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Difficulty: Very hardPreventive Care and Screening

A 7373-year-old man presents to the clinic for a routine health maintenance examination. He has no acute complaints and feels well. His medical history is significant for essential hypertension and mild benign prostatic hyperplasia. He is a former smoker who smoked 11 pack of cigarettes daily for 4040 years before successfully quitting 1616 years ago at age 5757. He has been receiving annual low-dose chest CT scans for lung cancer screening for the past several years; his most recent scan was 1313 months ago and was normal. His last screening colonoscopy was performed exactly 1010 years ago at age 6363 and was completely normal with excellent bowel preparation. He also underwent a normal abdominal aortic ultrasound at age 6666. He is highly functional, exercises daily, and has a life expectancy of greater than 1010 years. Vital signs and physical examination are unremarkable. Which of the following is the most appropriate next step in this patient's preventive care?

  1. Discontinue low-dose chest CT and schedule a screening colonoscopyAnswer
  2. B
    Schedule a low-dose chest CT and a screening colonoscopy
  3. C
    Discontinue both low-dose chest CT and routine colorectal cancer screening
  4. D
    Discontinue low-dose chest CT, schedule a screening colonoscopy, and repeat the abdominal aortic ultrasound
  5. E
    Discontinue low-dose chest CT, schedule a screening colonoscopy, and order a dual-energy x-ray absorptiometry (DEXA) scan

Answer

Discontinue low-dose chest CT and schedule a screening colonoscopy
The correct action involves discontinuing the low-dose chest CT and scheduling a screening colonoscopy. According to USPSTF guidelines, annual lung cancer screening with low-dose chest CT is recommended for adults aged 5050 to 8080 years with at least a 2020 pack-year smoking history who currently smoke or have quit within the past 1515 years. Because this patient quit smoking 1616 years ago, he has surpassed the 1515-year cessation threshold, and screening should be discontinued. For colorectal cancer screening, the USPSTF recommends routine screening for all adults aged 4545 to 7575 years. This patient is 7373 years old and his last colonoscopy was exactly 1010 years ago, meaning he has reached the end of the safe interval and is currently due for repeat screening. Finally, abdominal aortic aneurysm (AAA) screening with ultrasound is a one-time recommendation for men aged 6565 to 7575 who have ever smoked; because his prior scan was normal, it does not need to be repeated. Routine DEXA screening is not indicated for average-risk men.

Step-by-Step Solution

1
Evaluate the indication for continued lung cancer screening.
Determine that low-dose chest CT should be discontinued.
USPSTF guidelines recommend discontinuing annual lung cancer screening once a patient has not smoked for 15 years. This patient quit 16 years ago, surpassing the threshold.
2
Evaluate the indication for colorectal cancer screening.
Determine that a screening colonoscopy should be scheduled.
The patient is 73 years old, falling within the 45-75 year routine screening window. Because his last colonoscopy was exactly 10 years ago, his standard interval has lapsed and he is due for repeat screening.
3
Evaluate the need for abdominal aortic aneurysm (AAA) surveillance.
Determine that no further AAA screening is required.
AAA screening is a one-time ultrasound recommendation for men aged 65 to 75 who have ever smoked. Since his prior scan at age 66 was normal, it does not need to be repeated.
4
Evaluate the need for osteoporosis screening.
Determine that a DEXA scan is not indicated.
Routine DEXA screening is indicated for women aged 65 and older, but is not routinely recommended for men without specific major risk factors for bone loss.

Key Concept

Application of temporal discontinuation thresholds and upper age limits in USPSTF preventive screening guidelines.
Estimated Time:1m 30s
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Topics

Preventive Care and Screening

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