An asymptomatic 30-year-old woman comes to the physician for a routine health maintenance examination. She has a history of non-Hodgkin lymphoma (NHL) diagnosed at age 20, for which she received combination chemotherapy and radiation therapy to the chest. Follow-up PET/CT scans showed no relapse of the disease. Her last PET/CT scan was 5 years ago. She does not use tobacco, alcohol, or drugs. She has no family history of cancer.
Vital signs are within normal limits. Examination shows no lymphadenopathy. Breast examination does not reveal any nodules or nipple retraction. Cardiopulmonary examination shows no abnormalities.
Which of the following is the most appropriate next step in the management of this patient?

Question

An asymptomatic 30-year-old woman comes to the physician for a routine health maintenance examination.  She has a history of non-Hodgkin lymphoma (NHL) diagnosed at age 20, for which she received combination chemotherapy and radiation therapy to the chest.  Follow-up PET/CT scans showed no relapse of the disease.  Her last PET/CT scan was 5 years ago.  She does not use tobacco, alcohol, or drugs.  She has no family history of cancer.
Vital signs are within normal limits.  Examination shows no lymphadenopathy.  Breast examination does not reveal any nodules or nipple retraction.  Cardiopulmonary examination shows no abnormalities.
Which of the following is the most appropriate next step in the management of this patient?

Quizplus · Accepted Answer

11ec193a_9833_9eb7_853d_ed2ca03a90bc_MD0002_00 Non-Hodgkin lymphoma (NHL) survivors are at increased risk for many long-term complications such as second malignancies, cardiovascular disease, endocrine problems, and neuro-psychiatric complications. As the risk of NHL relapse decreases after five years of treatment, long-term care of these patients is increasingly provided by primary care physicians. Internists should be aware of these risks so that NHL survivors can receive adequate preventive care. The overall risk of second malignancies depends on the patient's age at treatment and the type of treatment received. Patients who received chest radiotherapy have a particularly increased risk of developing breast cancer, and the risk is higher in younger patients. The mean length of time between exposure to radiation therapy and presentation of breast cancer is approximately 15 years. Monthly self-breast examinations and annual screening mammograms are recommended beginning 8-10 years post therapy or at age 40, whichever comes first. (Choice A) Annual chest x-ray has not been shown to be an effective screening tool for lung cancer in these patients. Smoking cessation should be advised. (Choice C) There is no data to support routine colonoscopy as a screening or surveillance tool in long-term NHL survivors. Age appropriate screening guidelines should be followed. (Choice D) Routine pulmonary function tests are not indicated for screening or surveillance of NHL survivors; however, smoking cessation should be advised for prevention of lung cancer. (Choice E) Routine imaging is not recommended beyond five years unless there is clinical or laboratory evidence of relapse. Educational objective: In patients who received chest radiation, annual screening mammograms are recommended starting 8-10 years after radiation therapy. Annual TSH testing is also recommended in these patients. __________ References: Current perspectives on radiation-induced breast cancer. (http://www.ncbi.nlm.nih.gov/pubmed/9440762) The risk of secondary malignancies over 30 years after the treatment of non-Hodgkin lymphoma (http://www.ncbi.nlm.nih.gov/pubmed/16708354)

An Asymptomatic 30-Year-Old Woman Comes to the Physician for a Routine