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):
- 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.
- 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.
- 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.
- 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.
- Shared Decision-Making:
- Involves collaboration between GP and patient, discussing treatment options, benefits, harms, and patient preferences.
- Useful in screening decisions
- 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.
- 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.
- 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.
Absolute CVD-Risk Assessment
| Target population (age yrs) | What to measure / tool | Minimum review interval* | Key considerations / high-risk triggers |
|---|---|---|---|
| General 45 – 79 CKD (eGFR 30-44) 35 – 79 Aboriginal & Torres Strait Islander (ATSI) 30 – 79 | • Absolute CVD-risk calculator • Record smoking status, BP, fasting lipids, HbA1c (or FPG), eGFR ± UACR, BMI / waist circumference | Every 5 years (earlier if risk factors change) | Automatically high risk if : 1- eGFR <45mL/min/1.73m2, or 2- men with persistent uACR >25mg/mmol, or 3- women with persistent uACR >35mg/mmol. 4 – confirmed diagnosis of familial hypercholesterolaemia. |
| < 45 with ≥ 1 risk factor (smoking, diabetes, family Hx premature CVD, kidney disease, gestational diabetes, pre-diabetes, severe obesity, severe mental illness, FH) | Same panel as above | Start immediately; reassess 2-yearly | Begin before age-45; consider specialist review for very high single-risk parameters |
| ATSI 18 – 29 | Smoking status, BP, fasting lipids, HbA1c/FPG, eGFR ± UACR | Annual health check (or at least biennial) | Focus on individual risk factors and early lifestyle intervention |
*Use clinical judgement for shorter intervals in rapidly changing risk or after major events (e.g. pregnancy, new diabetes).
Familial Hypercholesterolaemia (FH) Case-finding
| What to look for | When / how often | Action points |
|---|---|---|
| • LDLR, APOB, PCSK9 mutation carriers or Dutch Lipid Network score ≥6 (Definite FH >8 Probable FH 6-8 Possible FH 3-5 Unlikely FH <3) • Clinical features – tendon / tuberous xanthomata, early arcus • LDL-C 5.0 – 6.5 mmol/L (+ premature CVD) | Opportunistic lipid panel in any adult with total-C >7.5 mmol/L or definite family Hx. | Confirm with genetic testing requested by a specialist (MBS rebate once per lifetime); initiate : intensive statin ± ezetimibe ± PCSK9-i; cascade screening of relatives |
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Coronary Artery Calcium (CAC) Scoring
Population screening: not recommended for general population screening
| Risk stratum | Role of CAC | Caveats |
|---|---|---|
| Red zone – DO NOT order • Established CVD or very-high-risk patients (e.g. prior MI, revascularisation, known CAD, diabetes with micro-albuminuria, stage 3b CKD, FH, SBP ≥ 180 mmHg, LDL-C ≥ 4.9 mmol/L) OR anyone with cardiac symptoms (chest pain, dyspnoea on exertion, equivocal angina). | No utility manage as secondary prevention | CAC result will not alter therapy; unnecessary radiation & cost |
| Orange zone – CONSIDER • Intermediate/moderate risk (5-10 % 5-yr ABS) • Traditional risk may underestimate true risk (e.g. strong family Hx, ATSI, metabolic syndrome) | May aid re-classification and intensify management | Shared decision-making essential; explain potential for incidental findings & anxiety |
| Green zone – TAKE ACTION • Low-to-borderline risk (≤ 5 %) requesting further clarification | Can identify subclinical atherosclerosis and prompt earlier statin ± lifestyle intensification | A CAC = 0 has strong “negative risk” value and may allow postponing pharmacotherapy in otherwise low-risk adults A positive score (> 0) re-opens the conversation about lipid-lowering and aggressive risk-factor control. Avoid overscreening (< 40 y, > 75 y) where prevalence or interpretability is poor. |
