Screenings

The Primary Care Providers will also assist in the following programs:

• Early detection and screening of cervical cancer (for women 19 years and older)
• Early detection of breast cancer (for women 40 years and older)
• Early detection and screening of prostrate cancer (for men 50 years and older)
• Detection and screening of HIV/AIDS
• NHI believes in prevention, therefore, a school screening program is being provided to all children 4-19 years with free eye examinations and if necessary prescription glasses. (Applies only to Belize City Southside and Southern Region)

1. Pap Smear

• If sexually active (start 3 years after the first sexual intercourse)
• If 3 consecutive annual screenings are found normal thereafter, screen every three years.
• If patient has never been sexually active: No screening required

If sexually active after age 20 and are at low risk:

• Cervical cancer screening (testing) should begin at age 21.
• Women between ages 21 and 29 should have a Pap test every 3 years. (HPV testing should not be used in this age group unless it is needed after an abnormal Pap test result). (HPV testing will not be covered by NHI but if patient chooses to do so at their own expense the recommendation applies)
• Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called “co-testing”) every 5 years. This is the preferred approach, but it is also OK to have a Pap test alone every 3 years.
• Women over age 65 who have had regular cervical cancer testing with normal results should not be tested for cervical cancer. Once testing is stopped, it should not be started again. Women with a history of a serious cervical pre-cancer should continue to be tested for at least 20 years after that diagnosis, even if testing continues past age 65.
• A woman who has had her uterus removed (and also her cervix) for reasons not related to cervical cancer and who has no history of cervical cancer or serious pre-cancer should not be tested.
• A woman who has been vaccinated against HPV should still follow the screening recommendations for her age group.
  Patients with compromised Immune systems (including HIV and auto-immune diseases should be screened annually regardless of age)

American Cancer Society Guidelines

2. Mammogram

• Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health
• Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over
• Women should know how their breasts normally look and feel and report any breast change promptly to their health care provider. Breast self-exam (BSE) is an option for women starting in their 20s. (American cancer society)

3. PSA

• The American Cancer Society recommends that men make an informed decision with their doctor about whether to be tested for prostate cancer. Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment. The American Cancer Society believes that men should not be tested without learning about what we know and don’t know about the risks and possible benefits of testing and treatment.

Starting at age 50, men should talk to a doctor about the pros and cons of testing so they can decide if testing is the right choice for them. If they are African American or have a father or brother who had prostate cancer before age 65, men should have this talk with a doctor starting at age 40. If men decide to be tested, they should have the PSA blood test with or without a rectal exam. How often they are tested will depend on their PSA level.

• If PSA is normal without any history of risk, repeat every 4 years.
• Any male after age of 50 should be screened with PSA every year.
• If PSA is abnormal refer patient to a urologist. PSA levels 4 or higher should be referred to the urologist.
• PSA should not be performed on males with a life expectancy of less than 10 years.
• Digital Rectal Exam: is recommended at least once annually as of age 50 or when presenting with an abnormal PSA.

4. Ultrasounds: (Prenatal)

• ONE ultrasound recommended primarily in second trimester to Diagnose fetal malformation
  • Weeks 20-28 for congenital malformations
• Structural abnormalities
• Confirm multiple pregnancies
• Verify dates and growth Confirm intrauterine death
• Identify hydramnios or oligohydramnios – excessive or reduced levels of amniotic fluid
• Evaluation of fetal well-being
  (American Pregnancy Association)
  If the pregnancy is not considered high risk and is normal there is no need to repeat the ultrasound.