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Difficulty: MediumPreventive Care and Screening

An asymptomatic 68-year-old woman is seen in the outpatient clinic for a health maintenance examination. Her medical history includes well-controlled primary hypertension and mild osteoarthritis of the knees. The patient reports smoking one pack of cigarettes daily from age 20 until she quit on her 60th birthday. Her last screening colonoscopy was performed at age 62 and revealed no polyps or abnormalities. A mammogram was obtained 6 months ago with benign findings. Bone densitometry at age 65 showed normal bone mineral density. Current medications include amlodipine and as-needed ibuprofen. Vital signs are within normal limits, and the physical examination shows no significant findings. Which of the following is the most appropriate next step in preventive screening for this patient?

  1. Low-dose computed tomography of the chestAnswer
  2. B
    Abdominal duplex ultrasonography
  3. C
    Fecal immunochemical testing
  4. D
    Transvaginal ultrasonography
  5. E
    Routine resting electrocardiography

Answer

The most appropriate next step is low-dose computed tomography of the chest.
This patient is 68 years old and has a 40 pack-year smoking history, having quit 8 years ago. According to the United States Preventive Services Task Force (USPSTF), annual screening for lung cancer with low-dose computed tomography of the chest is recommended for adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Because she meets all criteria and has not received this screening, it is a Grade B recommendation and the most appropriate next step in her preventive care.

Step-by-Step Solution

1
Evaluate the patient's age and smoking history to determine lung cancer screening eligibility.
The patient is 68 years old, has a 40 pack-year smoking history, and quit 8 years ago.
Lung cancer screening criteria require age 50-80, at least a 20 pack-year history, and having smoked within the past 15 years.
2
Assess the patient's eligibility for other age-appropriate preventive screenings based on her clinical history.
She is up to date on colorectal screening (colonoscopy 6 years ago), breast cancer screening (mammogram 6 months ago), and osteoporosis screening (normal DEXA at age 65).
To rule out other recommended screenings that might be due at this visit.
3
Determine the applicability of abdominal aortic aneurysm (AAA) screening given her smoking history.
AAA screening is not routinely recommended for women.
The USPSTF recommends AAA screening for men aged 65-75 with any smoking history, but evidence is insufficient for women.

Key Concept

USPSTF guidelines for lung cancer and abdominal aortic aneurysm (AAA) screening in older adults with a significant smoking history.
Estimated Time:1m 0s
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Topics

Preventive Care and Screening

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