Periodic Health Assessment

CTFPHC Guidelines

Asymptomatic Thyroid Dysfunction (2019)

CTFPHC recommends against screening asymptomatic nonpregnant adults aged 18 years and older for thyroid dysfunction in primary care settings (strong recommendation, low-certainty evidence).

Abdominal Aortic Aneurysm (2017)

CTFPHC recommends one-time screening with ultrasound for abdominal aortic aneurysm for men aged 65 to 80. (Weak recommendation; moderate quality of evidence)
CTFPHC recommends not screening men older than 80 years of age for abdominal aortic aneurysm. (Weak recommendation; low quality of evidence)
CTFPHC recommends not screening women for abdominal aortic aneurysm. (Strong recommendation; very low quality of evidence)

Asymptomatic Bacteriuria in Pregnancy (2018)

CTFPHC recommends screening pregnant women once during the first trimester with urine culture for asymptomatic bacteriuria (weak recommendation; very low-quality evidence). This recommendation applies to pregnant women who are not experiencing symptoms of a UTI and are not at increased risk for asymptomatic bacteriuria.

Cervical Cancer (2013)

For women aged < 20 CTFPHC recommends not routinely screening for cervical cancer (Strong recommendation; high quality evidence)
For women aged 20 to 24 CTFPHC recommends not routinely screening for cervical cancer. (Weak recommendation; moderate quality evidence)
For women aged 25 to 29 CTFPHC recommends routine screening for cervical cancer every 3 years. (Weak recommendation; moderate quality evidence)
For women aged 30 to 69 CTFPHC recommends routine screening for cervical cancer every 3 years. (Strong recommendation; high quality evidence)
For women aged ≥ 70 who have been adequately screened (i.e., 3 successive negative Pap tests in the last 10 years), CTFPHC recommends that routine screening may cease. For women aged 70 or over who have not been adequately screened CTFPHC recommends continued screening until 3 negative test results have been obtained. (Weak recommendation; low quality evidence)

Chlamydia and Gonorrhea (2021)

CTFPHC recommends opportunistic screening of sexually active individuals under 30 years of age who are not known to belong to a high-risk group, annually, for chlamydia and gonorrhea at primary care visits, using a self- or clinician-collected sample (Conditional recommendation; very low-certainty evidence).

Cognitive Impairment (2024)

CTFPHC recommends against instrument-based screening of asymptomatic older adults (≥ 65 years) for cognitive impairment. (Strong recommendation; low certainty evidence)

Colorectal Cancer (2016)

CTFPHC recommends screening adults aged 60 to 74 for CRC with FOBT (either gFOBT or FIT) every two years OR flexible sigmoidoscopy every 10 years. (Strong recommendation; moderate quality evidence)
CTFPHC recommends screening adults aged 50 to 59 for CRC with FOBT (either gFOBT or FIT) every two years OR flexible sigmoidoscopy every 10 years. (Weak recommendation; moderate quality evidence)
CTFPHC recommends not screening adults aged 75 years and over for CRC. (Weak recommendation; low quality evidence)
CTFPHC recommends not using colonoscopy as a screening test for CRC. (Weak recommendation; low quality evidence)

Depression during pregnancy and the postpartum period (2022)

CTFPHC recommends against instrument-based depression screening using a questionnaire with cut-off score to distinguish “screen positive” and “screen negative” administered to all individuals during pregnancy and the postpartum period (up to 1 year after childbirth) (conditional recommendation, very low-certainty evidence).

Depression in Adults (2025)

CTFPHC recommends against screening all adults aged 18 years and older for depression using a questionnaire with a cut-off score to distinguish “screen positive” and “screen negative” status (strong recommendation, very low-certainty evidence) based on evidence suggesting little to no effect of depression screening on health.
This recommendation does not apply to adults with a personal history, current diagnosis, or clinical suspicion of a diagnosis of depression or another mental health disorder.
This recommendation does apply to those who may be at an elevated risk of depression.

Developmental Delay (2016)

CTFPHC recommends against screening for developmental delay using standardized tools in children aged 1 to 4 years with no apparent signs of developmental delay and whose parents and clinicians have no concerns about development. (Strong recommendation; low quality evidence)

Diabetes, type 2 (2012)

For adults at low to moderate risk of diabetes (determined with a validated risk calculator), CTFPHC recommends not routinely screening for type 2 diabetes. (Weak recommendation; low-quality evidence)
For adults at high risk of diabetes (determined with a validated risk calculator), CTFPHC recommends routinely screening every 3–5 years with A1c. (Weak recommendation; low-quality evidence)
For adults at very high risk of diabetes (determined with a validated risk calculator), CTFPHC recommends routine screening annually with A1c. (Weak recommendation; low-quality evidence)

Esophageal Adenocarcinoma (2020)

CTFPHC recommends not screening adults (≥18 years) with chronic gastroesophageal reflux disease, for esophageal adenocarcinoma or its precursor conditions (i.e. Barrett esophagus or dysplasia) (strong recommendation; very low-certainty evidence).

