The Periodic Health Examination: 1989 Update (1989)

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  • Early detection of colorectal cancer: No screening procedure is recommended for people at average risk who are less than 40 years of age.
  • Early detection of colorectal cancer: There is insufficient evidence to recommend the inclusion of screening for colorectal cancer by means of fecal occult blood testing or sigmoidoscopy in the periodic health examination of people over 40 years who have no risk factors for colorectal cancer. The evidence is equally insufficient, however, to warrant stopping this practice where it already exists.
  • Early detection of colorectal cancer: Expert opinion supports the recommendation that periodic sigmoidoscopy or colonoscopy be performed among people at increased risk for colorectal cancer (i.e., first-degree relatives of patients with colorectal cancer and women with a history of endometrial, ovarian or breast cancer).
  • Early detection of colorectal cancer: Although people with diseases of the colon predisposing to colorectal cancer are not “asymptomatic, otherwise healthy” target patients of the periodic health examination, they are at highest risk and should be the focus of conscientious efforts at early detection. Periodic colonoscopy should be included in the clinical management of patients with a history of colorectal cancer, adenomatous polyps or ulcerative colitis of 10 years’ duration. Periodic sigmoidoscopy among family members of patients with familial polyposis, who are at highest risk for colonic cancer, should begin at an early age and should be followed by periodic colonoscopy after 30 years of age.
  • Problem drinking: Although no single screening instrument has shown optimal accuracy in detecting problem drinking there is good evidence that case-finding, counselling and follow-up are effective in managing the problem.
  • Problem drinking: Research has indicated specific questions and approaches that can be incorporated into the periodic health examination to raise clinical suspicion and prompt further enquiry; approaches may be combined sequentially to increase either sensitivity or specificity. If a problem drinker is identified the physician should discuss the problem and its consequences with the patient, counsel him or her to reduce alcohol consumption and monitor the patient’s progress periodically.