A 69-year-old woman comes to the office for a routine preventive visit. She has no specific concerns and feels well. The patient lives alone, drinks alcohol socially, and does not smoke. Other than an emergency appendectomy 40 years ago, she has no significant medical history. The patient takes no medications and has no personal or family history of cancer or heart disease. She had a normal mammogram and lipid panel 2 years ago and a normal resting ECG and Pap smear with human papillomavirus cotesting at age 65. A colonoscopy 7 years ago showed no lesions. Which of the following studies is most appropriate at this time?

Question

A 69-year-old woman comes to the office for a routine preventive visit.  She has no specific concerns and feels well.  The patient lives alone, drinks alcohol socially, and does not smoke.  Other than an emergency appendectomy 40 years ago, she has no significant medical history.  The patient takes no medications and has no personal or family history of cancer or heart disease.  She had a normal mammogram and lipid panel 2 years ago and a normal resting ECG and Pap smear with human papillomavirus cotesting at age 65.  A colonoscopy 7 years ago showed no lesions.  Which of the following studies is most appropriate at this time?

Quizplus · Accepted Answer

11ec25c8_d274_cef9_bc81_db8b12d9c60b_MD0003_00 The US Preventive Services Task Force recommends biennial (every 2 years) screening mammography for women age 50-74. Screening at age 40-49 is recommended by some experts but should be individualized because the prevalence of breast cancer is lower and false-positive rates are higher in this age group. Screening at age ≥75 is not routinely recommended but can be considered on an individual basis. Current evidence suggests a small decrease in breast cancer mortality with annual (rather than biennial) screening, but this benefit is at least partially offset by an increase in overdiagnosis and unnecessary invasive procedures. Other breast cancer screening tests (eg, breast MRI, ultrasound, BRCA genetic testing) are not recommended for women at average risk. This patient had a screening mammogram 2 years ago and should be offered repeat mammography at this time. (Choice A) Screening for lung cancer with low-dose CT scan is recommended for certain individuals with a history of smoking. However, lung cancer screening is not recommended for nonsmokers, and chest x-ray is not recommended for screening in any patient group. (Choice B) Screening for colon cancer in average-risk individuals is suggested starting at age 45 and is strongly recommended starting at age 50. Primary options include annual fecal occult blood testing or colonoscopy every 10 years. This patient has had a normal colonoscopy within the past 10 years, so screening is not indicated at this time. (Choice C) Resting ECG is often performed as part of a one-time "Welcome to Medicare" visit at age 65. However, for patients at average risk, screening ECG can lead to overdiagnosis and overtreatment, including unnecessary invasive procedures, and is not recommended. (Choice D) Many experts advise cholesterol screening in individuals at average risk beginning at age 40; a 3-5-year interval is most commonly recommended, and there is likely little benefit from more frequent testing. Educational objective: The US Preventive Services Task Force recommends biennial (every 2 years) screening mammography for women age 50-74. Screening at age 40-49 and age ≥75 is not routinely recommended but can be considered on an individual basis. References: Breast cancer screening: ACP releases guidance statements. (http://www.ncbi.nlm.nih.gov/pubmed/32003948)

A 69-Year-Old Woman Comes to the Office for a Routine