This recommendation does not apply to people exhibiting alarm symptoms or those diagnosed with BE (with or without dysplasia). Clinicians should be aware of alarm symptoms (e.g., dysphagia, odynophagia, recurrent vomiting, unexplained weight loss, anemia, loss of appetite or gastrointestinal bleeding) for EAC and evaluate, refer, and manage patients accordingly. They should also apply clinical judgement for the investigation and management of those unresponsive to GERD treatment or with symptoms suggestive of other upper gastrointestinal disorders (e.g. dyspepsia).

Fragility Fractures (2023)

CTFPHC recommends risk assessment-first screening to prevent fragility fractures in females aged ≥ 65 years as follows (conditional recommendation, low-certainty evidence):

FRAX: Apply the Canadian clinical FRAX risk assessment tool (without BMD). Use the 10-year absolute risk of MOFs to facilitate shared decision-making about the possible benefits and harms of preventive pharmacotherapy.
BMD + FRAX: After this discussion, if preventive pharmacotherapy is considered, request BMD measurement using dual energy X-ray absorptiometry of the femoral neck. Then re-estimate fracture risk by adding the BMD T-score into FRAX.
CTFPHC recommends against screening females aged 40-64 years and males ≥ 40 years to prevent fragility fractures (strong recommendation, very low-certainty evidence).

These recommendations apply to community-dwelling individuals not currently on pharmacotherapy to prevent fragility fractures.

Hepatitis C (2017)

CTFPHC recommends against screening for HCV in adults who are not at elevated risk. (Strong recommendation, very low quality evidence)

Hypertension (2012)

CTFPHC recommends blood pressure measurement at all appropriate primary care visits. (Strong recommendation; moderate quality evidence)
CTFPHC recommends that blood pressure be measured according to the current techniques described in the Canadian Hypertension Education Program CHEP recommendations for office and out-of-office (ambulatory) blood pressure measurement. (Strong recommendation; moderate quality evidence)
For people who are found to have an elevated blood pressure during screening, the CHEP criteria for assessment and diagnosis of hypertension should be applied to determine whether the patient meets diagnostic criteria for hypertension. (Strong recommendation; moderate quality evidence)

Impaired Vision (2018)

For community-dwelling adults aged 65 years and over CTFPHC recommends against screening for impaired vision in primary care settings (Weak recommendation, low quality evidence).

Lung Cancer (2016)

Low dose computed tomography (LDCT)
- For adults aged 55-74 years with at least a 30 pack-year smoking history who currently smoke or quit less than 15 years ago, CTFPHC recommends annual screening with LDCT up to three consecutive times. Screening should ONLY be carried out in health care settings with expertise in early diagnosis and treatment of lung cancer. Weak recommendation; low quality evidence.
- For all other adults, regardless of age, smoking history or other risk factors, CTFPHC recommends not screening for lung cancer with LDCT. Strong recommendation; very low quality evidence.
Chest x-ray (CXR): CTFPHC recommends that chest x-ray not be used to screen for lung cancer, with or without sputum cytology. Strong recommendation; low quality evidence.

Pelvic Exam (2016)

CTFPHC recommends not performing a screening pelvic examination to screen for noncervical cancer, pelvic inflammatory disease, or other gynecological conditions in asymptomatic women. (Strong recommendation; moderate-quality evidence)

Prostate Cancer (2014)

For men aged less than 55 years, CTFPHC recommends not screening for prostate cancer with the prostate-specific antigen test. (Strong recommendation; low quality evidence)
For men aged 55–69 years, CTFPHC recommends not screening for prostate cancer with the prostate-specific antigen test. (Weak recommendation; moderate quality evidence)
For men 70 years of age and older, CTFPHC recommends not screening for prostate cancer with the prostate-specific antigen test. (Strong recommendation; low quality evidence)

Tobacco Smoking in Adults (2025)

