Sreening / Prevention

Prevention Level	Focus	Goal	Examples
Primary Prevention	Prevent diseases before they occur	Promote overall health and well-being	– Encouraging regular exercise and a balanced diet. – Vaccination programs (e.g., MMR, flu shots). – Anti-smoking campaigns.
Secondary Prevention	Early detection and intervention for risk factors or early-stage diseases	Prevent progression of disease	– Mammograms for breast cancer screening. – Colonoscopies for colorectal cancer. – Blood pressure monitoring for hypertension.
Tertiary Prevention	Managing established diseases and preventing complications	Improve quality of life and rehabilitation	– Stroke rehabilitation programs. – Cardiac rehab for heart disease patients. – Diabetes management programs to prevent complications.

“Preventive Activities and Advice” (RACGP Guidelines):

1. Definition of Prevention:
   • Involves all measures to protect, promote, and maintain health and prevent disease, disability, and death.
   • Applies across the lifespan and at any stage of disease progression.
2. Opportunistic vs. Systematic Prevention:
   • Opportunistic prevention: Performed during patient encounters for unrelated reasons.
   • Systematic prevention: Proactive recall for screening (e.g., childhood immunizations, cancer screenings).
   • High-risk groups and populations with difficult access require targeted preventive measures.
3. Benefits and Harms of Preventive Health Activities:
   • Some activities may cause harm, such as overdiagnosis leading to unnecessary anxiety and interventions.
   • Preventive interventions must have a clear benefit-to-harm ratio based on evidence.
4. Ethical Considerations in Screening and Case Finding:
   • Screening in asymptomatic patients should be guided by whether it changes management.
   • Case finding occurs when patients present with symptoms or risk factors.
   • Consider potential harms such as false positives or unnecessary interventions.
5. Shared Decision-Making:
   • Involves collaboration between GP and patient, discussing treatment options, benefits, harms, and patient preferences.
   • Useful in screening decisions
6. Screening and Overdiagnosis:
   • Overdiagnosis can lead to physical, financial, and psychological harms and burden the healthcare system.
   • GPs must ensure that screening tests provide more benefit than harm.
7. Screening Tests of Unproven Benefit:
   • Some tests are not recommended for asymptomatic or low-risk populations but may have value in diagnostic contexts.
   • GPs should avoid unnecessary tests and manage patient requests appropriately.
8. Holistic Approach to Patients:
   • A patient’s health is influenced by social, psychological, and environmental factors.
   • GPs should consider these factors and tailor their advice accordingly, especially for disadvantaged groups.
   • Groups at higher risk of healthcare barriers include
     • Aboriginal and Torres Strait Islander people
     • socioeconomically disadvantaged populations
     • LGBTIQA+ individuals.

Primary and Secondary Prevention and Screening Programs in Australia

By adhering to these primary and secondary prevention and screening programs, healthcare providers in Australia can effectively manage and prevent a wide range of health conditions, promoting better health outcomes for their patients.

