yo overweight or obese
HbA1c, glucose tolerance test
Limited evidence on interval of screening
Every 3 years is reasonable

17. Metabolic Screening Osteoporosis Grade B
65+ or younger if risk factors
Smoker, alcohol use, parental fracture hx, low BMI, ect.
Duel-energy x-ray absorptiometry (DEXA)
FRAX tool
Treat if osteopenia with hip fracture risk >3% or major fracture >20%

18. Metabolic Screening Unhelpful or harmful
Vitamin D deficiency screening in asymptomatic – I
MVI for CVD and cancer prevention – I
Thyroid in asymptomatic - I

19. Infectious screening Syphilis grade A if increased risk
Chlamydia grade B if at risk
Gonorrhea – grade B if at risk
Hepatitis B – grade B if at high risk
Hepatitis C – grade B if high risk or born
TB – if at increased risk

20. Geriatric syndromes screening
Fall Prevention
Exercise for community-dwelling age >65 grade B
Vitamin D supplement for community-dwelling grade B
Inquire about falls – Yearly

21. Geriatric syndromes screening
Depression screening
USPSTF Grade B recommendation
Memory screening
Not endorsed by USPSTF for all patients
Yearly for patients of concern
Hearing impairment screening
Yearly
Visual impairment screening

25. Unhelpful/Harmful Screening
Menopausal hormone therapy for primary prevention – E&P or Estrogen alone (D)
COPD screening in asymptomatic adults (D)
Asymptomatic bacteriuria (D)

26. A Great Reference USPSTF age and risk based guidelines