Behavioural & Pharmacological Prevention Messages
| Intervention | Core recommendation (primary prevention) |
|---|---|
| Smoking cessation | Ask → Advise → Help: brief counselling ± NRT, varenicline or bupropion; offer Quitline or culturally-appropriate ATSI programmes |
| Physical activity | ≥ 150 min/week moderate-vigorous activity (or ≥ 75 min vigorous); muscle-strengthening ≥ 2 days/week; encourage workplace & incidental movement |
| Dietary advice | Mediterranean-style: ↑ vegetables, fruits, whole-grains, legumes, nuts, fish, olive oil ↓ saturated & trans fats, refined carbs, excess salt oily fish 2-3×/wk |
| Aspirin | Routine use for primary prevention NOT recommended bleeding risk likely outweighs CVD benefit in most Australians |
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CANCER
BREAST CANCER
| Risk group | Population share | Relative risk (RR) | Lifetime risk | Key family-history / genetic criteria* |
|---|---|---|---|---|
| Potentially high risk (includes known pathogenic-variant carriers) | < 1 % | > 3 × | 25 – 50 % | • ≥ 2 first-/second-degree relatives on the same side with breast ± ovarian cancer plus ≥ 1 of: – additional affected relatives – diagnosis < 40 y – bilateral cancer – breast + ovarian cancer in same person – Ashkenazi Jewish ancestry, male breast cancer • 1 first-/second-degree relative < 45 y and another relative on the same side with sarcoma < 45 y • Member of a family with a BRCA1/2, TP53, PALB2 or comparable high-risk mutation Cancer Australia |
| Moderately increased risk | ≈ 4 % | 1.5 – 3 × | 12 – 25 % | • One first-degree relative diagnosed < 50 y • Two first-degree relatives (any age) on the same side • Two second-degree relatives on the same side with breast cancer, ≥ 1 < 50 y Cancer Australia |
| Average / slightly increased risk | ≈ 90 % | ≤ 1.5 × | < 12 % | • No confirmed family history or • Single first-degree relative ≥ 50 y • ≤ 2 second-degree relatives ≥ 50 y on opposite sides of the family Cancer Australia |
* Counts breast and epithelial ovarian cancer; “same side” = maternal or paternal lineage.
Recommended surveillance & Medicare support
| Risk group | Imaging schedule | Suggested start age† | Medicare rebates / key notes |
|---|---|---|---|
| High risk | • Annual MRI + mammography (alternate every 6 months) • Add ultrasound if dense breasts or MRI contraindicated | 30–35 y or 10 y before youngest family diagnosis (whichever earlier) | MBS 63464 – 1 breast MRI / year for asymptomatic women < 60 y at high genetic risk; no rebate for average-risk MRI. BCNA Jones Radiology |
| Moderate risk | • Mammogram every 2 yrs (age 40 +) • Annual may be offered 40–49 y where service available | 40 y | Free biennial mammography through BreastScreen Australia 50–74 y; elective access 40–49 y. RACGPeviq |
| Average risk | • Biennial mammogram 50–74 y • Offer earlier (≥ 40 y) on individual preference | 50 y (40 y optional) | National invitation & recall system for women 50–74 y via BreastScreen Australia. RACGP |
† Clinical judgement required for women with treatment-related chest irradiation, extremely dense breasts, or accelerating family history.
Practical tips for primary care
- Risk assessment – take a three-generation pedigree; use validated tools (e.g. iPrevent, BOADICEA) to refine probability before referral.
- Referral – high-risk or uncertain cases → familial cancer clinic / genetics service for counselling ± testing.
- Lifestyle counselling – reinforce weight control, alcohol limits (< 10 drinks / week), regular physical activity, and smoking cessation across all risk groups.
- Dense breasts – explain that mammographic sensitivity falls; adjunct imaging is not routinely funded, but discussion of ultrasound or MRI is appropriate in individual cases.
- Documentation – record risk group, screening plan, and Medicare item numbers in the patient file for future recall systems.
