Routine Health Screenings

Determined upon the average of two or more properly measured readings at each of two or more office visits after an initial screening.

Hypertension blood pressure readings show a systolic of 140 mmHg or higher and diastolic of 90 mmHg or higher

"The USPSTF suggests annual screening for hypertension in adults 40 years or older and for adults at increased risk for hypertension(such as Black persons, persons with high-normal blood pressure, or persons who are overweight or obese). Screening less frequently (ie, every 3 to 5 years) is appropriate for adults aged 18 to 39 years not at increased risk for hypertension and with a prior normal blood pressure reading."

Prevention:

Weight loss

Low sodium diet

Reduced alcohol consumption 

Increased physical activity  

Hyperlipidemia 
(high cholesterol)
 

Diagnosed by the results of a fasting lipoprotein profile including total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein cholesterol (HDL), and triglycerides.

Men older than 35: every 5 years (if results are normal)

Men aged 20-35: every 5 years unless they are at increased risk for heart disease

Women older than 20: screen only if at an increased risk for heart disease

Weight control 

Dietary changes

Regular physical activity

Smoking prevention or cessation

The U.S Preventatitve Task Force recommends that all women get screened for breast cancer every other year, starting at age 40 and continuing through age 74, to reduce their risk of dying from this disease. This is a B grade.

In this final recommendation statement (https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening), they urgently call for more research that will allow us to build on our existing guidance and help all women live longer and healthier lives. Specifically, there is a need to know how best to address health disparities across screening and treatment experienced by Black, Hispanic, Latina, Asian, Pacific Islander, Native American, and Alaska Native women. They also call for studies on what more should be done for women with dense breasts as well as evidence on the benefits and harms of screening in older women

Skin Cancer
(Collection of abnormal skin cells. Usually found in moles or other spots on the skin)

Screening: 
Visual examination criteria: 

 A = asymmetry (one half of the mole does not match the other half).

B = border irregularity (edges of the mole are ragged, notched, or blurred).

C = color (pigmentation of the mole is not uniform, with varying degrees of tan, brown, or black)

.
D = diameter of more than ¼ inch (about the size of a pencil eraser).

E = evolving (the mole is changing over time).

Yet in 2016, the USPSTF found insufficient evidence to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adults, and this has not been updated.

Stool Test: checks for the presence of blood in the stool

Colonoscopy: To check inside the colon and rectum for abnormalities

Flexible sigmoidoscopy: To check the lower colon for abnormalities

Multi-targeted stool DNA testing: stool sample that checks for DNA mutations and blood

CT colonography: Using X-rays to see images of the colon

The USPSTF recommends screening for colorectal cancer (https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening) in all adults aged 50 to 75 years.

The USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years.

The USPSTF recommends that clinicians selectively offer screening for colorectal cancer in adults aged 76 to 85 years. Evidence indicates that the net benefit of screening all persons in this age group is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the patient's overall health, prior screening history, and  preferences.

Two types of screening: 

1.    Prostate-specific antigen (PSA) blood test: Checks for high amounts of PSA. However high PSA does not always indicate prostate cancer

2.    Digital rectal exam: doctor inserts a gloved, lubricated finger into the rectum to feel the prostate for lumps or anything else unusual

For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision.

Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening.   

 The USPSTF recommends against PSA-based screening (https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening)for prostate cancer in men 70 years and older.

Diabetes Mellitus Type 2 

The pancreas struggles to produce enough insulin. 

Myeloma patients have increased blood sugar levels, especially those on a long-term steroid therapy treatment.

Various kinds of blood tests, including:

A1C (reflects average blood sugar levels for the past 2-3 months)

Glucose tolerance test (determines how well your body processes sugar)

Fasting blood glucose

Frequency: 

Before age 50, tests should be conducted every 10 years 

Patients 50 and older should be screened every 3 years

Smoking
Patients with myeloma are already at greater risk for shortness of breath (dyspnea) and smoking will worsen this condition

Can also cause other cancers

Increases the risk of pulmonary infections

Health care providers will ask if you are an active smoker

Counseling following guidelines to stop the use of tobacco in myeloma patients

Alcohol 

Contributes to increased risk for liver disease, high blood pressure, inflammation of the pancreas, cancer, and mental dysfunction

Health care providers will ask if you about your alcohol consumption

Counselling: 

Face-to-face sessions

Written self-help materials

Computer-based programs

Telephone counselling

During counseling, healthcare professionals work with patients on various strategies, such as action plans, drinking diaries, stress management, and problem-solving.

For the general population, but also essential for immunocompromised (myeloma) patients. 

Should be offered in early autumn, however, can be offered year-round when an outbreak is detected in the community. 

Immunocompromised patients with multiple myeloma are at risk for developing pneumococcal disease. 
There are two types of the vaccination: 

1. the pneumococcal polysaccharide vaccine

2. the pneumococcal conjugate vaccine

Tetanus Booster 

After transplantation, a patient remains immunocompromised for 6-12 months. 

Immunizations such as polio, tetanus toxoid, diphtheria toxoid, pneumococcus, hepatitis B, haemophilus influenzae type B conjugate, and measles, mumps, and rubella, should be given to the patient as per the recommendations of the transplantation center.

General dental care includes brushing teeth twice daily, cleaning between the teeth daily with floss or an interdental cleaner, and seeing the dentist regularly for examinations (including X-rays, if warranted), and professional cleaning.

Minimum twice-yearly visits to the dentist is required to maintain good oral hygiene.

For myeloma patients there is risk of reduced blood flow to the bone in the jaw which can be prevented, diagnosed, and treated by an oral health care provider

Direct inspection and palpation (feeling with the fingers or hands) of the oral cavity is the most recommended method of screening for oral cancer, which can be completed by a dentist during routine visits.

Smoking: increases risk for oral cancer

Alcohol Combined with Smoking: increases risk of oral cancer