Age Appropriate Cancer Screening Recommendations (**) 

Breast Cancer  (back to top)
Yearly mammograms are recommended starting at age 40 an continuing for as long as a woman is in good health.
Clinical breast exam about every three years in 20's and 30's, and yearly for women 40 and over.  Breast self examination is an option for women starting in their 20's.
Women at high risk (>20% lifetime risk) of breast cancer should get an MRI and mammogram yearly.  MRI should be considered with a lifetime risk of breast cancer between 15% and 20%.  MRI is not recommended for a lifetime breast cancer risk of <15%. (back to top)

Colon and Rectal Cancer
Beginning at age 50, both men and women at average risk for developing colorectal cancer should use one of the screening tests below
Flexible sigmoidoscopy every 5 years*
Colonoscopy every 10 years
Double contrast barium enema every 5 years*
CT colonograpy (virtual colonoscopy) every 5 years*
Fecal occult blood test every year*

*Colonoscopy should be performed if abnormality is found on test

Screening early should be discussed with your health care provider if you have any of the following risk factors:
- a personal history of colorectal cancer or adenomatous polyps
- a personal history of chronic inflammatory bowel disease (Crohns Disease or ulcerative colitis)
- a strong family history of colorectal cancer or polyps in a parent, sibling, or child less than 60yo, or in two first degree relatives regardless of age
- a known family history of hereditary colorectal cancer syndromes such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC). (back to top)

Cervical Cancer
All women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse, but no later than 21 years old.  Screening should be done yearly with a regular Pap test, or every two years with newer liquid-based Pap test.
Beginning at age 30, women who have had 3 normal Pap test results in a row may get screened every 2-3 years.  Another reasonable option for women over 30 is to get screened every 3 years with either the conventional or liquid-based Pap test, plus the HPV DNA test.
Women 70 or older who have had 3 or more normal Pap tests in a row and no abnormal test results in the last 10 years may choose to stop having cervical cancer screening.
Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer screening, unless the surgery was done as a treatment for for cervical cancer or pre-cancer. (back to top)

Prostate Cancer
Prostate cancer screening available includes prostate specific antigen (PSA) testing and digital rectal exam (DRE) yearly, beginning at age 50, in men at average risk of prostate cancer.  Screening may begin earlier (age 40-45yo) in men at higher risk, including African American men and those with a first degree relative (father, son, or brother) diagnosed at an early age (<65yo).  Routine prostate cancer screening is not supported at this time by the American Cancer Society.  However, unless there is a specific reason not to test, healthcare professionals are encouraged to test any men not objectionable and requesting their healthcare provider's opinion. (back to top)

** References:
American Cancer Society. Cancer Facts & Figures 2009. Atlanta, GA: American Cancer Society; 2009.

Levin B, Lieberman DA, McFarland, et al. Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Published online March 5, 2008. CA Cancer J Clin. 2008;58.

Saslow D, Boetes C, Burke W, et al for the American Cancer Society Breast Cancer Advisory Group. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007;57:75-89.

                                         Vaccines for Children                                            
AAP Recommendations 2010 (click link for pdf file)                       (back to top)     

The vaccine recommendation schedule from the American Academy of Pediatrics provides for some variability in vaccine administration times.  Combination vaccines are preferred over separate injections.  In order to meet with the AAP recommendations, as well as local school vaccine requirements, we have adopted the following schedule for vaccine administration.  Missed vaccine doses due to missed appointments or illness will be made up at the earliest opportunity.   (back to top)

Hepatitis B vaccine, if administered in hospital prior to discharge.

2 months
Pediarix (Hepatitis B, IPV, and DTaP)       Vaccine Info Sheet
Haemophilus influenzae type b (Hib)  Vaccine Info Sheet
Prevnar (pneumococcal, strep)         Vaccine Info Sheet

4 months
Pediarix (Hepatitis B, IPV, and DTaP)       Vaccine Info Sheet
Haemophilus influenzae type b (Hib)  Vaccine Info Sheet
Prevnar (pneumococcal, strep)         Vaccine Info Sheet

6 months
Pediarix (Hepatitis B, IPV, and DTaP)       Vaccine Info Sheet
Haemophilus influenzae type b (Hib)  Vaccine Info Sheet
Prevnar (pneumococcal, strep)         Vaccine Info Sheet

9 months
No planned vaccines - make up previous missed vaccines if necessary

12 months
Varivax (chicken pox)        Vaccine Info Sheet
Haemophilus influenzae type b (Hib)   Vaccine Info Sheet
Hepatitis A Vaccine Info Sheet

15 months
MMR (measles, mumps, rubella)                      Vaccine Info Sheet
DTaP                                                                     Vaccine Info Sheet
Prevnar (pneumococcal, strep)           Vaccine Info Sheet

18 months
Hepatitis A  Vaccine Info Sheet

4 years
MMR (measles, mumps, rubella)                      Vaccine Info Sheet
DTaP                                                                     Vaccine Info Sheet
IPV (polio)                  Vaccine Info Sheet
Varivax (chicken pox)        Vaccine Info Sheet

In addition, yearly flu vaccination (Vaccine Info Sheet) will be worked into the schedule with adjustments as needed based on where these fall in relation to the child's age.