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Colorectal‐Cancer
| Cohort | Modality | Start ∕ stop | Interval | Key points |
|---|---|---|---|---|
| National Bowel Cancer Screening Program (NBCSP) All asymptomatic adults 50 – 74 y | Immunochemical FOBT (iFOBT) mailed kit | Age 50 y → 74 y | Every 2 years | Kits automatically mailed by NBCSP; positive test → colonoscopy referral. RACGP |
| Average-risk adults 45 – 49 y | iFOBT (on request) | Age 45 y | Every 2 years | NHMRC now recommends commencing at 45 y; kits not yet mailed—must be requested via GP or NBCSP website. Cancer Council AustraliaThe Guardian |
| Chemoprevention (optional) | Aspirin 100 mg daily | Begin 45–70 y | Long-term | Discuss gastro-intestinal bleeding risk; evidence of CRC risk reduction. Cancer Council Australia |
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Family-History Risk Categories & Surveillance
| Category (RACGP / Cancer Council) | Lifetime CRC risk | Eligibility criteria (any one) | Recommended test & frequency | Start age (stop 74 y unless otherwise stated) |
|---|---|---|---|---|
| 1. Average / slightly ↑ | ~ < 2 × population | • No FDR with CRC & ≤2 SDR ≥60 y • One FDR ≥ 60 y | iFOBT 2-yearly; colonoscopy not routine | 45 y (or 50 y if using NBCSP) |
| 2. Moderately ↑ | 12 – 25 % | • One FDR < 60 y • Two FDR any age • One FDR + ≥1 SDR any age | Colonoscopy q 5 y (plus iFOBT 40–49 y if colonoscopy deferred) | 50 y or 10 y < earliest family diagnosis (whichever earlier) |
| 3. Potentially high | 25 – 80 % (heterogeneous) | • ≥ 2 FDR + ≥ 1 SDR (≥ 1 < 50 y) • 3 + FDR any age • FDR + SDR with multiple cancers or early onset | Colonoscopy q 5 y | 40 y or 10 y < earliest diagnosis |
| Lynch syndrome (MMR mutation) | 75 – 80 % | Pathogenic MLH1, MSH2, MSH6, PMS2, EPCAM | Colonoscopy q 1–2 y | 25 y or 5 y < earliest family case |
Genetic referral – Offer to all Category 3 families and to Category 2 if criteria suggest Lynch/FAP (e.g. Amsterdam II, Bethesda). Document pedigree and discuss MBS-rebated germline testing where appropriate.
Practical GP Notes
- Aspirin – Discuss 100 mg daily for anyone 45–70 y at ≥ average risk without contra-indications; continue for ≥ 2.5–5 years for meaningful benefit. Cancer Council Australia
- iFOBT logistics – Negative test ≠ no risk; emphasise biennial repetition and prompt investigation of symptoms regardless of last result.
- Aboriginal & Torres Strait Islander peoples – Higher incidence < 50 y; offer screening at 40–49 y after shared decision-making.
- Stopping age – Consider health status & life expectancy (> 15 y) when deciding to continue beyond 74 y.
- Data entry – Record risk category, recall dates, kit result, and colonoscopy reports in the practice software to trigger automated reminders.
