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Adult preventive screening in primary care
A screening test is justified only when the disease is common and serious, has a detectable latent phase, and early treatment changes the outcome — which is why every test has a start age, a stop age and an interval.
Why it matters in the exam
Family medicine papers almost always include questions such as "which of these patients needs a screening test now?" or "what do you recommend to a 74-year-old man who asks for a PSA?". The answer rests on age, sex and risk factors, and on telling the Israeli national programme (mammography, faecal occult blood) apart from international recommendations (USPSTF).
A recurring trap is screening beyond the age at which it helps, or choosing a diagnostic test (colonoscopy, CT) for an average-risk patient for whom a simple screening test is enough. Other questions test the levels of prevention and the family doctor's role in coordinating screening: he reminds, refers, receives the result and makes sure a positive finding reaches work-up in time.
Key points
- Screening is justified only when early detection changes the outcome.
- Colon: yearly faecal occult blood at 50–74; first-degree relative under 60 — colonoscopy from 40.
- Breast: mammography every 2 years at 50–74; family risk — yearly from 40.
- Aortic aneurysm: one ultrasound in a man aged 65–75 who has smoked.
- Over 75 or with a short life expectancy — consider stopping screening.
Summary table
| Disease | Who is screened | Test and interval | Note |
|---|---|---|---|
| Colorectal cancer | Age 50–74 at average risk | Faecal immunochemical test (FIT) yearly, or colonoscopy every 10 years | First-degree relative diagnosed before 60 — colonoscopy from age 40 every 5 years |
| Breast cancer | Women aged 50–74 | Mammography every 2 years | First-degree relative — yearly mammography from age 40 |
| Abdominal aortic aneurysm | Male ever-smokers between 65 and 75 | One abdominal ultrasound | No routine screening in women who never smoked |
| Diabetes and prediabetes | Every adult from 35, earlier with overweight plus a risk factor | Fasting glucose or HbA1c every 3 years | A normal result — repeat after 3 years |
| Osteoporosis | Women from 65, and younger postmenopausal women with risk factors | DXA | Treatment depends on the T-score and fracture risk |
| Lung cancer | Age 50–80 with 20 pack-years or more, current smokers or quit within 15 years | Yearly low-dose CT | In Israel a national programme is being phased in; shared decision |
Free exam questions
בבדיקת על שמע של בן 65 נמצאה הרחבה של אבי העורקים הביטני לקוטר של 4.5 .ס"מ מהי ההמלצה המתאימה ביותר? (the question as examined, in Hebrew)
- א. מעקב אחת לחצי שנה אחר קוטר המפרצת
- ב. הורדת לחץ דם ליעד של 120/80
- ג. הפניה לניתוח תיקון מפרצת בהקדם
- ד. טיפול.בנוגדי טסיות באופן קבוע
בן 74 , בריא בדרך כלל. מגיע אליך עם בקשה להוסיף לבדיקות הדם הבאות שלו גם בדיקה לגילוי מוקדם של סרטן הערמונית. מה ההמלצה לגבי בצוע הבדיקה? (the question as examined, in Hebrew)
- א. מעל גיל 70 אין המלצה לבדיקת סקר עם PSA
- ב. ערך PSA .גבוה חד פעמי אינו אינדיקציה להמשך בירור
- ג. בדיקת DRE ( Digital Rectal Examination ) עדיפה על PSA .כבדיקת סקר
- ד. אצל מעשנים מומלץ לעשות בדיקת סקר עם PSA
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Sources
- Israeli Task Force on Health Promotion and Disease Prevention (Israeli Medical Association / Israel Association of Family Physicians), current edition — Recommendations for adults
- Israel Ministry of Health, current programmes — National programmes for early detection of breast and colorectal cancer
- US Preventive Services Task Force, 2016–2024 — Recommendation statements for adult screening
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.
See also: Cancer screening in older adults