based on redbook v10

Program	Target Group	Screening/Intervention	Frequency	Notes
Immunization
National Immunisation Program (NIP)	Children, Adults, Pregnant Women, ATSI	Various vaccines	As per schedule
Cardiovascular
hypertension	from age 18 years
cardiovascular disease (CVD) risk	45–79 years 35–79 years with CKD 30–79 years for ATSI	CVD risk assessment https://www.cvdcheck.org.au/calculator	Every 5years unless risk factors worsen	Considered high risk if: = Moderate-severe chronic kidney disease – CKD 3b – eGFR 30-44 = Familial hypercholesterolaemia
	under 45y but people with risk factors: – smoking – diabetes – family history of premature CVD – kidney impairment – gestational diabetes – pre-diabetes – familial high Chol (FH) – severe mental illness – severe obesity	smoking status blood pressure (BP) HbA1c eGFR/urine ACR serum lipids Body Mass Index (BMI) or waist circumference:		For those with significant risk factors – screening may need to start before the usual age of 45 years for the general population. – For younger patients (even those under 30) with clinically high-risk conditions, screening and management may be required sooner. (https://www.cvdcheck.org.au/identifying-people-for-assessment – practical points)
	18-29 years ATSI	smoking status blood pressure (BP) HbA1c eGFR/urine ACR serum lipids	an annual health check (or opportunistically) or at least every 2 years.	assess individual risk factors 18-29 years
Familial hypercholesterolaemia (FH)	LDLR, PCSK9 and APOB genes			– clinical features such as tendon xanthomata MBS criteria( requested by a specialist or consultant physician, Applicable only once per lifetime): – a Dutch Lipid Clinic Network score of at least 6 – LDL-cholesterol level of at least 6.5 mmol/L in the absence of secondary causes; – LDL-cholesterol level of between 5.0 and 6.5 mmol/L with signs of premature or accelerated atherogenesis
coronary artery calcium (CAC) score	Population screening: not recommended for general population screening		from: https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/first-do-no-harm/gp-resources/coronary-artery-calcium-scoring	not recommended in the general population Red Zone (Do Not Take Action): – High-risk or established CVD patients: CAC scoring should not be used in patients who already have a high risk of CVD or have established CVD (e.g., history of myocardial infarction or coronary artery disease). – These patients should already be managed according to their high risk, and CAC scoring would not change management. – Patients with chest pain or coronary artery disease symptoms: CAC scoring is not appropriate for symptomatic patients. need cardiac investigations like stress testing or angiography are more appropriate for diagnosing or managing coronary artery disease. Orange Zone (Consider Action): – Moderate risk individuals: CAC scoring may be considered for people at moderate risk of CVD, particularly if their risk might be underestimated by traditional methods. – can be used when results are likely to influence the intensity of management Green Zone (Take Action): – Shared decision-making: Before ordering the CAC test, clinicians should engage in shared decision-making with the patient. – Discuss the potential benefits and risks, false reassurance or anxiety based on the test outcome, Oversimplification of CVD risk assessment and management, Significant out-of-pocket cost for the test
Smoking cessation				Encourage, support, and advise all smokers to quit, with referral to behavioral interventions (e.g., smoking cessation counseling) and pharmacotherapy if indicated.
Physical activity				Promote regular, sustainable physical activity (e.g., exercise programs) to reduce cardiovascular disease (CVD) risk.
Diet	Healthy eating			Recommend a diet low in saturated and trans fats, rich in vegetables, fruits, wholegrains, a variety of protein sources, unflavoured dairy, and healthy fats (e.g., olive oil, nuts, fish).
	Consume oily fish			Advise regular consumption of oily fish to reduce the risk of coronary heart disease and mortality.
	Restrict sodium			Encourage limiting sodium intake to help lower blood pressure.
Alcohol
Aspirin				Currently unclear if the benefits of aspirin for primary CVD prevention outweigh the risks of gastrointestinal bleeding.
Atrial Fibrilation	>65 years			Opportunistic clinical palpation or auscultation to detect asymptomatic AF in people aged 65 years or more
Cancer Screening
Breast Screen	women at potentially high risk or carrying a mutation	Individual plan: – regular clinical breast examination – annual breast imaging with mammography, MRI or ultrasound – chemoprevention with (SERMs; eg tamoxifen or raloxifene) or aromatase inhibitors – mastectomy and/or salpingo-oophorectomy.		offer referral to a familial cancer clinic for: – risk assessment – possible genetic testing – risk reduction management plan
	Women 40–74	mammographic screening in moderately increased risk of breast cancer	Every 2 years	moderate risk: – One first-degree relative diagnosed with breast cancer at age <50 years (without additional features of the high-risk group) – Two first-degree relatives, on the same side of the family, diagnosed with breast cancer (without additional features of the high-risk group) – Two second-degree relatives, on the same side of the family, diagnosed with breast cancer, at least one at age <50 years (without the additional features of the high-risk group)
	Women 50-74	mammographic screening	Every 2 years	Generally not recommended
		Magnetic resonance imaging – as a stand-alone screening test in average-risk women	Strongly not recommended	average-risk women: – No confirmed family history of breast cancer – One first-degree relative diagnosed with breast cancer at age ≥50 years – One second-degree relative diagnosed with breast cancer at any age – Two second-degree relatives on the same side of the family diagnosed with breast cancer at age ≥50 years
		Breast thermography in breast cancer screening or as an adjunct to mammography	Strongly not recommended	Strongly not recommended
		Clinical breast examination for breast cancer screening in average-risk women	Generally not recommended	average-risk women: – No confirmed family history of breast cancer – One first-degree relative diagnosed with breast cancer at age ≥50 years – One second-degree relative diagnosed with breast cancer at any age – Two second-degree relatives on the same side of the family diagnosed with breast cancer at age ≥50 years
	Women ≥75 years		Generally not recommended	due to insufficient evidence
National Bowel Cancer Screening Program	all 50 to 74	Faecal Occult Blood Test (FOBT)		NHMRC endorsed updated guidelines recommending iFOBT screening to begin at age 45 for the general (average risk) population. NBCSP will continue sending iFOBT kits to individuals aged 50–74
	Category 1: Average or slightly increased (age 45–74 years)	iFOBT screening Aspirin low-dose (100 mg) Colonoscopy is generally not recommended	Every 2 years	— near-average risk if no family history of colorectal cancer — above average, but less than twice the average risk, if they have only ONE first-degree relative with colorectal cancer diagnosed at age ≥60 years.
