Screening for cancer and coronary risk factors through a nurse practitioner-staffed preventive health clinic

The Preventive Health Examination (PHE) program was designed to screen for cancer of the lung, colon, skin, and prostate (or breast) and to detect the risk factors for coronary artery disease, i.e., arterial hypertension, hypercholesterolemia, cigarette smoking, and obesity. To investigate the cost-effectiveness of PHE performed by nurse practitioners, the first 176 subjects enrolled in the PHE program at a northeastern, suburban VA Medical Center were evaluated prospectively. The subjects were recruited through random mailing. The direct cost of PHEs was $80 per patient. PHEs were performed on 171 men and 5 women, mean age 57.2 years, divided into groups according to the date of evaluation. Nine percent of patients had findings highly suspicious of cancer (lung nodules in 7, skin lesions in 9). As a consequence, one patient underwent lobectomy for squamous carcinoma of the lung and another underwent prostatectomy for adenocarcinoma of the prostate. Fifty-five percent of patients had high cholesterol levels, 53% were obese, 30% were heavy cigarette smokers, and 19% were hypertensive. Nineteen percent of the patients had three or more coronary artery disease risk factors. We conclude that low cost PHEs performed by nurse practitioners have a high yield in detecting risk factors for coronary artery disease, and for detecting potentially treatable malignancies.