Preventive Care on the ABFM: USPSTF Guidelines You Must Know

Preventive care is one of the most testable domains on the ABFM, and the primary source is the United States Preventive Services Task Force (USPSTF) recommendations. The USPSTF grades recommendations A through D (with I for insufficient evidence). For the ABFM, you need fluency with the A and B recommendations — these represent the "should do" standard of primary care and are heavily tested.

This is a consolidated reference. Memorize the ages and cadences; the rest is judgment.

Cancer Screening

Colorectal Cancer - Ages 45-75: screen (Grade B for 45-49, Grade A for 50-75). This 45-start is a 2021 change — know it. - Ages 76-85: selectively; individualized - Options: colonoscopy every 10 years, FIT annually, FIT-DNA every 3 years, flex sig every 5 years, CT colonography every 5 years

Breast Cancer - Ages 40-74: biennial mammography (Grade B). Updated in 2024 to start at 40 (previously 50 in most scenarios). - High-risk populations: earlier and/or more intensive screening (individualized; BRCA-positive referral for genetic counseling)

Cervical Cancer - Ages 21-29: Pap every 3 years - Ages 30-65: Pap every 3 years, OR HPV testing every 5 years, OR co-testing every 5 years - Under 21 or over 65 with adequate prior negative screening: do not screen - Post-hysterectomy for benign disease with cervix removed: no screening

Lung Cancer - Ages 50-80 with ≥20 pack-year smoking history, currently smoking or quit within 15 years: low-dose CT annually (Grade B) - Stop if 15 years since quit or life expectancy too limited

Prostate Cancer - Ages 55-69: individualized shared decision-making (Grade C) - Age 70+: do not screen (Grade D) - African American men and those with family history: consider starting earlier discussion

Skin Cancer - Insufficient evidence for screening asymptomatic adults (Grade I). Behavioral counseling for UV avoidance is Grade B in fair-skinned children and young adults.

Cardiovascular Prevention

Blood Pressure Screening - Ages 18+: screen (Grade A). Confirm outside clinic setting for new elevated readings before diagnosis.

Statins for Primary Prevention - Ages 40-75 with ≥1 CVD risk factor and 10-year ASCVD risk ≥10%: offer statin (Grade B) - 10-year risk 7.5-10%: individualize (Grade C)

Aspirin for Primary Prevention - Ages 40-59 with ≥10% 10-year ASCVD risk: individualize (Grade C) — reduced indications compared to older guidelines - Age 60+: do NOT initiate for primary prevention (Grade D). Big change from older recommendations. - Does not apply to secondary prevention after established ASCVD

AAA Screening - Men 65-75 who have ever smoked: one-time ultrasound (Grade B) - Men 65-75 who never smoked: selectively (Grade C) - Women: generally not screened

Diabetes / Prediabetes - Ages 35-70 with overweight/obesity: screen for prediabetes and type 2 diabetes (Grade B)

Infectious Disease

HIV - Ages 15-65: screen at least once (Grade A) - Higher-risk populations: repeat periodically

Hepatitis B - All adults ≥18: screen at least once (Grade B — updated 2024) - Pregnant women: every pregnancy

Hepatitis C - Ages 18-79: screen at least once (Grade B)

Latent TB - Adults at increased risk (immigrants from high-prevalence regions, residents/employees of congregate settings, healthcare workers): screen (Grade B)

Syphilis - Adolescents and adults at increased risk: screen (Grade A) - Pregnant women: all, early in pregnancy (Grade A)

Chlamydia and Gonorrhea - Sexually active women ≤24 or older women at increased risk: screen (Grade B) - Men: insufficient evidence for routine screening

Behavioral Health

Depression - All adults including pregnant/postpartum women: screen with adequate systems for follow-up (Grade B) - Adolescents 12-18: screen (Grade B) - Children under 12: insufficient evidence

Anxiety - Adults under 65: screen (Grade B — new 2023 recommendation) - Adolescents 8-18: screen (Grade B)

Unhealthy Alcohol Use - Adults including pregnant women: screen and offer brief behavioral counseling (Grade B)

Tobacco - All adults: ask and advise to quit; offer pharmacotherapy and behavioral support (Grade A) - Pregnant women: behavioral interventions (Grade A)

Intimate Partner Violence - Women of reproductive age: screen (Grade B)

Obesity and Nutrition

Obesity in Adults - BMI ≥30: offer or refer for intensive behavioral intervention (Grade B)

Obesity in Children - Ages ≥6 with obesity: comprehensive intensive behavioral intervention, ≥26 hours over 6-12 months (Grade B)

Healthy Diet and Activity - Adults with CVD risk factors: refer for behavioral counseling (Grade B) - Adults without CVD risk factors: individualize (Grade C)

Women's Health

Folic Acid Supplementation - Planning pregnancy: 0.4-0.8 mg daily (Grade A)

Osteoporosis - Women ≥65: screen (Grade B) - Postmenopausal women <65 with FRAX-calculated fracture risk ≥9.3%: screen (Grade B)

BRCA Risk Assessment - Women with family or personal history suggestive of BRCA-related cancer: family history assessment and genetic counseling referral (Grade B)

Gestational Diabetes - At 24 weeks gestation or later: screen (Grade B)

Preeclampsia Prevention - Pregnant persons at high risk: low-dose aspirin after 12 weeks (Grade B)

Pediatric-Specific (For the Family Medicine Exam)

Vision - Ages 3-5: screen for amblyopia at least once (Grade B)

Obesity - Ages ≥6: screen and intervene (Grade B)

Autism - Insufficient evidence for universal screening in asymptomatic children (Grade I) — but AAP recommends M-CHAT screening at 18 and 24 months, which is the clinical standard regardless

Depression - Adolescents 12-18: screen (Grade B)

How to Use This List

This is a reference, not a memorization list for next week. Drop it into your spaced repetition queue and let the algorithm do the work over 2-3 months. On exam day you want to be able to answer "at what age does colon cancer screening now begin?" instantly, without computation.

A useful micro-drill: before looking up any screening question, state your answer out loud first. Then check. Over dozens of reps, the cutoffs become automatic.

A Final Trap

Preventive care questions on the ABFM often test not just "is this recommended" but "when to stop." Screening cessation ages are frequently tested:

- Colonoscopy: generally stop at 75, individualize 76-85 - Cervical cancer: stop at 65 with adequate prior screening - Breast cancer: continue through 74 per 2024 update (older guidelines stopped at 74 as well) - Lung cancer: stop at 80 or when 15 years since quit

Stopping is as testable as starting. Know both ends.

Preventive care is one of the best-yield domains for focused study — concentrated guideline content, predictable question structure, and frequent updates that reward currency. Getting this domain cold is one of the highest-leverage moves you can make in the final two months of prep.