A 55-year-old woman comes to the clinic for a routine health maintenance examination. Her past medical history is notable for hypertension, which is well controlled on lisinopril. She currently smokes 1 pack of cigarettes daily and has a 35 pack-year smoking history. Her surgical history includes a total abdominal hysterectomy for symptomatic uterine fibroids at age 42. She has not seen a physician in 6 years and does not remember her previous health screening dates, except for a normal screening mammogram at age 49. Her blood pressure is 126/78 mm Hg, heart rate is 72/min, and BMI is 24 kg/m². She is asymptomatic. Which of the following preventive care interventions are indicated for this patient at this visit? (Select all that apply.)
- Low-dose computed tomography of the chestAnswer
- Screening mammographyAnswer
- Screening colonoscopyAnswer
- DCervical cytologic and human papillomavirus cotesting
- EAbdominal duplex ultrasonography
Answer
The indicated interventions are low-dose computed tomography of the chest, screening mammography, and screening colonoscopy.
The correct interventions for this 55-year-old female smoker are low-dose computed tomography (LDCT) of the chest, screening mammography, and screening colonoscopy. Annual LDCT is recommended for adults aged 50 to 80 years who have a 20 pack-year smoking history and either currently smoke or have quit within the past 15 years. Biennial screening mammography is indicated for women aged 40 to 74 years; because her last mammogram was 6 years ago, she is overdue. Lastly, colorectal cancer screening is universally recommended for adults aged 45 to 75 years, and this patient lacks documented screening.
Step-by-Step Solution
Key Concept
Preventive screening guidelines in ambulatory medicine require synthesizing the patient's age, biological sex, surgical history (e.g., hysterectomy), and lifestyle risk factors (e.g., smoking).