Secondary Prevention: Periodic Assessment and Screening

SECONDARY PREVENTION: PERIODIC ASSESSMENT AND SCREENING

Periodic assessments conducted at regular intervals (e.g., annually) are an integral part of preventive health care and include screening, evaluation, and counseling. Recom-mendations for periodic health assessments and screening are segregated by age group and are based on risk factors . Assessment should include a thorough medical history, physical examination, and laboratory testing.

The findings elicited from the history and physical examination and results of laboratory tests help guide interventions and coun-seling and may reveal additional risks that require targeted screening or evaluation.

The recommendations presented in Appendix B have been selected from many sources. A variety of factors have been considered in recommending the assessments and screening tests, such as the leading causes of morbidity and mortality in each age group. Other factors are chronic health conditions that limit activity of working-age adults in the United States, such as arthritis or other muscu-loskeletal disorders, and circulatory disorders that become more prevalent as women age.

Characteristics of Screening Tests

The principle behind routine screening is to detect the pres-ence of disease in asymptomatic individuals without specific risk factors. The diseases screened for should be prevalent in the population and amenable to early intervention. Screen-ing tests are currently available for a variety of cancers, meta-bolic disorders, and sexually transmitted diseases. Examples of screening tests are the Pap test and mammography

Not every disease can be detected by screening, and screening is not cost-effective or feasible for every disease. The concepts of sensitivity and specificity are used to de-scribe the efficacy of screening tests in detecting a dis-order. The sensitivity of a test is the proportion of affected individuals that test positive on the screening test. The specificity is the proportion of unaffected individuals that test negative on the screening test. An effective screening testshould be both sensitive (it has a high detection rate) and specific (it has a low false-positive rate). Other criteria for effectivescreening tests pertain to the population being tested and the disease itself (Box 2.2).

Cancer Screening

Tests are available to detect some, but not all cancers. There is no screening test with the requisite sensitivity and speci-ficity to detect ovarian cancer. Women should be educated about the early signs and symptoms of ovarian cancer that may aid in earlier diagnosis. Likewise, screening tests are not avail-able for endometrial, vaginal, or vulvar cancers. Endome-trial cancer can often be diagnosed at an early stage based on symptoms.

Endometrial, vulvar, and vaginal biopsies are not screening tests.