#1 - USPSTF Recommendations (2025 Update)

Hey Gabby, what are you doing to prepare for the Family Medicine shelf exam? Hey Shria, I've been using High-Yield Family Medicine. High-Yield Family Medicine, what's that? Oh, it's this great new question bank with over 500 practice questions. It covers pretty much everything you need to know in order to ace the Family Medicine shelf exam. And the best part? It's only 30 bucks a month. 30 bucks a month? That's amazing. I love doing practice questions. For those big named companies, charge hundreds. How do I sign up? It's easy. Just go to patreon.com/highyieldfamilymedicine. Follow the link and you're good to go. Hello and welcome to episode one of the High-Yield Family Medicine Podcast. In this episode, we're going to be doing an overview of some of the most high-yield things you need to know for the NBME as it pertains to screening guidelines. Specifically, the latest recommendations from the United States Preventive Services Task Force, or USPSTF. The USPSTF is a trusted organization that provides evidence-based guidelines for preventive medicine. Their recommendations are a cornerstone of Family Medicine, and frequently appear on the shelf exam. And so it's very important that you know these guidelines like the back of your hands before showing up for test day. This episode is actually a re-upload back from years ago from when I recorded my first episode. And this is because the guidelines are constantly being updated, and now this episode is reflecting the most current guidelines as of January 2025. If you're finding this information helpful, please consider subscribing. If you subscribe right now, you'll be helping the algorithm to reach other students who may also find it helpful. Thank you. And now my friends, let's begin our discussion on the USPSTF recommendations. Okay, so in order to get the questions correct on the exam, as it pertains to screening guidelines, there's really no other way to do it other than just memorizing the guidelines. Unlike many other aspects of medicine, it's very difficult to reason your way through these types of screening questions. And so we're just going to run through all of the main recommendations you need to know in a rapid fire approach. So let's just jump right in, starting with abdominal aortic aneurysms or triple A's. So who qualifies for triple A screening? That's right, it's men aged 65 to 75 who have ever smoked. And what imaging modality do we use to screen for triple A's? That's right, it's ultrasound. And how often do we do them? One time only. So remember, triple A screening is done in men aged 65 to 75 who have ever smoked. With a one time abdominal ultrasound. And this does not apply to women. So if you have a question on the test about an asymptomatic older woman who has smoked, triple A screening is not going to be the correct answer. Next up, let's discuss lung cancer screening. Who qualifies for lung cancer screening? That's right, it's adults aged 50 to 80 years old with a 20 pack year smoking history and currently smoke or if they have quit smoking within the past 15 years. And what imaging modality do we use to screen for lung cancer? That's right, it's a low dose CT scan. And how often do we do it? That's right, it's every year. So lung cancer screening is adults aged 50 to 80 with a 20 pack year smoking history who currently smoke or if they quit smoking within the past 15 years with a low dose CT done annually. Very good. Next up, let's discuss colon cancer screening. Who qualifies for colorectal cancer screening? That's right, it's asymptomatic adults starting at age 45. It used to be 50, but now it's 45 as a class B recommendation. The exception being those with a family history of colon cancer, in which case screening starts either at age 40 or 10 years before their family members age of diagnosis. In addition, anyone with a diagnosis of inflammatory bowel disease like Crohn's disease or ulcerative colitis should have a screening colonoscopy within at least 8 years of the diagnosis. There's also a few hereditary syndrome that necessitate earlier and more frequent screenings such as hereditary non polyposis colorectal cancer, HNPCC or LYNCH syndrome, which should have colonoscopies every 1 to 2 years starting at age 20. And also familial adenominus polyposis or FAP, which almost always leads to a diagnosis of colorectal cancer before age 40. And so these patients should have colonoscopies every 1 to 2 years starting at around age 10. But generally speaking, for the overall population screening starts at age 45. And how often should colon cancer screening occur? Well, it depends on the modality of screening. The gold standard for colon cancer screening is colonoscopy, as this allows for direct visualization of the colon and tissue sampling. And if all is normal, it is recommended every 10 years. But there are several other acceptable screening modalities for colon cancer, so can you name any? Well, I hope you're thinking of fecal occult blood testing, which can be done every 1 year. And if there's a positive result, then it needs to be followed up with a colonoscopy. Another test is the fecal immunochemical testing, or FIT, which also detects blood in the stool. But it uses an antibody-based test which detects the presence of hemoglobin in the stool, making it more reliable than the older guiach-based tests. And FIT testing can also be done every 1 year. Colorguard is another stool-based test, and this uses a combined approach of using both FIT testing, combined with DNA testing, to detect abnormal DNA, which may be shed by pre-cancerous or cancerous polyps in the colon, and are detectable in the stool. And the USPSTF recommends that colorguard is an acceptable method