	Category 2: Moderately increased	Colonoscopy Aspirin low-dose (100 mg) genetic testing is not indicated at present.	every 5 years starting at 10 years younger than the earliest age of diagnosis of colorectal cancer in a first-degree relative – or – age 50	— only 1 first-degree relative with colorectal cancer diagnosed before age 60 years — 1 first-degree relative and one or more second-degree relatives with colorectal cancer diagnosed at any age — 2 first-degree relatives with colorectal cancer diagnosed at any age.
	Category 3: Individuals at potentially higher risk,	Colonoscopy Aspirin low-dose (100 mg) genetic testing should be offered	every five years starting at 10 years younger than the earliest age of diagnosis of colorectal cancer in a first-degree relative – or – age 40	— 2 first-degree relatives and one second-degree relative with colorectal cancer, with at least one diagnosed before age 50 years — 2 first-degree relatives and two or more second-degree relatives with colorectal cancer diagnosed at any age — 3 or more first-degree relatives with colorectal cancer diagnosed at any age
	Hereditary non-polyposis Colon Cancer (Lynch Syndrome)	colonoscopy	every 1 to 2 years	Diagnosed on average by age 45 years, and 75-80% lifetime Colon Cancer risk
Cervical Screening Program	Women 25-74	CST testing – self-collected vaginal sample or – clinician-collected sample.	Every 5 years	Consider a short course of topical oestrogen therapy in postmenopausal women, individuals with vaginal dryness, or trans men before collecting cervical screening samples (e.g., daily for at least 2 weeks, stopping 1–2 days before the appointment). This helps reduce discomfort from the speculum and improves diagnostic accuracy of liquid-based cytology (LBC).
	<25 years but:	Screening not recommended	Screening not recommended	Screening not recommended
	first sexual activity at a young age (<14 years) + not received the HPV vaccine before sexual debut	HPV test between age 20-24	once off test	could considered on an individual basis but is not required.
	Women >75 years or older who have never had a CST or have not had one in the previous 5 years	may request a CST testing and can be screened	once off test
	during pregnancy	Women who are due or overdue for screening should be screened.	Cervical screening can be performed safely at any time during pregnancy, as long as correct sampling equipment is used.	Endocervical brushes should not be inserted into the cervical canal during pregnancy due to the risk of bleeding, which may distress the woman.
Prostate Screen	50–69 years at average* risk	PSA testing Digital rectal examination is not recommended as a routine addition to PSA testingin asymptomatic men	every 2 years	Average = Men without family history initial total PSA >3.0 ng/mL, offer repeat PSA within 1–3 months initial total PSA >3.0 – 5.5 ng/mL, measure free-to-total PSA percentage at the same time as repeating the total PSA. offer further investigation if total PSA is greater than 3.0 ng/mL.