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Cervical Screening
| Eligibility & scenario | Test / option | Interval | Nuanced practice points |
|---|---|---|---|
| Routine population 25 – 74 y (all people with a cervix) | HPV-based Cervical Screening Test (CST) – self-collected swab or clinician sample | 5-yearly | All pathology bulk-billed under MBS 73070/73071. Self-collection now universally available. Health and Aged Care AustraliaHealth and Aged Care Australia |
| < 25 y | No routine screening | — | HPV test once at 20-24 y if first intercourse < 14 y and un-vaccinated; otherwise start at 25 y. could considered on an individual basis but is not required. |
| > 75 y with < 2 lifetime CSTs or none in past 5 y | One-off CST | Once only | After a negative result the NCSP considers screening complete. Cancer Australia |
| Pregnancy | CST when due/overdue | Any trimester | Safe if correct broom is used; avoid endocervical brush to minimise bleeding and anxiety. Health and Aged Care Australia |
| Post-hysterectomy (total) | • No CIN2+ history → stop • Incomplete test-of-cure for HSIL (CIN2/3) → annual vault HPV + LBC until 2 consecutive negatives • Adenocarcinoma in situ (AIS) → annual vault co-test indefinitely • Subtotal (supracervical) hysterectomy – cervix left in situ CST → every 5 years to age 74 | As indicated | Benign indication (e.g. fibroids, prolapse, menorrhagia) AND • normal pre-op screening history AND • no cervical pathology in hysterectomy specimen : NO Cervix : None – screening stopped Previous HSIL with completed TOC before surgery NO Cervix : None – screening stopped |
| Symptomatic vaginal atrophy / trans men | Consider topical vaginal oestrogen daily ≥ 2 wks cease 1-2 d pre-test | — | Improves comfort & LBC adequacy; explain purpose to patient. Cancer Australia |
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Prostate Cancer
| Risk tier | Age range to offer PSA | Frequency | Definition (NHMRC / PCFA) | Practical notes & funding |
|---|---|---|---|---|
| Average | 50 – 69 y | 2-yearly | Men without – first-degree relatives (FDRs) | • Initial PSA > 3.0 ng/mL → repeat in 1-3 mo • If 3.0 – 5.5 ng/mL, add % free PSA at repeat • DRE not done routinely in asymptomatic men. Prostate Cancer Survivorship Kit |
| Moderate | 45 – 69 y | 2-yearly | ≥ 1 affected FDR (father/brother) | Same testing cadence; identical PSA action thresholds. |
| High | 40 – 69 y | 2-yearly | ≥ 3 affected FDRs or known BRCA2/PALB2 | Early baseline aids lifetime risk stratification. PCFA |
| ≥ 70 y | Shared decision | — | Life-expectancy < 7 y – testing generally not recommended | Discuss over-diagnosis, potential harms (incontinence, ED). |
| Abnormal PSA | mpMRI prostate prior to biopsy | — | Medicare 63541/63542 (diagnosis) reimburses ~AUD 450. | Pathology items 66654/66655 for PSA are bulk-billed; % free automatically covered if PSA 3.0-5.5 ng/mL. |
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Skin Cancer
| Risk tier | Suggested exam | Frequency | Who is in the tier? |
|---|---|---|---|
| Average / below | No routine checks | — | Population baseline |
| Above-average | Opportunistic look | ≤ 1 × 12 mo | Fair skin (I–II) outdoor occupation high UV exposure ≥ 40 common naevi |
| High | Full skin check by trained clinician | 12-monthly | Personal hx melanoma or ≥ 10 atypical naevi |
| Very high | Full exam + total body photography & dermoscopy | 6-monthly | Previous melanoma plus multiple atypical naevi multiple primary melanomas CDKN2A variant immunosuppression (eg, transplant) |
Always document Fitzpatrick type, naevus load & UV exposure counselling.
Risk prediction tools | Melanoma Institute Australia
Melanoma risk predictor | QIMR Berghofer Medical Research Institute
Keratinocyte risk score | QIMR Berghofer Medical Research Institute
- 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.
