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Difficulty: EasyPreventive Care and Screening

A 46-year-old man comes to the clinic for a routine health maintenance examination. He feels well and has no concerns. His medical history is unremarkable, and he takes no medications. He has no family history of colorectal, prostate, or lung cancer. He does not smoke, drink alcohol, or use illicit drugs. Vital signs are within normal limits. Physical examination is unremarkable. He has not had any cancer screening tests in the past. Which of the following is the most appropriate next step in preventive care for this patient?

  1. Recommend screening colonoscopyAnswer
  2. B
    Advise returning at age 50 for initial colorectal cancer screening
  3. C
    Order a screening prostate-specific antigen test
  4. D
    Order a low-dose chest computed tomography scan
  5. E
    Order an abdominal ultrasound

Answer

Recommend screening colonoscopy
The correct action is to recommend screening for colorectal cancer. According to current United States Preventive Services Task Force (USPSTF) guidelines, average-risk adults should begin screening for colorectal cancer at age 45. Options for screening include colonoscopy every 10 years, annual fecal immunochemical testing, or other approved modalities. Because this patient is 46 years old and has no history of screening, it is indicated now.

Step-by-Step Solution

1
Identify the patient's demographic and risk profile.
The patient is a 46-year-old man with average risk for malignancies (no family history, no smoking history).
Risk factors and age determine the appropriate preventive screening guidelines.
2
Apply the USPSTF guidelines for an average-risk 46-year-old.
Colorectal cancer screening is indicated starting at age 45.
Guidelines for colorectal cancer screening were updated to lower the initiation age from 50 to 45 for average-risk adults.

Key Concept

Initiation of colorectal cancer screening in average-risk adults
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Topics

Preventive Care and Screening

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