A 50-year-old woman comes to the office for an annual preventive visit. She says, "I want to be tested for colon cancer because my 83-year-old mother was diagnosed with stage IV colon cancer a month ago." The patient has had no abdominal pain, nausea, vomiting, anorexia, weight loss, melena, hematochezia, or changes in bowel habits. She had a normal screening colonoscopy at age 45. Medical history is notable for hyperlipidemia and type 2 diabetes mellitus. Except for her mother, the patient has no family history of cancer. Temperature is 36.7 C (98 F), blood pressure is 120/70 mm Hg, and pulse is 80/min. The abdomen is nondistended, soft, and nontender with no hepatosplenomegaly. Bowel sounds are normal. Which of the following is the best recommendation regarding colorectal cancer screening in this patient?

Question

A 50-year-old woman comes to the office for an annual preventive visit.  She says, "I want to be tested for colon cancer because my 83-year-old mother was diagnosed with stage IV colon cancer a month ago."  The patient has had no abdominal pain, nausea, vomiting, anorexia, weight loss, melena, hematochezia, or changes in bowel habits.  She had a normal screening colonoscopy at age 45.  Medical history is notable for hyperlipidemia and type 2 diabetes mellitus.  Except for her mother, the patient has no family history of cancer.  Temperature is 36.7 C (98 F), blood pressure is 120/70 mm Hg, and pulse is 80/min.  The abdomen is nondistended, soft, and nontender with no hepatosplenomegaly.  Bowel sounds are normal.  Which of the following is the best recommendation regarding colorectal cancer screening in this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bf2a_65e5_8f63_779427cc1edf_MD0005_00 Patients who have a first-degree relative with colorectal carcinoma (CRC) or advanced adenomatous polyps (eg, ≥10 mm, high-grade dysplasia) are at increased risk of developing CRC. Screening recommendations for these patients should be more aggressive than those for average-risk individuals. Initial screening for these patients should begin with colonoscopy at age 40 or 10 years earlier than the age of diagnosis in the relative, whichever comes first. If the first-degree relative's CRC was diagnosed at age <60, the patient should undergo repeat colonoscopy every 5 years thereafter. However, patients whose relative's CRC was diagnosed later in life (ie, age ≥60) and who have a normal initial colonoscopy are at only nominally increased risk and can be rescreened at routine 10-year intervals. This patient had a colonoscopy at age 45 and was considered average risk at the time. Since then, her mother was diagnosed with CRC at age 83 (ie, age ≥60). Therefore, the patient's next colonoscopy should be offered at age 55, 10 years after the initial one (Choice A). (Choices C, D, and E) Although multiple screening modalities can be considered for the average-risk patient, colonoscopy is the preferred screening test for this patient and others at increased risk. It has the highest sensitivity for CRC and adenomatous polyps compared to CT colonography, fecal immunochemical testing, and sigmoidoscopy. Educational objective: Patients who have a first-degree relative with colorectal carcinoma (CRC) or advanced adenomatous polyps should undergo screening colonoscopy at age 40. If the patient's initial colonoscopy is negative and the relative's CRC was diagnosed at age ≥60, the patient should undergo colonoscopy every 10 years thereafter. If the relative's CRC was diagnosed early in life (age <60), colonoscopy should be repeated every 5 years.

A 50-Year-Old Woman Comes to the Office for an Annual