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Difficulty: MediumPreventive Care and Screening

A 61-year-old man presents to the ambulatory clinic to establish care. He has not seen a physician in over 15 years. He feels well and has no acute complaints. His only past medical history is hyperlipidemia, for which he previously took a medication but stopped 10 years ago. He currently takes no medications. He smoked one pack of cigarettes daily from age 20 to 50 but quit 11 years ago (30 pack-year history). He drinks 1 to 2 beers on weekends. Family history is notable for a father who died of a myocardial infarction at age 78. Vital signs include blood pressure 138/86 mmHg, heart rate 72/min, respiratory rate 14/min, and BMI 27 kg/m². Physical examination is unremarkable. Which of the following preventive screening interventions are indicated for this patient at this visit according to current guidelines? (Select all that apply)

  1. Annual low-dose computed tomography (LDCT) of the chestAnswer
  2. Screening for colorectal cancerAnswer
  3. C
    One-time ultrasound screening for abdominal aortic aneurysm
  4. D
    Dual-energy x-ray absorptiometry (DEXA) scan
  5. E
    Screening resting electrocardiogram (ECG)

Answer

The explicitly indicated preventive screening interventions for this patient are annual low-dose computed tomography (LDCT) of the chest and screening for colorectal cancer.
Based on current preventive guidelines, a 61-year-old man with a 30 pack-year smoking history who quit 11 years ago meets all criteria for annual lung cancer screening with low-dose CT (age 50-80, ≥20 pack-years, quit within 15 years). Furthermore, all average-risk adults aged 45 to 75 should be screened for colorectal cancer. Since he has not received medical care in over a decade, both of these interventions are indicated.

Step-by-Step Solution

1
Assess the patient's demographic profile, risk factors, and timeline of prior medical care.
The patient is a 61-year-old male with a 30 pack-year smoking history who quit 11 years ago. He has had no routine care for over 15 years.
Preventive guidelines are strictly stratified by age, biological sex, and specific exposures such as smoking.
2
Evaluate the indication for lung cancer screening.
Annual LDCT of the chest is strongly indicated.
Guidelines recommend annual LDCT for adults aged 50 to 80 years who have at least a 20 pack-year smoking history and either currently smoke or have quit within the past 15 years.
3
Evaluate the indication for colorectal cancer screening.
Colorectal cancer screening is indicated.
Guidelines recommend screening for all adults aged 45 to 75 years. Because he has not been evaluated in 15 years, he is due for screening.
4
Evaluate other common screening modalities present in the options.
AAA ultrasound, DEXA scan, and screening ECG are not indicated.
AAA screening begins at age 65 for men with a smoking history. Routine DEXA is indicated primarily for women 65 and older. Routine ECG is not recommended for asymptomatic adults.

Key Concept

Age- and risk-factor specific implementation of USPSTF preventive screening guidelines.
Estimated Time:1m 30s
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Topics

Preventive Care and Screening

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