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Zorluk: OrtaPreventive Care and Screening

A 61-year-old woman presents to the clinic for a routine health maintenance examination. She feels well and reports no new symptoms. Her medical history is notable for essential hypertension and a total abdominal hysterectomy with bilateral salpingo-oophorectomy performed at age 51 for symptomatic uterine fibroids. She has a 25 pack-year smoking history but successfully quit 16 years ago. Her current medication is amlodipine. Her most recent preventive screenings include a normal colonoscopy at age 53 and a normal screening mammography at age 59. Vital signs today are within normal limits. Physical examination reveals a well-appearing woman with a normal cardiovascular and pulmonary assessment. Which of the following is the most appropriate cancer or disease screening intervention for this patient at today's visit?

  1. A
    Cervical cytology
  2. B
    Dual-energy x-ray absorptiometry
  3. C
    Low-dose computed tomography of the chest
  4. D
    Screening colonoscopy
  5. Screening mammographyCevap

Cevap

Screening mammography is the indicated preventive measure because the patient is due for her biennial breast cancer screening.
The correct answer is screening mammography. According to the United States Preventive Services Task Force (USPSTF), biennial screening mammography is recommended for women aged 40 to 74 years. Because this patient's last mammogram was two years ago at age 59, she is now due for her next screening at age 61.

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1
Evaluate the patient's breast cancer screening status.
The patient is 61 years old and her last mammogram was at age 59.
Current USPSTF guidelines recommend biennial (every 2 years) screening mammography for women aged 40 to 74. Therefore, she is due for a mammogram.
2
Evaluate the patient's lung cancer screening eligibility.
The patient has a 25 pack-year smoking history but quit 16 years ago.
USPSTF guidelines indicate annual low-dose computed tomography for adults aged 50 to 80 with a 20 pack-year smoking history who currently smoke or quit within the past 15 years. Because she quit 16 years ago, screening is no longer indicated.
3
Evaluate the patient's cervical cancer screening status.
The patient had a total hysterectomy for benign disease (fibroids) at age 51.
Women who have had their cervix removed for benign indications and do not have a history of high-grade cervical precancer or cervical cancer do not require further cervical cytology screening.
4
Evaluate the patient's colorectal cancer and osteoporosis screening status.
Last colonoscopy was 8 years ago at age 53. She is 61, and routine DEXA scans begin at age 65.
Average-risk patients with a normal colonoscopy should be rescreened in 10 years (at age 63 for this patient). DEXA is not routinely indicated until age 65 without elevated clinical risk.

Anahtar Kavram

Preventive Care Guidelines in Older Adults
Tahmini Süre:1m 0s
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Konular

Preventive Care and Screening

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