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Difficulty: MediumClinical Preventive Services and Screening

A 68-year-old woman presents to her primary care provider for an annual check-up. Her past medical history includes hypertension and osteoarthritis. She is a current tobacco user who has smoked 1.5 packs of cigarettes daily since she was 18 years old. She underwent natural menopause at age 54 and confirms she has experienced absolutely no vaginal bleeding or spotting since that time. During today's visit, she expresses high anxiety regarding uterine cancer due to a friend's recent diagnosis and asks if a biopsy can be performed to confirm she is cancer-free. Furthermore, she requests the intranasal flu vaccine because she strongly dislikes needles. A review of her electronic health record demonstrates a normal screening colonoscopy at age 63, a normal bone densitometry scan at age 65, and a normal screening mammogram 6 months ago. Which of the following is the most appropriate action regarding this patient's preventive care?

  1. Order a low-dose chest computed tomography scanAnswer
  2. B
    Proceed with an endometrial tissue biopsy for cancer screening
  3. C
    Provide the intranasal, cold-adapted influenza immunization
  4. D
    Arrange for a one-time abdominal aortic ultrasound
  5. E
    Conduct a follow-up bone densitometry evaluation

Answer

Order a low-dose chest computed tomography scan
The correct action is to order a low-dose chest computed tomography (LDCT) scan. According to the United States Preventive Services Task Force (USPSTF), annual screening for lung cancer with LDCT is recommended 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. This 68-year-old patient has a 75 pack-year history and is a current smoker, making her highly eligible for this Grade B recommended screening.

Step-by-Step Solution

1
Analyze the patient's demographic data and risk factor profile.
The patient is a 68-year-old current smoker with a 75 pack-year smoking history.
To identify which age- and risk-appropriate preventive screenings are indicated.
2
Evaluate the patient's specific requests against current clinical guidelines.
The requests for a screening endometrial biopsy and an intranasal live-attenuated influenza vaccine are contraindicated based on her asymptomatic status and age (>50 years), respectively.
To ensure patient safety and avoid unnecessary or harmful medical interventions.
3
Select the evidence-based screening intervention that matches her high-risk profile.
Low-dose chest computed tomography is strongly indicated based on USPSTF guidelines for lung cancer screening.
To reduce mortality through early detection in a high-risk demographic.

Key Concept

Clinical Preventive Services and Screening
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Topics

Clinical Preventive Services and Screening

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