Examkin

Soru

Zorluk: OrtaPreventive Care and Screening

A 42-year-old woman presents to the ambulatory clinic for a routine wellness examination. She has not seen a physician in four years. The patient has no specific health complaints. Her medical history is significant only for mild allergic rhinitis, for which she takes over-the-counter cetirizine as needed. Menarche occurred at age 12, and she is nulliparous. She currently uses an oral contraceptive pill. Family history is notable for her maternal grandmother being diagnosed with breast cancer at age 78. She drinks one glass of wine on weekends and has never smoked. Vital signs are within normal limits. Physical examination reveals soft, non-tender breasts with no palpable masses, skin dimpling, axillary lymphadenopathy, or nipple discharge. She has never undergone breast imaging. Which of the following is the most appropriate next step in preventive care for this patient?

  1. Order a bilateral screening mammogramCevap
  2. B
    Reassure the patient and defer screening mammography until age 50
  3. C
    Order a screening breast magnetic resonance imaging scan
  4. D
    Perform a clinical breast examination and defer radiographic imaging
  5. E
    Refer the patient for genetic counseling and BRCA mutation testing

Cevap

Order a bilateral screening mammogram
Based on updated United States Preventive Services Task Force (USPSTF) guidelines, average-risk women should begin biennial screening mammography at age 40. Previously, the decision to initiate screening between ages 40 and 49 was considered an individualized choice, but the recommendation was definitively updated to universally commence at age 40 to address rising breast cancer incidence in younger demographics and further reduce breast cancer mortality. Because this patient is 42 years old, at average risk, and has never been screened, ordering a bilateral screening mammogram is the correct guideline-concordant next step.

Adım Adım Çözüm

1
Assess the patient's baseline risk for breast cancer.
The patient is 42 years old with a single second-degree relative diagnosed with breast cancer at age 78, placing her in the average-risk category.
Determining risk stratification dictates the modality and timing of breast cancer screening.
2
Recall current USPSTF recommendations for average-risk breast cancer screening.
The USPSTF updated its guidelines to recommend biennial screening mammography for all women beginning at age 40 and continuing until age 74.
Applying the most up-to-date guidelines is required for appropriate evidence-based ambulatory care.
3
Compare the patient's age and history to the screening guidelines.
Because the patient is 42 and has never been screened, she should undergo bilateral screening mammography now.
She meets the age criteria for the initiation of routine screening.

Anahtar Kavram

Initiation of Breast Cancer Screening (Updated Guidelines)
Tahmini Süre:1m 15s
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Konular

Preventive Care and Screening

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