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Difficulty: MediumPreventive Care and Screening

A 42-year-old woman comes to the clinic for an annual health maintenance examination. She has a history of generalized anxiety disorder, which is well controlled with sertraline. She has no family history of breast, colon, ovarian, or other malignancies. She underwent cervical cancer screening with cytology and human papillomavirus (HPV) co-testing 3 years ago, which yielded negative results. She does not smoke and drinks one glass of wine on weekends. Her body mass index is 23 kg/m2, and her blood pressure is 118/76 mmHg. Physical examination, including a clinical breast examination, reveals no abnormalities. Which of the following cancer screening recommendations is most appropriate for this patient at this time?

  1. Recommend biennial screening mammographyAnswer
  2. B
    Reassure the patient that routine breast cancer screening begins at age 50
  3. C
    Refer the patient for a screening colonoscopy
  4. D
    Perform cervical cytology and human papillomavirus co-testing
  5. E
    Order a screening transvaginal ultrasound and serum CA-125 level

Answer

The most appropriate cancer screening recommendation is to recommend biennial screening mammography.
The correct answer is to recommend biennial screening mammography. The United States Preventive Services Task Force (USPSTF) guidelines recommend biennial screening mammography for all women aged 40 to 74 years (Grade B recommendation). Because this patient is 42 years old and at average risk, she is currently eligible and due to begin routine breast cancer screening.

Step-by-Step Solution

1
Evaluate the patient's demographic and risk profile.
The patient is a 42-year-old female at average risk for all major malignancies, with no significant family history.
Risk stratification is essential to determine the correct screening guidelines and starting ages.
2
Assess the indication for breast cancer screening.
Biennial screening mammography is indicated.
The United States Preventive Services Task Force (USPSTF) recommends biennial screening mammography for all average-risk women beginning at age 40.
3
Review the patient's eligibility for other routine cancer screenings.
No other cancer screenings are currently indicated.
Her cervical cancer screening is up to date (5-year interval for co-testing), and she is not yet 45 years old, which is the starting age for colorectal cancer screening.

Key Concept

Breast cancer screening guidelines for average-risk women
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Topics

Preventive Care and Screening

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