of colon cancer screening, and should be done at least once every 3 years. With the caveat that again, because it's an indirect method of screening, if there is a positive result, then it should be followed up with a colonoscopy. Flexible sigmoidoscopy is another acceptable screening modality for colon cancer, and this could be done every 5 years, unless it's done in conjunction with FITs every 1 year. In which case, it could be done every 10 years. And lastly, there's an imaging study known as a CT colonography, which is another acceptable method of colon cancer screening done every 5 years. Next up, let's discuss breast cancer screening. So who qualifies for breast cancer screening? According to the USPSTF, breast cancer screening should be performed with a screening mammogram once every 2 years. This is a relatively new recommendation, whereas they used to recommend to start at age 50. But now they say to start at age 40 and to do them every 2 years. This is still in contrast, however, to some other agencies, like the American Cancer Society, who also recommends mammograms starting at age 40, but the differences they recommended every 1 year, versus the USPSTF, which still recommends it once every other year. But usually on the test, they won't make it so vague, and instead they'll present a woman who's over 40 years old, who hasn't been to the doctor in a few years, and in this case you'd be expected to recognize that she's due for a screening mammogram. Stepping away from screening for just a moment, what if you had a woman who presents to your office with a complaint of a palpable breast mass? Then what would your next step be in this case? That's right, it's going to depend on how old they are. For women younger than 40, your next step is going to be to do an ultrasound, because younger women have very dense breast tissue, which makes it hard to detect abnormalities on just a mammogram. And if they're over 40, then you would do a mammogram plus or minus ultrasound. So, palpable breast mass in woman younger than 40, ultrasound. Over 40, then mammogram plus or minus ultrasound. Next up, let's discuss cervical cancer screening. How often should women be screens for cervical cancer? That's right, women aged 21 to 29 can have pap smears with cervical cytology alone every three years. But starting at age 30, they can then have the option of co-testing for cytology plus HPV every five years. And this goes up until age 65, at which point they can stop screening just so long as their last couple of pap smears were normal. Next up, let's discuss a few prenatal screening guidelines. What supplements should women take if they are either planning or capable of becoming pregnant? That's right, it's folic acid in order to prevent neural tube defects. The USPSTF recommends that all women who are capable of or planning to become pregnant should take a daily supplement containing 0.4 to 0.8 milligrams of folic acid daily. What is the recommended therapy for women who are high risk for preeclampsia? That's right, it's low dose aspirin, 81 milligrams per day, starting at 12 weeks gestation. And in terms of prenatal screening tests, there's really quite a bit to know here, so I have a whole episode on it in episode 2. But some big things to remember are to test for asymptomatic bacteria area, whether urine culture, as well as hepatitis B virus, chlamydia, gonorrhea, syphilis, HIV, and gestational diabetes. But I go into more detail, including the timing of one to do all these tests and much more in episode 2, so check that out if you haven't already. Other than pregnant women, though, who gets screens for chlamydia and gonorrhea? That's right, it's all sexually active women 24 years ago. old or younger, as well as women over 25 who are at increased risk. Moving on now, when should women be screened for osteoporosis? That's right, women over 65 or postmenopausal women younger than 65 who are at increased risk, such as anyone on chronic steroids, or if someone has a history of prior fragility fractures. And what imaging modalities should be used to screen for osteoporosis? That's right, it's a dexascan, which is basically a low dose x-ray used to measure bone density, and the results are given in terms of standard deviations, with a t-score less than negative 2.5 consistent with a diagnosis of osteoporosis, while a t-score between negative 1 and negative 2.4 indicates osteopenia. And what is the recommendation for adults over 65 who are at increased risk for falls? That's right, it's a weight bearing exercise program. And in terms of cardiovascular prevention, what kind of patients should be placed on statins for the primary prevention of cardiovascular events, such as symptomatic CAD or stroke? And for clarification, primary prevention means preventing the first-ever event, while secondary prevention means preventing something from happening again. That's right, statin therapies should be started for the primary prevention of cardiovascular events in any individual aged 40 to 75 years old, who has one or more of the following risk factors, such as dyslipidemia, diabetes, hypertension, or if they're a smoker. And they need to have an estimated 10-year risk of a cardiovascular event, like an ASCVD score of 10% or greater. In addition, statins should also be started with anyone with an LDL level greater than 190 kilograms per deciliter, regardless of any other risk factors. Now let's talk about some things that the USPSTF does not recommend. It is no longer recommended that patients over 60 use aspirin for the primary prevention of cardiovascular disease, and said it's used for secondary prevention. It is also not recommended to screen for carotid artery stenosis in asymptomatic individuals. It's