	45-69 years at moderate* risk	PSA testing	every 2 years	Moderate = Men with a brother or multiple first-degree relatives diagnosed with prostate cancer
	40 to 69 year at high* risk	PSA testing	every 2 years	High = Men with three affected 1st-degree relatives diagnosed with prostate cancer
	men aged ≥70 years	Shared decision-making		– Harms of PSA testing, such as overdiagnosis, unnecessary treatment, and quality-of-life issues (e.g., incontinence, erectile dysfunction) should be discussed – Men who are likely to live less than another 7 years is not recommended
Skin Checks	average/below average risk Risk prediction tools | Melanoma Institute Australia Melanoma risk predictor | QIMR Berghofer Medical Research Institute Keratinocyte risk score | QIMR Berghofer Medical Research Institute	regular skin checks are not recommended	Note: – Each risk tool provides a valid personal risk assessment but differs based on the target population (e.g., with or without previous melanoma). – There’s limited evidence on optimal risk category classification and cut-points. – While comprehensively developed, some rare risk factors, such as immunosuppression in organ transplant recipients, may be missing.	Note: All people (especially children, adolescents, young adults) should be advised to be ‘sun smart’ – broad-brimmed hat, covering clothing, sunscreen, sunglasses and shade. – Every morning sunscreen should be applied to the head, neck, arms and hands. – It should be reapplied after heavy sweating, bathing or long sun exposure, especially if outdoors when the UV Index is ≥3 – counsel patients against personal home use of sunbeds or sunlamps for cosmetic tanning purposes –avoid getting sunburnt, especially to the point of blistering and skin peeling, because multiple episodes have been shown to increase the risk of developing melanoma.
	above-average risk	Opportunistic examination of the skin	Opportunistically (usually no more than once every 12 months).
	high risk of developing melanoma or keratinocyte cancer.	Regular skin checks	At least every 12 months.	high risk: – those with previous melanoma (Once a person has developed a melanoma, they are 5- to 10-times more likely to develop another primary melanoma)
	very high risk of developing a new primary melanoma	full skin examination supported by total body photography and dermoscopy.	six-monthly	Very high risk: 1) those with previous melanoma PLUS any of – multiple atypical naevi  – multiple primary melanomas  – family history of melanoma 2) known carrier of high-risk variant in CDKN2A gene. 3) Immunosuppression is also a strong risk factor for skin cancer, and organ transplant recipients are at very high (very much above average) risk of keratinocyte cancers.
RENAL
CKD	acute kidney injury (AKI)	eGFR urine ACR	every year for first 3 years post-AKI then every 2 years	diagnosis: 1) eGFR <60 mL/min/1.73m2 that is present for ≥3 months with or without evidence of kidney damage 2) evidence of kidney damage, with or without decreased GFR, that is present for ≥3 months, as evidenced by the following: – albuminuria – haematuria after exclusion of urological causes – structural abnormalities (eg on kidney imaging tests) – pathological abnormalities (eg kidney biopsy). Note: Attempts should be made to identify the underlying cause of CKD and to fully specify it
	family history of kidney failure	eGFR urine ACR	every 2 years
	diabetes	eGFR urine ACR	annually
	hypertension	eGFR urine ACR	annually
	established cardiovascular disease	eGFR urine ACR	every 2 years
	obesity	eGFR urine ACR	every 2 years
	smoking	eGFR urine ACR	every 2 years
Osteoporosis
Calcium and Vitamin D Supplementation	General Population	Dietary intake and supplements	Ongoing	should not be routinely used in non-institutionalized elderly individuals. Absolute benefit of fracture reduction is low. Significant benefit for individuals at risk of deficiency, especially institutionalized individuals. Offer supplements to those taking osteoporosis treatments if dietary calcium intake is <1300 mg/day or vitamin D concentrations are <50 nmol/L.
