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Difficulty: MediumPreventive Care and Screening

A 65-year-old woman presents to the clinic for a routine wellness visit. She has a history of primary hypertension and osteoarthritis, for which she takes amlodipine and acetaminophen. She does not smoke or consume alcohol. Her family history is notable for a mother who experienced a hip fracture at age 75. Her vital signs and physical examination are unremarkable. A review of her medical records reveals the following preventive care history:

- Mammography: Normal results 3 years ago
- Colonoscopy: Normal results 11 years ago
- Pap smear with human papillomavirus (HPV) co-testing: Negative 4 years ago. She has a documented history of two additional consecutive negative co-tests over the prior decade, with no history of cervical intraepithelial neoplasia.
- Tetanus, diphtheria, and acellular pertussis (Tdap) vaccine: Administered 6 years ago

Which of the following combinations of screening tests is most appropriate to order for this patient today?

  1. Dual-energy x-ray absorptiometry, mammography, and colonoscopyAnswer
  2. B
    Dual-energy x-ray absorptiometry, mammography, and cervical cytology with HPV co-testing
  3. C
    Mammography, colonoscopy, and empiric alendronate therapy
  4. D
    Dual-energy x-ray absorptiometry, colonoscopy, and magnetic resonance imaging of the lumbar spine
  5. E
    Mammography, cervical cytology with HPV co-testing, and transvaginal ultrasonography

Answer

The most appropriate combination of screening tests includes dual-energy x-ray absorptiometry (DEXA), mammography, and a colonoscopy.
Based on current USPSTF guidelines, this 65-year-old woman is due for a dual-energy x-ray absorptiometry (DEXA) scan, mammography, and colonoscopy. Osteoporosis screening with DEXA is universally indicated for women beginning at age 65. Her last mammogram was 3 years ago; she is due for a repeat because guidelines recommend biennial screening. Her last colonoscopy was 11 years ago, exceeding the recommended 10-year interval. Cervical cancer screening can be safely discontinued as she is 65 years old and has a documented history of adequate negative prior screening with no history of high-grade cervical lesions.

Step-by-Step Solution

1
Evaluate the patient's breast cancer screening requirements.
She is due for mammography.
The USPSTF recommends biennial screening mammography for women aged 40 to 74 years. Her last mammogram was 3 years ago.
2
Evaluate the patient's colorectal cancer screening requirements.
She is due for a colonoscopy.
Routine screening colonoscopy is recommended every 10 years for average-risk adults up to age 75. Her last colonoscopy was 11 years ago.
3
Evaluate the patient's osteoporosis screening requirements.
She requires a baseline DEXA scan.
The USPSTF recommends bone measurement testing to prevent osteoporotic fractures in all women aged 65 years and older.
4
Evaluate the patient's cervical cancer screening requirements.
Screening should be discontinued.
Cervical cancer screening is not recommended in women older than 65 years who have had adequate prior screening (at least two consecutive negative HPV co-tests within the past 10 years, most recent within 5 years) and are not at high risk.

Key Concept

Application of current USPSTF preventive screening guidelines, focusing on age-based initiation (DEXA), interval maintenance (mammography, colonoscopy), and criteria for discontinuation (cervical cancer screening).
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Topics

Preventive Care and Screening

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