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Difficulty: MediumPreventive Care and Screening

A 48-year-old male construction worker visits a primary care clinic to establish care. He states that he feels entirely healthy and has avoided the medical system for over twenty years. He currently smokes one pack of cigarettes daily and has maintained this habit since his early twenties. He is in a monogamous relationship with a new female partner. Vital signs are within normal limits, and his body mass index is 23 kg/m². He has no family history of malignancy or premature cardiovascular disease. Based on current evidence-based guidelines, which of the following preventive screening tests should be ordered for this patient today? (Select all that apply)

  1. Colorectal cancer screening via colonoscopy or stool-based testingAnswer
  2. Routine screening for human immunodeficiency virus (HIV) infectionAnswer
  3. One-time screening for hepatitis C virus (HCV) infectionAnswer
  4. D
    Annual lung cancer screening with low-dose computed tomography
  5. E
    One-time abdominal aortic aneurysm screening with ultrasonography

Answer

The correct interventions are colorectal cancer screening, human immunodeficiency virus (HIV) screening, and hepatitis C virus (HCV) screening.
Based on current US Preventive Services Task Force (USPSTF) guidelines, adults aged 45 to 75 should undergo routine colorectal cancer screening. Furthermore, because this patient has had no medical care in over twenty years, he requires catch-up baseline screenings. The USPSTF recommends universal one-time screening for HIV in individuals aged 15 to 65, and one-time screening for HCV in adults aged 18 to 79. All three of these are strongly recommended (Grade A or B) and appropriately timed for a 48-year-old male.

Step-by-Step Solution

1
Analyze the patient's demographic and historical profile.
The patient is a 48-year-old male with a 20+ pack-year smoking history, normal BMI, and no prior preventive medical care.
Preventive screening guidelines are strictly dependent on age, biological sex, and specific risk factors like smoking history.
2
Evaluate for indicated age-appropriate general screenings.
Colorectal cancer screening (starts at age 45), HIV screening (once for ages 15-65), and HCV screening (once for ages 18-79) are all indicated.
The patient has not been seen by a physician in over 20 years, meaning he has missed all universal one-time and age-based baseline screenings.
3
Evaluate for risk-specific screenings based on his smoking history.
He does not qualify for low-dose computed tomography (requires age 50-80) or abdominal aortic aneurysm screening (requires age 65-75).
Applying exact guideline age cutoffs prevents unnecessary testing and potential false positives in younger patients.

Key Concept

Application of age-specific and risk-specific USPSTF preventive screening guidelines in primary care.
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Topics

Preventive Care and Screening

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