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Zorluk: OrtaPreventive Care and Screening

During a comprehensive health review, a 58-year-old female patient provides her medical history to her new primary care clinician. Her past medical diagnoses include type 2 diabetes mellitus, which is well-controlled on metformin, and a prior hepatitis C infection that was cured with direct-acting antivirals. She had a negative fourth-generation HIV test during her previous hepatitis C workup. She currently feels well and has no acute symptoms. The patient's substance use history is notable for a 25-pack-year smoking habit; however, she emphasizes that she achieved complete cessation 13 years ago. Review of her preventive care documentation reveals a normal screening colonoscopy six years ago and negative cervical cytology with human papillomavirus co-testing three years ago. Her most recent bilateral mammogram was performed two months ago and showed no abnormalities. She received a 20-valent pneumococcal conjugate vaccine upon her diabetes diagnosis and had her seasonal influenza vaccine two weeks ago. Vital signs and physical examination are unremarkable today. Based on current preventive guidelines, which of the following is the most appropriate next step in screening for this patient?

  1. Non-contrast low-dose computed tomography of the chestCevap
  2. B
    Bone mineral density measurement via dual-energy x-ray absorptiometry
  3. C
    Fecal immunochemical testing for hemoglobin
  4. D
    Cervical cytology combined with human papillomavirus testing
  5. E
    Abdominal ultrasonography for aortic aneurysm evaluation

Cevap

Non-contrast low-dose computed tomography of the chest
This patient meets the United States Preventive Services Task Force (USPSTF) criteria for annual lung cancer screening with non-contrast low-dose computed tomography of the chest. The guidelines recommend screening for adults aged 50 to 80 years who have a 20 pack-year or greater smoking history and who currently smoke or have quit within the past 15 years. Because this 58-year-old patient has a 25-pack-year history and achieved complete cessation 13 years ago, she is within the 15-year window and requires this screening.

Adım Adım Çözüm

1
Evaluate the patient's smoking history against lung cancer screening criteria.
The patient has a 25-pack-year history and quit 13 years ago.
Guidelines recommend annual screening for adults aged 50 to 80 with a 20 pack-year or greater smoking history who currently smoke or quit within the past 15 years.
2
Assess the need for colon, cervical, and breast cancer screening based on her previous test dates.
None of these are currently due. Colonoscopy is due in 4 years, Pap/HPV co-testing in 2 years, and mammogram is up to date.
Applying standard screening intervals prevents overutilization of medical tests.
3
Determine indications for bone density and abdominal aortic aneurysm screening.
Neither test is indicated for this patient.
Bone density screening routinely begins at age 65 for women, and abdominal aortic aneurysm screening is not a standard recommendation for women.

Anahtar Kavram

Lung cancer screening criteria require annual low-dose chest computed tomography for adults aged 50 to 80 years with a 20 pack-year smoking history who currently smoke or have quit within the past 15 years.
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Konular

Preventive Care and Screening

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