A 68-year-old woman comes to the office and inquires about screening mammography. The patient has had normal biennial mammographies in the past and reports no breast symptoms. Medical conditions include hypertension, type 2 diabetes mellitus treated with insulin, hypercholesterolemia, end-stage renal disease on hemodialysis, ischemic stroke with residual deficits, and congestive heart failure with an ejection fraction of 15%. The patient has been hospitalized 3 times in the past year due to decompensated heart failure. She has a 50-pack-year smoking history. The patient has no personal or family history of breast or ovarian malignancies. She ambulates using a walker.
Which of the following is the most appropriate recommendation regarding breast cancer screening for this patient?

Question

A 68-year-old woman comes to the office and inquires about screening mammography.  The patient has had normal biennial mammographies in the past and reports no breast symptoms.  Medical conditions include hypertension, type 2 diabetes mellitus treated with insulin, hypercholesterolemia, end-stage renal disease on hemodialysis, ischemic stroke with residual deficits, and congestive heart failure with an ejection fraction of 15%.  The patient has been hospitalized 3 times in the past year due to decompensated heart failure.  She has a 50-pack-year smoking history.  The patient has no personal or family history of breast or ovarian malignancies.  She ambulates using a walker.
Which of the following is the most appropriate recommendation regarding breast cancer screening for this patient?

Quizplus · Accepted Answer

11ec193a_97eb_9999_853d_53c88fce0a47_MD0002_00 Overdiagnosis is the detection of a disease that would not become clinically apparent in a patient's lifetime. Patients who are overdiagnosed with a disease face both psychological harm from a new clinical diagnosis and possible physical harm during treatment. Patients with limited life expectancy (such as this patient with end-stage renal disease, symptomatic heart failure, and ischemic stroke) are at risk for overdiagnosis as they are unlikely to live long enough to benefit from the detection of malignancies. Therefore, patients with a life expectancy of <10 years should not undergo routine cancer screening (eg, colonoscopy, mammography). (Choices B, C, D, and E) Multiple modalities for screening are available for breast cancer screening and may be considered in healthy patients with a life expectancy of ≥10 years. Mammography is the best validated screening test for breast cancer and the best test for a healthy patient in this age group. MRI of the breasts is considered for women with a confirmed familial breast cancer syndrome or in whom the sensitivity of standard mammography is impaired (eg, breast implants), but it is more expensive and less validated than mammography. Ultrasonography is used as an adjunct to mammography, not as a standalone test. Breast self-examination is not recommended for any patient population due to high false-positive rates. Educational objective: Patients with limited life expectancy are unlikely to live long enough to benefit from the detection of malignancies and are more likely to experience harm (both physical and psychological) from the diagnosis. Patients with an expected lifespan of <10 years should not be screened for malignancy (eg, breast, colon). __________ References: The importance of prognosis in cancer screening in patients with chronic kidney disease. (http://www.ncbi.nlm.nih.gov/pubmed/21338386)

A 68-Year-Old Woman Comes to the Office and Inquires About