About Age and Sex in Preventive Medicine

About Age and Sex in Preventive Medicine

The ages of significance in prevention for an adult are: 19 years, 40 years, 50 years, and 65 years. For this reason, we will group preventive interventions by age brackets that begin at these milestones.

A detailed medical history for each patient may, however, reveal that the risk for a particular disease is significantly elevated — either through a significant accumulation of risk factors or through notable family history — in which case these age thresholds no longer apply. For example, if there is a family history of genetically transmitted cancer, screening should begin at least 10 years before the age of onset of the cancer in the affected relative.

Once preventive consultations have been initiated and the risk level established, recall intervals vary across different age groups.

For adults aged 19 to 39, the frequency of visits may be every 3 years, provided there is no family history of cardiovascular or oncological diseases, which would warrant earlier initiation.

Individuals aged 40 to 49 are evaluated annually, although the content of each visit will vary depending on the screening intervals for each of the patient’s individual risk factors. For those over 40 with a cardiovascular risk below 5%, reassessment is recommended every 3 years. In contrast, individuals aged 50 to 64 are monitored more actively, as the majority of risks become relevant in the general population. Particular emphasis is placed on the evaluation and management of cardiometabolic risk.

The age of 50 also marks the start of screening for breast cancer and colon cancer. Many individuals over 65 already have accumulated conditions that are managed through case management. For this reason, it is recommended that certain screenings be discontinued when existing pathology impacts the patient’s prognosis to such a degree that prevention would no longer be meaningful. Guidelines recommend discontinuing certain screenings at the age of 75, such as those for colorectal or breast cancer.

Preventive visits place emphasis on conditions that may lead to disability and handicap, such as vision and hearing disorders, and osteoporosis.

Women

Cervical Cancer Screening

According to international treatment guidelines, cervical cancer screening consists of two tests: the Papanicolaou test (PAP smear) and the genetic test for detecting human papillomavirus (HPV) infection. The PAP test is recommended annually, without the HPV test, starting at age 21 up to age 30, or 3 years after the onset of sexual activity. The PAP test can be performed conventionally (on a slide) or in liquid-based medium.

After reaching the age of 30, both the PAP test and the HPV test are recommended every 3 to 5 years. Some specialists recommend performing only the PAP test every 3 years.

Remember:

• The PAP test is necessary after a hysterectomy only if the procedure was performed as a result of cancer or a precancerous lesion
• Continue screening even if you have been vaccinated against HPV!

Breast Cancer Screening

Breast cancer can be detected in its early stages, when the prognosis is much better and treatment options are more effective, through:

• Screening mammography, every 1 to 3 years, starting at age 40 to 50
• Clinical breast examination performed by a gynecologist, annually, starting at age 40 to 50
• Monthly breast self-examination, following the gynecologist’s instructions, starting at age 20

Men

Prostate Cancer Screening

The American Cancer Society recommends that all men discuss prostate cancer with their urologist, including the importance of testing as well as the benefits and risks of screening. The decision to undergo testing should be an informed one. American experts recommend testing starting at age 50, or even earlier (age 40) if there are cases of prostate cancer in the family. The investigation consists of a blood test to determine PSA — prostate-specific antigen, with or without a digital rectal examination of the prostate. The frequency of testing depends on the PSA level.

Women and Men

Colorectal Cancer Screening

Colorectal cancer is one of the most common and most serious cancers. Fortunately, it can be detected in its early stages through a colonoscopy — a method for evaluating the rectum and large intestine. Colonoscopy is recommended once every 10 years for individuals at average risk, starting at age 50. If you are at increased risk based on your family medical history or other risk factors, consult your physician to determine when to begin testing.

Skin Cancer Screening

Melanoma is one of the most aggressive types of skin cancer; however, when detected in its early stages, it can be successfully treated and cured. Skin cancer screening is recommended for all men and women starting at age 18. It includes:

• Clinical skin examination performed by a dermatologist
• Dermoscopy — examination of the skin and moles using a dermatoscope; it is considered the most effective method for detecting skin cancer

Additionally, monthly self-examination of the skin and moles is recommended to identify any changes in shape and color early on. Remember the ABCDE rule, which helps you detect melanoma with the naked eye!

Cholesterol Screening

Elevated cholesterol levels increase the risk of heart disease — the leading cause of death worldwide, among both women and men. Therefore, determining the lipid profile (LDL cholesterol, HDL cholesterol, total cholesterol, triglycerides) is extremely important in preventing and detecting cardiovascular diseases early. Cardiologists, internists, or general practitioners recommend a blood test to determine the lipid profile every 5 years, starting at age 20.

Diabetes Screening

Screening is recommended every 3 years, starting at age 45, or more frequently at the physician’s recommendation depending on family medical history. Screening consists of performing individually or as a panel the following tests: fasting blood glucose measurement (glycemia), glucose tolerance test, or glycated hemoglobin (HbA1c).

Arterial Hypertension Screening

This consists of measuring blood pressure values in all individuals, regardless of age. According to international guidelines, arterial hypertension screening is recommended every 1 to 2 years.

Combined Screening: Heart Disease and Type 2 Diabetes

This is recommended starting at age 20, every 2 to 3 years, if test values are within normal limits, and includes the following tests:

• Lipid profile
• Blood glucose
• Blood pressure measurement
• Body Mass Index (BMI) measurement

Children

Vision Screening

Children should be evaluated regularly to detect any vision disorders early. In the first year of life, a child cannot tell you that they cannot see — they rely on you as a parent to identify potential vision problems through early ophthalmological screening.

International screening guidelines recommend performing an ophthalmological examination:

• Before discharge from the maternity ward, or between 6 and 12 months of age
• At 3 years of age
• At 5 years of age (before starting school)

Hearing Screening

According to the Centers for Disease Control and Prevention (CDC) in the United States, hearing quality should be verified in all children by performing audiometry before discharge from the maternity ward or within the first month of life. Conducting preliminary tests while still in the maternity ward provides reliable information about the newborn’s hearing level. If testing indicates the possibility of hearing loss, the child should undergo a comprehensive audiological evaluation as soon as possible.