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Chronic Kidney Disease(KHA-CARI 2023)
diagnosis:
1) eGFR <60 mL/min/1.73m 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
| High-risk condition | Tests | Minimum frequency |
|---|---|---|
| AKI – Post-AKI (eGFR drop) | eGFR + Urine ACR | Annually × 3 y, then 2-yearly |
| Diabetes (T1/T2) | eGFR + Urine ACR | Annual |
| Hypertension | eGFR + Urine ACR | Annual |
| Established CVD | eGFR + Urine ACR | 2-yearly |
| Obesity, Smoking, FHx kidney failure | eGFR + Urine ACR | 2-yearly |
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Osteoporosis & Bone-Density Testing
| Scenario | Action | Re-test | Treat when… |
|---|---|---|---|
| Women/men ≥ 50 y plus ≥ 1 clinical risk factor (lifestyle or non-modifiable) | Calculate 10-yr fracture risk with FRAX® (BMD not recured for calculation) | — | If FRAX MOF ≥ 10 % → order DXA |
| postmenopausal Women/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 | DXA (spine + hip) if Minimal trauma – hip # or – VB # DXA to establish baseline BMD recommended – But not essential After DXA→ recalculate risk using FRAX® combined with the BMD reading | Not < 2 y unless major clinical change | Begin therapy if T ≤ -2.5 OR T -1 to -2.5 + FRAX (high risk) – MOF ≥ 20 % – hip ≥ 3 % |
| Age ≥ 70 y (no prior #) | Baseline DXA | T ≥ −1.5 → 5-yearly −2.5 < T < −1 → 2-yearly T ≤ −2.5 or new # → 12-monthly (item 12315) | Begin therapy if T ≤ -2.5 OR FRAX (high risk) MOF ≥ 20 % hip ≥ 3 % |
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
Calcium / Vitmain D – 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.
MOF = major osteoporotic fracture
| Drug (PBS criteria) | Standard course / review point | Notes |
|---|---|---|
| Alendronate / Risedronate (oral BP) | 5 y, consider 1-5 y drug holiday if low-mod risk | Max 10 y continuous |
| Zoledronic acid 5 mg IV | 3 annual doses, reassess at 6 y | Anti-fracture effect persists ≈ 3 y post-course |
| Denosumab 60 mg s/c | Q6 mo, indefinite; review at 5 y | Must switch to BP on cessation (rebound risk) |
| Romosozumab 210 mg mth | 12 mo max then anti-resorptive | PBS for severe post-menopausal OP with # |
| Teriparatide 20 µg daily | 24 mo lifetime | Follow with anti-resorptive |
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Menopause
| Age / context | Tests needed? | Key point |
|---|---|---|
| < 40 y (premature) or 40-45 y (early) | FSH ± E2, TFTs, PRL to exclude secondary causes | Confirm POI discuss fertility & bone health |
| ≥ 45 y with classic vasomotor symptoms & ≥ 12 mo amenorrhoea | No routine blood tests | Diagnosis is clinical labs rarely change management |
| MHT use for CHRONIC disease prevention | Not recommended | Discuss CVD, VTE, breast-cancer risk-benefit |
Chronic conditions include:
– Coronary heart disease
– Breast cancer
– Fractures
– Diabetes
– Colorectal cancer
– Thromboembolic events
– Stroke
– Dementia
– Gallbladder disease
– Urinary incontinence
– All-cause mortality
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Sexually Transmissible Infection Screening
| Condition | Who & how | Minimum interval | Extra notes |
|---|---|---|---|
| Chlamydia / Gonorrhoea | • Women ≤ 24 y → self-collected vaginal swab • ≥ 25 y if high-risk (new partner, multiple partners, MSM, sex work, ATSI, incarceration) | Opportunistic (12-monthly if risk persists) | Vaginal swab more sensitive than FPU add pharyngeal & anal swabs for MSM. |
| Heterosexual men | No routine screen | — | Test to prevent partner transmission if risk. |
| Syphilis | All pregnant women: first antenatal visit + repeat at 28-32 w & delivery if high risk | — | Rising incidence; low threshold for presumptive treatment. |
| Asymptomatic STI screen (HIV, Hep B) | Anyone with new partner, recent exposure (< 12 mo), MSM, sex workers, ATSI, trans & gender-diverse | Offer antigen/antibody HIV, HBsAg, anti-HBs, anti-HBc | Repeat HIV if exposure during window period (6 w). |
| Mycoplasma genitalium | Do not screen if asymptomatic | — | Test only if persistent urethritis/cervicitis after common causes excluded. |