Guide to Clinical Preventive Services

Screening
SERVICE
WHO NEEDS
HOW OFTEN
COMMENTS
Blood pressure measurement to detect hypertension All adults. Periodic screening. Optimally once every 1-2 years for those with normal blood pressure. Those with elevated blood pressure need to be under medical care.
Cholesterol measurement All adults. At least once every 5 years, but more frequently if total number is elevated, HDL is low, and/or you have cardiac risk factors. The Task Force and some other experts recommend screening only for men aged 35-65 and women aged 45-65, but we advise screening for all adults.
Pap smear (for early detection of cervical cancer.) All women with a cervix, starting at age 18 or earlier if sexually active. Every 3 years. Possibly more often, depending on risk factors such as smoking or multiple sex partners. Some experts advise that women who have never had an abnormal result can stop being screened at age 65.
Breast cancer screening (mammogram and clinical breast exam) All women aged 50 and over; those 40-49 should discuss their risk factors with their clinicians. Annually. Medicare reimburses only for every other year. There is debate about screening those in their forties; the National Cancer Institute recommends age 40 and over.
Colorectal cancer screening (fecal occult blood test and/or sigmoidoscopy) Everyone aged 50 and over; earlier in those at high risk. Occult blood test annually; sigmoidoscopy every 3-10 years on professional advice. There's still debate about the usefulness of occult blood testing. Digital rectal exam may also be done.
Prostate cancer screening (prostate specific antigen, or PSA test, and digital rectal exam) Routine screening is not recommended. However, men over 50 who are black or have a family history should consider testing. On professional advice. Usefulness of PSA test for screening all men remains controversial.
Thyroid disease screening People over 60, especially women, should discuss with their clinician. On professional advice. If you don't have symptoms, there may be no reason to be tested.
Glaucoma screening People at high risk: those over 65, very nearsighted, or diabetic; blacks over 40; those with a family history On professional advice of eye specialist. Many eye specialists advise screening all adults starting at age 40 or 50.
Dental checkup All adults. On professional advice. Should include cleaning.

Immunizations
SERVICE
WHO NEEDS
HOW OFTEN
COMMENTS
Tetanus/diphtheria booster All adults. Every 10 years. People over 50 are least likely to be adequately immunized.
Influenza vaccine Everyone 65 and over, people with lung or heart disease or cancer, and other at high risk. Annually, in the fall. Even healthy younger adults can benefit and should consider getting the shot, according to a 1995 study.
Pneumococcal vaccine Everyone 50 and over, and others at high risk for complications. At least once. Effective against most strains of pneumonia; lasts at least 5-10 years.
Rubella vaccine All women of childbearing age. Once. Avoid during pregnancy.
Hepatitis B vaccine All young adults, as well as adults at high risk On professional advice. All newborns should be vaccinated.

Counseling
SERVICE
WHO NEEDS
HOW OFTEN
COMMENTS
Counseling for substance use, diet and exercise, injury prevention, sexual health and dental health. All adults. Every 1-3 years.