Thimerisal in vaccines
While there is no clear scientific evidence of vaccines causing autism, many parents continue to be concerned about this risk.  For this reason, none of our vaccines in the office contain thimerisal, or are listed as "trace" if no thimerisal-free version is available.  The only exception to this is the seasonal flu vaccine and the H1N1 vaccine that was provided to us by the Federal Government.  There are nasal mist versions of these vaccines that do not contain thimerisal, but we do not have them available in the office.

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                                            Vaccines for Adults                                             

CDC Recommendations 2010 (click link for pdf file)                       (back to top)

1. Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination
Tdap should replace a single dose of Td for adults aged 19-64yo who have not received a Tdap previously.  Then a Td booster should be administered every 10 years.
2. Human papillomavirus (HPV)                      
HPV vaccination is recommended for all women aged 9-26yo who have not completed the vaccine series.  A complete series consists of 3 doses with the second dose two months after the first, followed by a third dose six months after the first dose.
3. Varicella vaccination (Chicken Pox)
All adults without evidence of immunity to varicella should receive 2 doses of vaccine if they have never been vaccinated, or a second dose if they have previously only received a single dose.
4. Herpes Zoster vaccination (Shingles)
A single dose of zoster vaccine is recommended for adults age 60 years and older regardless of whether they report a prior episode of herpes zoster.
5. Measles, mumps, and rubella (MMR) vaccination
Adults born before 1957 are generally considered to be immune to measles and mumps.  Adults born after 1957 should receive 1 or more doses of MMR vaccine.  A single dose of MMR vaccine is recommended for women whose rubella vaccination history is unreliable or who lack evidence of immunity.
6. Influenza vaccination (seasonal flu)
Recommended for those with chronic medical conditions of the cardiovascular or respiratory systems, diabetes, kidney or liver dysfunction, immunocompromising conditions, pregnancy during flu season, healthcare providers, residents of nursing homes or other long-term care facilities, in-home household contacts of children less than 5yo, persons greater than 65yo.
7. Pneumococcal polysaccharide (Pneumonia/Pneumovax)
Recommended for those with chronic lung disease (including asthma), chronic cardiovascular diseases, diabetes, liver or kidney disease, those without a spleen, immunocompromising conditions, cochlear implants, cerebrospinal fluid leaks, nursing home residents or residents of long-term care facilities, persons greater than  65yo.  One time revaccination may be repeated after 5 years in those over 65yo who had their first dose prior to age 65.
8. Hepatitis A vaccination
Recommended for persons with chronic liver disease and persons who receive clotting factor concentrates, or people traveling to areas with high endemic levels of hepatitis A.
9. Hepatitis B vaccination
Recommended for persons with chronic liver disease, chronic kidney disease, persons with HIV infection, healthcare personnel and public safety workers with potential exposure to body fluids, household contacts and sex partners of those with chronic hepatitis B virus infection
10. Meningococcal vaccination
Adults without a spleen or with terminal complement deficiencies, first year college students living in dormitories, travel to sub-Saharan Africa
8. H1N1 (swine flu) vaccination- see link below     
              CDC 2009 H1N1 (Swine Flu) Information

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                                     Osteoporosis Screening                                        
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Osteoporosis is a "thinning" of the bones that weakens them and makes a person more likely to fracture a bone.  A "pathologic" fracture occurs when someone breaks a bone during normal activities at the site of the weakened bone.  Recommendations to screen for osteoporosis begins as early as 50 years old in people with certain risk factors.  Women are more likely to develop osteoporosis than men, but men may also suffer from the disease, usually at an older age.
A "DEXA" scanner is available in our Hopewell office to assess your bone density.  The test provides an objective measure of your bone density in your hip and spine.  Recommendations for treatment and lifestyle changes can be made through interpretation of your results. 
Some people are confused about the terms "osteoporosis" and "osteopenia".  The measurement of your bone density is compared to standardized charts of normal bone densities.  Your results are then converted to a "T-score".  People with a T-score of greater than -1.0 are considered to have normal bone density.  A T-score of less than -2.5 represents osteoporosis.  The scores in between, from -2.5 to -1.0 represent bone that is weaker than normal bone, but not so thin as to be considered osteoporosis.  This condition of mildly decreased bone density is called osteopenia.
Multiple treatment options are available and may be discussed with your provider.  These included taking Vitamin D and calcium, oral medications to increase bone strength, subcutaneous injections, and IV infusion of medication (usually arranged by our office at John Randolph Medical Center).
If you would like to schedule a DEXA to assess your bone density, call our office in Hopewell at (804) 458-8557 ext. 108.
For more information about osteoporosis and bone density testing click the links below which will take you to the National Osteoporosis Foundation website.

Osteoporosis - What is it?                                              25 Calcium-Rich Foods

Bone Density Testing                                                     Top 25 Ways to Prevent Falls

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Information For Your Health
Colonial Heights Medical Center            Hopewell Medical Center
(804) 520-1110                                  (804) 458-8557
Vaccines for Children Vaccine Information Sheets
American Cancer Society