As part of good clinical care, providers are expected to be knowledgeable about their patients’ smoking status. CTFPHC recommends that all people who smoke tobacco cigarettes be encouraged to stop and be offered one or more recommended smoking cessation interventions (strong recommendation, high certainty).
Individuals who smoke should be engaged in shared decision-making about options to support quitting. This involves a collaborative process to help people make choices that align with evidence and their own values and preferences
CTFPHC recommends several behavioural, pharmacotherapy, and combined intervention options (strong recommendation):
Behavioural (low to high certainty of effect estimates across interventions)
- Advice or education from a healthcare provider
- Individual or group counselling from a trained tobacco cessation counsellor
- Mobile phone text message-based interventions
- Self-help materials
Pharmacotherapy (low to moderate certainty of effect estimates across interventions)
- Bupropion
- Cytisine
- NRT
- Varenicline
Combined pharmacotherapy and behavioural approaches (low certainty of effect estimates)
CTFPHC suggests that interactive computer-based or online programs with additional behavioural support may also be considered (conditional recommendation, very low certainty of effect estimates).
CTFPHC recommends against several alternative interventions (strong recommendation, very low to low certainty of effect estimates across interventions):
- Acupuncture
- Continuous auricular stimulation (using indwelling needles or other means to apply continuous stimulation to the auricle)
- Hypnotherapy
- Laser therapy (applying low level lasers to specific anatomical locations)
- Electrostimulation (applying electrical current to specific anatomical locations on the head)
- S-Adenosyl-L-Methionine (SAMe)
- St. John’s wort
CTFPHC suggests against using interactive computer-based or online programs without additional behavioural support (i.e., those only involving interaction between the individual and a website or app) (conditional recommendation, very low certainty of effect estimates).
CTFPHC suggests against using e-cigarettes for smoking cessation except in certain circumstances (conditional recommendation, low certainty of effect estimate).
For people who have unsuccessfully attempted other interventions, are otherwise unwilling to try other interventions, or express a strong preference, practitioners may engage in shared decision-making regarding the possible use of e-cigarettes with or without nicotine.
People who decide to use e-cigarettes to quit smoking should be informed of the uncertainties related to e-cigarettes. These include the lack of approved therapeutic products with consistent formulations, the lack of long-term safety data, and that ongoing use of e-cigarettes with nicotine does not address their addiction to nicotine since it would continue to be consumed.

Tobacco Smoking in Children and Adolescents (2017)

Prevention: For children and youth (5-18 years) who do not currently smoke tobacco, whether they have never smoked or are former smokers, CTFPHC recommends an intervention asking children and youth or their parents about tobacco use and offering brief information and advice at appropriate primary care visits to prevent tobacco smoking. Weak recommendation, low quality evidence.
Treatment: For children and youth (5-18 years) who have smoked tobacco within the past 30 days CTFPHC recommends asking children and youth and/or their parents about tobacco use by the child or youth and offering brief information and advice at appropriate primary care visits to treat tobacco smoking. Weak recommendation, low quality evidence.

USPSTF A & B Guidelines

Grade A

The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. For women aged 30 to 65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting). (August 2018)
The USPSTF recommends screening for colorectal cancer in all adults aged 50 to 75 years. (May 2021)
The USPSTF recommends that all persons planning to or who could become pregnant take a daily supplement containing 0.4 to 0.8 mg (400 to 800 mcg) of folic acid. (August 2023)
The USPSTF recommends screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit. (July 2019)
The USPSTF recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk of infection should also be screened. (June 2019)
The USPSTF recommends that clinicians screen for HIV infection in all pregnant persons, including those who present in labor or at delivery whose HIV status is unknown. (June 2019)
The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. (April 2021)
The USPSTF recommends prophylactic ocular topical medication for all newborns to prevent gonococcal ophthalmia neonatorum. (January 2019)
The USPSTF recommends that clinicians prescribe preexposure prophylaxis using effective antiretroviral therapy to persons who are at increased risk of HIV acquisition to decrease the risk of acquiring HIV. (August 2023)
The USPSTF strongly recommends Rh(D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care. (February 2004)
The USPSTF recommends early, universal screening for syphilis infection during pregnancy; if an individual is not screened early in pregnancy, the USPSTF recommends screening at the first available opportunity. (May 2025)
The USPSTF recommends screening for syphilis infection in persons who are at increased risk for infection. (September 2022)
The USPSTF recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioural interventions and US Food and Drug Administration (FDA)—approved pharmacotherapy for cessation to nonpregnant adults who use tobacco. (January 2021)
The USPSTF recommends that clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioural interventions for cessation to pregnant persons who use tobacco. (January 2021)

