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Difficulty: MediumPreventive Care and Screening

A 58-year-old woman is evaluated in the clinic for a routine health maintenance examination. She feels well and reports no new symptoms. Her medical history includes essential hypertension and hyperlipidemia, both of which are well-controlled with lisinopril and atorvastatin. The patient reports a 25 pack-year smoking history but successfully quit smoking 10 years ago. Family history is significant for a mother who was diagnosed with colon cancer at age 66. The patient's most recent screenings include a normal colonoscopy 8 years ago, a negative screening mammogram 8 months ago, and a negative cervical cytology with high-risk human papillomavirus (hrHPV) co-testing 3 years ago. Vital signs and physical examination are unremarkable. Which of the following is the most appropriate next step in preventive care for this patient?

  1. Low-dose computed tomography of the chestAnswer
  2. B
    Screening colonoscopy
  3. C
    Dual-energy x-ray absorptiometry
  4. D
    Resting electrocardiography
  5. E
    Cervical cytology with human papillomavirus co-testing

Answer

Low-dose computed tomography of the chest
The correct answer is low-dose computed tomography (LDCT) of the chest. According to the United States Preventive Services Task Force (USPSTF) guidelines, annual screening for lung cancer with LDCT is indicated for 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 58-year-old patient has a 25 pack-year history and quit 10 years ago, placing her squarely within the eligibility criteria for screening.

Step-by-Step Solution

1
Evaluate the patient's age and smoking history against lung cancer screening guidelines.
The patient is 58 years old, has a 25 pack-year smoking history, and quit 10 years ago.
To determine if she meets the USPSTF criteria for annual low-dose computed tomography (LDCT) screening.
2
Assess the need for colon cancer screening based on family history and prior colonoscopy.
Her mother was diagnosed at age 66. This does not change her from the average-risk 10-year screening interval. Her last colonoscopy was 8 years ago.
To rule out the need for a shortened colonoscopy interval, confirming the next test is due in 2 years.
3
Check current status for other age- and gender-appropriate screenings.
Mammogram is up to date (done 8 months ago, due biennially), Pap/HPV is up to date (done 3 years ago, due every 5 years), and she is too young for routine DEXA screening (starts at 65).
To eliminate the remaining preventive care options as inappropriate at this exact visit.

Key Concept

The USPSTF recommends annual lung cancer screening with LDCT for 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.
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Topics

Preventive Care and Screening

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