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Screening Guidelines - Canada and USA

USPTSF: United States Preventive Services Task Force
CTFPHC: Canadian Task Force on Preventive Health Care

Condition/Patient/Demographic Screening/Intervention Evidence/Sources/Recommendation
Screen for AAA:

USPSTF:

Males aged 65 - 75 who have ever smoked.

CTFPHC:
ALL Men aged 65 - 80. There is no separate recommendation for smokers.
USPSTF & CTFPHC: 1 time abdominal ultrasound.
Screen for Diabetes Mellitus:


USPSTF:

Adults aged 40 - 70 who are overweight or obese without symptoms of diabetes.
  • May Screen earlier if:
    • Family hx of diabetes.
    • Black, American Indians or Alaska natives, Asian American, Hispanics or Latinos, or Native Hawaiians or Pacific Islanders.
    • Personal hx of gestational diabetes or PCOS


CTFPHC:

Based on risk assessment for diabetes in all adults.

Likely unimportant for exam what "risk assessment" is. Click to expand, however if you're a keener.

Copied from here:

FINDRISC (the Finnish Diabetes Risk Score) has been selected as the preferred validated risk calculator, but CANRISK (the Canadian Diabetes Risk Questionnaire) is an acceptable alternative. Factors considered in FINDRISC and CANRISK are age, obesity, history of elevated glucose levels, history of hypertension, family history of diabetes, limited activity levels, and diet with limited intake of fruits and vegetables. The CANRISK questionnaire can be found on the Task Force website or on the PHAC.
USPSTF:
  1. A1C ≥ 6.5%.

  2. OR
  3. FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours*.

  4. OR
  5. 2-hour plasma glucose ≥200 mg/dL (11.1 mmol/L) during an OGTT (75 g).

  6. OR
  7. In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L).


CTFPHC recommends q.3-5years screening and q.1year screening with A1c for those at moderate and high risk, respectively.
Screen for Osteoporosis:


Females aged ≥ 65 years old.

If at risk (use tool to calculate risk) and postmenopausal:

(Risk factors include: - click to expand) (Parental history of fracture, tobacco use, excessive alcohol consumption, low body weight, Caucasian/Not African American, glucocorticoid use, rheumatoid arthritis, never using estrogen therapy. Note: treatment most effective in postmenopausal patients.)

Note:There is no recommendations for screening for osteoporosis by CTFPHC.
USPSTF: Bone measurement testing (DEXA scan or ultrasound).
Screen for Lung Cancer:


USPSTF:

Adults aged 55 - 80 who:
  • 30 pack-year smoking history, OR
  • Quit smoking in the past 15 years.

CTFPHC has the same recs. but in adults aged 55 - 74
USPSTF: Annual low-dose chest CT.

CTFPHC: Annual low-dose chest CT up to 3 consecutive times.
Screen for Colorectal Cancer:


USPSTF AND CTFPHC:

Adults age 50, continue until age 75.

Note: Some sources suggest screening for people 10 yrs prior to diagnosis of CRC in first relative, or 50 yrs old, whichever comes first.

Note: This does not include pts w/ prev. polpys/CRC, IBD, FamHx of hereditary cancer syndromes (e.g. Lynch syndrome).
USPSTF:
  • Colonoscopy q.10 years
  • FOBT q.1years
  • Flex-sig q.5years


CTFPHC:
  • FOBT q.2years
  • Flex-sig q.10 years
  • CTFPHC does not recommend screening with colonoscopy for CRC


Both screening protocols recommend another test FIT (immunochemical) that is not likely to be brought up on the exam.
Screen for Breast Cancer:


USPSTF AND CTFPHC:

Asymptomatic females aged 50 - 75 years old.

In women aged >35 yrs old, AND at increased risk due to:

  • FamHx of BreastCa, OvarianCa, PeritonealCa OR
  • BRCA1/2 mutation hx
Then, genetic counselling and tesitng is recommended.
USPSTF: Biennial mammography, CTFPHC recommends 2 to 3 years.

If at increasd risk, and low risk of side fx, preventative tx may be recommended (i.e.Tamoxifen, Raloxifene, aromatase inhibitors.)
Screen for Cervical Cancer:


USPSTF:

Asx females aged 21 to 65.

CTFPHC: Asx females aged 25-70
USPSTF:
  • In asx females aged 21 to 29:
    • q.3 years with cervical cytology alone.
  • In asx females aged 30 to 65:
    • q.3 years with cervical cytology alone OR
    • q.5 years with high-risk HPV testing alone OR
    • q.5 years cotesting HPV + cervical cytology

CTFPHC just recommends cervical cancer screening q.3 years in target population.

Note: The rest of the recommendations are mostly lifestyle counselling, such as smoking, alcohol cessation or STD screening/contraceptive use in at-risk individuals.
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