Grade B

The USPSTF recommends 1-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked. (December 2019)
The USPSTF recommends screening for anxiety disorders in adults (64 years old or younger), including pregnant and postpartum persons. (June 2023)
The USPSTF recommends screening for anxiety in children and adolescents aged 8 to 18 years. (October 2022)
The USPSTF recommends the use of low-dose aspirin (81 mg/day) as preventive medication after 12 weeks of gestation in persons who are at high risk for preeclampsia. (September 2021)
The USPSTF recommends screening for asymptomatic bacteriuria using urine culture in pregnant persons. (September 2019)
The USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing. (August 2019)
The USPSTF recommends that clinicians offer to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer (aged 35 years or older) and at low risk for adverse medication effects. (September 2019)
The USPSTF recommends biennial (every other year) screening mammography for women aged 40 to 74 years. (April 2024)
The USPSTF recommends providing interventions or referrals, during pregnancy and after birth, to support breastfeeding. (April 2025)
The USPSTF recommends screening for gonorrhea in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection. (September 2021)
The USPSTF recommends screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection. (September 2021)
The USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years. (May 2021)
The USPSTF recommends screening for depression in the adult population, including pregnant and postpartum persons, as well as older adults. (June 2023)
The USPSTF recommends screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years. (October 2022)
The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. (June 2024)
The USPSTF recommends screening for gestational diabetes in asymptomatic pregnant persons at 24 weeks of gestation or after. (August 2021)
The USPSTF recommends offering or referring adults with cardiovascular disease risk factors to behavioural counseling interventions to promote a healthy diet and physical activity. (November 2020)
The USPSTF recommends that clinicians offer pregnant persons effective behavioural counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy. (May 2021)
The USPSTF recommends screening for hepatitis B virus (HBV) infection in adolescents and adults at increased risk for infection. (December 2020)
The USPSTF recommends screening for hepatitis C virus (HCV) infection in adults aged 18 to 79 years. (March 2020)
The USPSTF recommends that clinicians provide or refer children and adolescents 6 years or older with a high body mass index (BMI) (≥95th percentile for age and sex) to comprehensive, intensive behavioural interventions. (June 2024)
The USPSTF recommends screening for hypertensive disorders in pregnant persons with blood pressure measurements throughout pregnancy. (September 2023)
The USPSTF recommends that clinicians screen for intimate partner violence (IPV) in women of reproductive age, including those who are pregnant and postpartum. (June 2025)
The USPSTF recommends screening for LTBI in populations at increased risk. (May 2023)
The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. (March 2021)
The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk for an osteoporotic fracture as estimated by clinical risk assessment. (January 2025)
The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in women 65 years or older. (January 2025)
The USPSTF recommends that clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions. (February 2019)
The USPSTF recommends screening for prediabetes and type 2 diabetes in adults aged 35 to 70 years who have overweight or obesity. Clinicians should offer or refer patients with prediabetes to effective preventive interventions. (August 2021)
The USPSTF recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. (December 2021)
The USPSTF recommends that primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride. (December 2021)
The USPSTF recommends repeated Rh(D) antibody testing for all unsensitized Rh(D)-negative women at 24 to 28 weeks’ gestation, unless the biological father is known to be Rh(D)-negative. (February 2004)
The USPSTF recommends behavioural counseling for all sexually active adolescents and for adults who are at increased risk for sexually transmitted infections (STIs). (August 2020)
The USPSTF recommends counseling young adults, adolescents, children, and parents of young children about minimizing exposure to ultraviolet (UV) radiation for persons aged 6 months to 24 years with fair skin types to reduce their risk of skin cancer. (March 2018)
The USPSTF recommends that clinicians prescribe a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more CVD risk factors (i.e. dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year risk of a cardiovascular event of 10% or greater. (August 2022)
The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents. (April 2020)
The USPSTF recommends screening for unhealthy alcohol use in primary care settings in adults 18 years or older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioural counseling interventions to reduce unhealthy alcohol use. (November 2018)
The USPSTF recommends screening by asking questions about unhealthy drug use in adults age 18 years or older. Screening should be implemented when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred. (Screening refers to asking questions about unhealthy drug use, not testing biological specimens.) (June 2020)
The USPSTF recommends vision screening at least once in all children aged 3 to 5 years to detect amblyopia or its risk factors. (September 2017)
The USPSTF recommends that clinicians offer or refer adults with a body mass index (BMI) of 30 or higher (calculated as weight in kilograms divided by height in meters squared) to intensive, multicomponent behavioural interventions. (September 2018)

Objectives

Do a periodic health assessment in a proactive or opportunistic manner (i.e., address health maintenance even when patients present with unrelated concerns).
In any given patient, selectively adapt the periodic health examination to that patient’s specific circumstances (i.e., adhere to inclusion and exclusion criteria of each manoeuvre/intervention, such as the criteria for mammography and prostate-specific antigen [PSA] testing).
In a patient requesting a test (e.g., PSA testing, mammography) that may or may not be recommended:
- Inform the patient about limitations of the screening test (i.e., sensitivity and specificity).
- Counsel the patient about the implications of proceeding with the test.
Keep up to date with new recommendations for the periodic health examination, and critically evaluate their usefulness and application to your practice.