not recommended to screen for COPD with spirometry in asymptomatic individuals. Vitamin D and calcium supplements are not recommended for the primary prevention of fractures in elderly or postmenopausal women. Again, the recommendation is weight-bearing exercise programs. And finally, in terms of cancers, the following cancers are not recommended for routine screening in asymptomatic individuals. Thyroid, ovarian, testicular, renal, brain, and pancreatic. Prostate cancer is a little bit of a tricky one. It's a class C recommendation to screen for prostate cancer with a serum PSA level in asymptomatic individuals aged 55 to 69. And a class C recommendation means that for this population, it is recommended that screening could take place after a discussion between the patients and the provider weighing the risks and benefits of screening. However, once this hypothetical patient reaches age 70, it then becomes a class D recommendation to screen for prostate cancer, meaning that they actually recommend against it. And that about wraps it up. There's only one way to end an episode like this, and that's with some practice questions. Question 1. A 68-year-old man presents for his annual wellness visit. He has a 40-pack year smoking history, but quit smoking 15 years ago. He denies abdominal or back pain and has no history of vascular disease. Physical examination is unremarkable. According to the United States Preventive Services Task Force, USPSTF, which of the following is the most appropriate screening recommendation for this patient? A) No screening needed at this time. B) One time abdominal ultrasound now. C) Abdominal ultrasound now and then again once every five years. Or D) Abdominal ultrasound only if he develops symptoms. Answer B) One time abdominal ultrasound now. The USPSTF recommends one time screening for abdominal aortic aneurysms with an abdominal ultrasound in men aged 65 to 75 who have ever smoked. This patient's age and 40-pack year smoking history qualify him for screening, as smoking significantly increases the risk for triple a's. Routine repeat ultrasounds are not recommended for screening for triple a's, as it only performs once unless the initial result is abnormal. Screening only when symptoms arise is inappropriate because most triple a's are asymptomatic until they rupture. Question 2. A 55-year-old woman presents for a routine checkup. She has a 30-pack year smoking history and continues to smoke one pack of cigarettes daily. She has no significant symptoms, and denies cough, dyspnea or weight loss. Her physical exam and vital signs are unremarkable. According to the United States Preventive Services Task Force, which of the following lung cancer screening recommendations is most appropriate for this patient? B) Annual chest x-ray. C) Annual low-dose CT scan. Or D) Chest CT only if a new pulmonary nodule is suspected. Answer C) Annual low-dose CT scan. The USPSTF recommends annual low-dose CT screening for lung cancer and adults aged 50 to 80 years old who have at least a 20-pack year smoking history and currently smoke or have quit smoking within the past 15 years. This patient meets the criteria for her ongoing smoking, age and significant pack year smoking history. Chest x-rays are not recommended for lung cancer screening, as they are less sensitive than low-dose CTs. Screening only one symptomatic is inappropriate because lung cancer is often asymptomatic in the early stages. Question 3. A 45-year-old man with no significant medical history presents for a routine wellness visit. He has no family history of colorectal cancer. He is asymptomatic and has never undergone colorectal cancer screening. A) No screening needed until age 50. B) Colnoscopy now and then wants every 5 years. C) Fecal Immunochemical Testing fit annually starting now. Or D) Flexible Sigmoydoscopy every 10 years. Answer C) Fecal Immunochemical Testing fit annually starting now. Annual fit testing is a non-invasive and evident spaced option. Other acceptable options include Fecal Acoblod Testing every year. Full-a-guard at least every 3 years, which combines fit testing with stool DNA testing, or CT colonography every 5 years. Keeping in mind, however, that colonoscopy is the gold standard and any abnormal result on any of these tests should be followed up with a colonoscopy for direct tissue sampling. And delaying screening until age 50, option A, is inappropriate as this would be reflective of outdated screening recommendations. Number 4. A 52-year-old woman presents with a 2-week history of mild headaches. She reports no changes in vision, nausea, vomiting, or other neurological symptoms. She has no significant medical history and takes no medications. She last visited the doctor several years ago. Her physical exam and neurological exam are normal. You suspect a diagnosis of tension headaches. Which of the following is the most appropriate next step in management? A. Prescribe Sumatriptin. B. Order an MRI of the brain. C. Refer to neurologist for further evaluation. D. Order a screening mammogram. Answer. D. This patient's presentation of tension headaches are benign and require no imaging or specific pharmacologic intervention. However, her age of 52 years in lack of recent preventive care make it crucial to address gaps in screening, such as mammography. The USPSTF recommends mammograms for women aged 40 to 74 years old, every other year, in order to screen for breast cancer. Ordering a screening mammogram is the most appropriate next step for managing her overall health, even though it is unrelated to her presenting complaint. Sumatriptin A. Is not indicated for tension headaches. Immaging or neurologic referral is unnecessary for tension headaches without red flags.