Harrisons Manual of Medicine, 18th Ed.

CHAPTER 213. Routine Disease Screening

A primary goal of health care is to prevent disease or to detect it early enough that interventions will be more effective. In general, screening is most effective when applied to relatively common disorders that carry a large disease burden and have a long latency period. Early detection of disease has the potential to reduce both morbidity and mortality; however, screening asymptomatic individuals carries some risk. False-positive results can lead to unnecessary lab tests and invasive procedures and can increase pt anxiety. Several measurements have been derived to better assess the potential gain from screening and prevention interventions:

• Number of subjects needed to be screened to alter the outcome in one individual

• Absolute impact of screening on disease (e.g., lives saved per thousand screened)

• Relative impact of screening on disease outcome (e.g., the % reduction in deaths)

• The cost per year of life saved

• The increase in average life expectancy for a population

Current recommendations include performance of a routine health care examination every 1–3 years before age 50 and every year thereafter. History should include medication use, allergies, vaccination history, dietary history, use of alcohol and tobacco, sexual practices, safety practices (seat belt and helmet use, gun possession), and a thorough family history. Routine measurements should include assessments of height, weight, body-mass index, and blood pressure. Screening should also be considered for domestic violence and depression.

Counseling by health care providers should be performed at health care visits. Tobacco and alcohol use, diet, and exercise represent the vast majority of factors that influence preventable deaths. While behavioral changes are frequently difficult to achieve, it should be emphasized that studies show even brief (<5 min) tobacco counseling by physicians results in a significant rate of long-term smoking cessation. Instruction about self-examination (e.g., skin, breast, testicular) should also be provided during preventative visits.

The top causes of age-specific mortality and corresponding preventative strategies are listed in Table 213-1. Formal recommendations from the U.S. Preventive Services Task Force are listed in Table 213-2.

TABLE 213-1 AGE-SPECIFIC CAUSES OF MORTALITY AND CORRESPONDING PREVENTATIVE OPTIONS

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TABLE 213-2 CLINICAL PREVENTIVE SERVICES FOR NORMAL-RISK ADULTS RECOMMENDED BY THE U.S. PREVENTIVE SERVICES TASK FORCE

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In addition to the general recommendations applicable to all persons, screening for specific diseases and preventive measures need to be individualized based on family history, travel history, or occupational history. For example, when there is a significant family history of breast, colon, or prostate cancer, it is prudent to initiate screening about 10 years before the age at which the youngest family member developed cancer.

Specific recommendations for disease prevention can also be found in subsequent chapters on “Immunization and Advice to Travelers” (Chap. 214), “Cardiovascular Disease Prevention” (Chap. 215), “Prevention and Early Detection of Cancer” (Chap. 216), “Smoking Cessation” (Chap. 217), and “Women’s Health” (Chap. 218).

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For a more detailed discussion, see Martin GJ: Screening and Prevention of Disease, Chap. 4, p. 29, in HPIM-18.