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Difficulty: MediumPreventive Care and Screening

A 61-year-old man visits his primary care provider to establish care and review his preventive health needs. His past medical history is significant for essential hypertension and hyperlipidemia. He currently smokes one pack of cigarettes daily and has done so for the past 30 years (30 pack-year history). His current medications include amlodipine and atorvastatin. A review of his medical records shows that he had a normal screening colonoscopy 6 years ago. He completed the recombinant zoster vaccine series at age 55 and received the current seasonal influenza vaccine at a local pharmacy last month. He denies any chest pain, shortness of breath, cough, or changes in bowel habits. Which of the following preventive interventions are indicated for this patient at this visit? (Select all that apply)

  1. Low-dose computed tomography of the chestAnswer
  2. 20-valent pneumococcal conjugate vaccineAnswer
  3. C
    Ultrasonography of the abdominal aorta
  4. D
    Fecal immunochemical testing
  5. E
    Dual-energy x-ray absorptiometry scan

Answer

The indicated interventions are low-dose computed tomography of the chest and the 20-valent pneumococcal conjugate vaccine.
The correct interventions are low-dose computed tomography (LDCT) of the chest and the 20-valent pneumococcal conjugate vaccine. The patient meets the USPSTF criteria for annual LDCT screening because he is between the ages of 50 and 80, has a smoking history of at least 20 pack-years, and is a current smoker. Additionally, current cigarette smoking is an indication for pneumococcal vaccination in adults aged 19 to 64 years, as it significantly increases the risk of invasive pneumococcal disease.

Step-by-Step Solution

1
Evaluate the patient's age and smoking history to determine lung cancer screening eligibility.
The patient is 61 years old with a 30 pack-year smoking history and currently smokes. He meets criteria for annual low-dose computed tomography (LDCT).
Guidelines recommend LDCT for adults aged 50 to 80 years with at least a 20 pack-year smoking history who currently smoke or quit within the last 15 years.
2
Assess the patient's vaccination history and risk factors.
The patient has a history of smoking, which is a qualifying condition for pneumococcal vaccination in adults under 65.
Cigarette smoking compromises respiratory defenses, placing the patient at higher risk for invasive pneumococcal disease.
3
Review the patient's prior screening for colorectal cancer.
The patient had a normal colonoscopy 6 years ago. The next screening is not due for another 4 years.
A normal colonoscopy provides a 10-year screening interval, during which interim testing with other modalities is not recommended.
4
Consider other age-based screening guidelines for this male patient.
Abdominal aortic aneurysm screening and osteoporosis screening are not indicated.
AAA screening begins at age 65 for men who have ever smoked. Routine DEXA scans are generally reserved for women aged 65 and older or those at elevated risk.

Key Concept

Age and risk-factor specific preventive screening guidelines
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Topics

Preventive Care and Screening

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