Prophylactic screening and vaccinations in adults.

Explanation:

Cancer screening:

Breast: Self examination of breast - 1 week after menses are over, done every month. Doctor checks every year. Mammography starts at age of  40 (some say 50) and is done every 1-2 years.

Cervix: Revised 1/31/04 : Pap done 3 years after patient starts vaginal intercourse or at 21 years whichever is earlier. If a liquid based pap is done, screen every 2 years. If conventional slide test is done, then every year.  After age 30, one may increase interval to 3 years after 3 consecutive normal smears. Can discontinue after age 69 if previously normal. Can discontinue if hysterectomy done for benign reasons.
A new option is that patients over 30 should also get an HPV screen. If both HPV and Pap are normal, can increase interval to 3 years. (Negative predictive value over 99%).

Colon: Rectal exam done every year after the age of 40. Check for occult blood in stool every year. preferably 3 times in the year. Sigmoidoscopy every 3 years after the age of 50 unless there is family history in 2 or more first degree relatives before age 60 - in which case, colonoscopy begins at age 10 years younger than the index relative or age 40 (whichever comes first). Post curative resection for cancer patient gets a  colonoscopy within 1yr. Then 3yrs then every 5 yrs thereafter assuming no new malignancy or polyps are found.

Prostate: DRE (digital rectal exam) and PSA after the age of 50, done every year. For details, click here