Bone Density Screening	postmenopausal women and men aged >50 years or older + lifestyle or non-modifiable risk factors	FRAX® tool https://frax.shef.ac.uk – BMD not recured for calculation		FRAX® risk – major osteoporotic fracture (MOF) is ≥10%, refer the patient for a DXA (dual energy X-ray absorptiometry) scan to assess BMD. FRAX® risk – major osteoporotic fracture (MOF) is <10%, a DXA scan is not recommended.
	postmenopausal women and men >50 years or older + – diseases – chronic conditions – on medications – Minimal trauma hip # or VB # – Minimal trauma spine # and proximal femur # that are associated with increased fracture risk	BMD assessment by DXA of spine and proximal femur if Minimal trauma hip # or VB # DXA to establish baseline BMD – recommended but not essential (from healthybonesaustralia.org.au)	Do not routinely repeat BMD or FRAX® calculations within 2 years, except in special circumstances (e.g., a significant change in risk factors or clinical status).	medical conditions: — minimal trauma fracture — long-term corticosteroid therapy, corticosteroid ≥ 7.5 mg for ≥ 3 months. — Rheumatoid arthritis — hypogonadism (Turner syndrome or androgen deficiency) — chronic liver disease — chronic kidney disease — malabsorption disorders (e.g., coeliac disease) — primary hyperparathyroidism After DXA, recalculate risk using FRAX® combined with the BMD reading. Treatment should be initiated if:The BMD T-score is ≤–2.5 (indicative of osteoporosis). If the BMD T-score is between –1.5 and –2.5 and the FRAX® risk for MOF is ≥20% and/or the hip fracture risk is ≥3%.
	Aged ≥ 70 years – No history of minimal trauma fracture	BMD assessment by DXA of spine and proximal femur		High 10-year risk of fracture – Hip fracture >3% – any fracture >20% – OR T-score ≤–2.5 start Rx else: Address lifestyle risk factors » Implement falls reduction strategies » Encourage balance training and resistance exercise » Modify diet, smoking and alcohol intake » Provide education and psychosocial support
Womens Health
Menopause	before age 45 = ‘early’ before age 40 = ‘premature’	Blood tests		blood tests to exclude other causes of oligomenorrhoea or amenorrhoea are appropriate
	after age 45	Blood tests for diagnosis of menopause are typically not required		MHT (combined estrogen and progestin or estrogen alone) is generally not recommended for the primary prevention of cardiovascular disease (CVD) or other chronic conditions. Chronic conditions include: – Coronary heart disease – Breast cancer – Fractures – Diabetes – Colorectal cancer – Thromboembolic events – Stroke – Dementia – Gallbladder disease – Urinary incontinence – All-cause mortality (redbood v10)
Sexually transmissible infections
Chlamydia and Gonorrhoea	Women: – ≤24 years: all sexually active – ≥25 years: if at increased risk	Screen with Self-collected – vaginal swab – Urethral first-pass urine (FPU) For MSM – oropharyngeal and anorectal swabs	Opportunistically if indicated (testing interval unclear)	A vaginal swab is more sensitive than FPU and is the specimen of choice. Women aged ≥25 years are at increased risk if they: – have a new sexual partner – more than one sexual partner – a sexual partner with concurrent partners or a sexual partner who has a sexually transmissible infection (STI) – practice inconsistent condom use when not in a mutually monogamous relationship – have a previous or coexisting STI – exchange sex for money or drugs and have a history of incarceration
	Heterosexual Men	Screening is not routinely recommended		consider testing to prevent transmission to partners.
Syphilis	Pregnant Women			Test all pregnant women during the first trimester of antenatal screening. Repeat testing in the third trimester (28–32 weeks) and at birth for women at high risk of infection or reinfection
Asymptomatic STIs	any age, people who: –>Perform an asymptomatic STI check	HIV (antigen/antibody test) – Repeat if recent exposure (6-week window period if antigen/antibody test) Syphilis serology – If recent exposure, repeat at 12 weeks and treat presumptively Hepatitis B HBsAg (hepatitis B surface antigen) Anti-HBs (hepatitis B surface antibody) Anti-HBc (hepatitis B core antibody)		people who: = Have been exposed to an STI or had an STI in the past 12 months = at increased risk (e.g., new partner, travel to high-prevalence areas) = Request STI testing = partners of special subpopulations (e.g., MSM, sex workers, pregnant women, ATSI people, trans and gender-diverse people).
Asymptomatic Mycoplasma Genitalium	Not recommended			routine screening for asymptomatic infections is not recommended, but it should be considered in symptomatic individuals, particularly when other common causes of urethritis or cervicitis (such as chlamydia or gonorrhea) have been excluded.