Cervical Cancer
Cervical cancer screening is only recommended for sexually active patients with a uterus.
What is False?
USPSTF recommends screening for average risk patients for breast cancer in what age range?
What is the recommended frequency?
What is ages 40-74? Grade B
Grade I (Insufficient) for ages 75 and up
Frequency:
USPSTF: every 2 years (biennial)
ACOG/ACR: annually
Lung cancer screening is recommended as a one time screening for patients between ages 55 to 75.
What is False?
Lung cancer screening is recommended on an annual basis for patients between ages 50 to 80 (more criteria in other questions).
USPSTF recommends screening for colon cancer in what age range?
What is 45-75?
Grade A for 50-75, Grade B for 45-49
Grade C for 76-85 (selective)
What are USPSTF's recommendations for prostate cancer screening?
Shared decision making for men aged 55-69
Other guidelines (for average risk pts):
-Can initiate discussion of screening at age 50
-Alternate strategy to do initial screening at 45 and using results for subsequent risk stratification
What is cytology only and every 3 years?
USPSTF has given this Grade recommendation for supplemental screening for breast cancer using MRI in patients who have dense breasts on an otherwise negative screening mammogram.
What is Grade I?
How many pack year smoking history qualifies someone for lung cancer screening?
What is at least 20 pack years?
What are screening options for colon cancer for average risk patients? List at least 3 to get credit and list the frequency.
What are screening options for patients at high risk for colon cancer?
FIT annually
Cologuard (Stool DNA) every 3 years
Colonoscopy every 10 years (preferred option for high risk patients)
CT colonography every 5 years
Flexible sigmoidoscopy every 5 years
Flexible sigmoidoscopy every 10 years + annual FIT
Blood test is FDA approved but not part of guidelines yet
What are risk factors that put patients at increased risk for prostate cancer? (at least 2 to get half credit)
Black race
Family hx of prostate cancer in first degree relative (particularly if the relative was <65 yr old)
Known or probable BRCA1 or BRCA2 mutation
Lynch syndrome genetic mutations
How do you screen for cervical cancer in patients over >30 and at what frequency? List all options.
1) clinician collected hrHPV only screening -> every 5 years (preferred)
2) clinician collected co-testing -> every 5 years
3) patient collected hrHPV only screening -> every 3 years
4) clinician collected cytology only -> every 3 years
Are breast cancer screening guidelines different for:
patients who are on HRT for perimenopause/menopause?
patients with breast augmentation for benign reasons?
What is NO?
Only patients who currently smoke are eligible for lung cancer screening.
What is currently smoke or have quit within the past 15 years?
A. Age 40
B. Age 42 (Today)
C. Age 45
D. Age 50
E. No screening needed until age 60
What is A?
For patients with FDR with colon cancer, you start screening at age 40 or 10 years before the youngest affected first degree relative's diagnosis, whichever is earlier.
When should you initiate discussion of prostate cancer screening in patients at increased risk?
What is 40-45 years of age?
Cervical cancer screening is recommended between ages ____ and ____.
What are the exceptions to this?
What is 21 and 65?
Exceptions:
1)for immunocompromised patients and/or with pts with HIV, you continue screening for patient's lifetime:
-Cytology testing only every 3 years until age 30
-Cytology or co-testing every 3 years after age 30
2) S/p hysterectomy: continue vaginal cancer screening with HPV based testing (3 consecutive negative annual tests) followed by Q 3 years screening for 25 years from abnormality dx (CIN2, CIN3, AIS, cervical cancer, HSIL, AGC or persistent ASC-H cytology)
According to NCCN guidelines, how should women at high risk for breast cancer and/or with lifetime breast cancer risk >/=20% be screened for breast cancer and starting at what age?
Annual mammogram + MRI (staggered by 6 months recommended), starting at age 40 or 10 years prior to when the youngest family member was dx with breast cancer but not prior to age 30
What imaging modality is used for lung cancer screening?
For a patient with a first degree relative with an advanced polyp, when should screening for colon cancer start for patient?
Start screening at the age of diagnosis of the advanced polyp if that is earlier than age 40
Advanced polyp/adenoma: adenoma >/=1 cm, adenoma with high grade dysplaisa, adenoma with villous or tubulovillous histology
Advanced serrated polyp: sessile serrated lesion >/=1 cm, traditional serrated adenoma >/=1 cm, cytologic dysplasia
Should you screen for prostate cancer if the life expectancy is <10 years?
What is NO?
A 67-year-old female presents for a wellness examination. She has not been seen for medical care for several years and reports that her last Papanicolaou test was 15 years ago. She does not recall any medical problems and has no known history of abnormal cervical cytology in the past. According to the U.S. Preventive Services Task Force, which one of the following should you recommend regarding further cervical cancer screening?
A) No further screening due to the patient's age
B) Cervical cytology alone now, with no further screening if the result is normal
C) Cervical cytology alone now, then repeated in 3 years with no further screening if the results are normal
D) Cervical cytology with HPV co-testing now, with no further screening if the results are normal
E) Cervical cytology with HPV co-testing now, then repeated in 5 years with no further screening if the results are normal
What is E?
The U.S. Preventive Services Task Force recommends against cervical cancer screening in women older than 65 years only if they have had adequate prior screening.
Adequate screening is defined as 3 consecutive negative cytology results or 2 consecutive negative co-testing results within 10 years before stopping screening, with the most recent test occurring within 5 years.
Because this patient has not had adequate prior screening, she requires either 2 consecutive negative co-testing results that are 5 years apart or 3 consecutive negative cytology results that are 3 years apart before stopping screening.
Which one of the following puts a patient at the highest risk of developing breast cancer?
A) A first pregnancy at <30 years of age
B) Onset of menopause at <50 years of age
C) Fatty breasts on mammography
D) A grandmother with a history of breast cancer
E) Chest radiation therapy as a child
What is ANSWER: E?
Women who received chest radiotherapy prior to age 30 are at increased risk for breast cancer as adults, with those who received whole lung radiation at especially high risk.
Other risk factors for breast cancer include known BRCA or other susceptibility genes, the onset of menopause at >55 years of age, certain breast conditions such as atypical hyperplasia, a first pregnancy at >35 years of age, and a first-degree relative with breast cancer. Patients with dense breasts have a higher amount of glandular and stromal tissue compared with adipose tissue on mammography and are at higher risk for breast cancer.
You are seeing a 44-year-old female who has a 25-pack-year smoking history. She quit smoking 6 years ago after a friend received a diagnosis of lung cancer. According to U.S. Preventive Services Task Force recommendations, lung cancer screening should be initiated at what age in this patient?
A) No screening is indicated
B) 45
C) 50
D) 55
E) 60
What is ANSWER: C?
Lung cancer is the leading cause of cancer death in the United States, with approximately 90% of cases linked to smoking.
When should colon cancer screening begin for patients with second/third degree relatives with colon cancer and with what modality?
What is Colonoscopy starting at age 45?
A 63-year-old male presents for his annual health maintenance examination. He maintains a healthy lifestyle, eats well, and exercises regularly. A physical examination is normal. His most recent prostate cancer screening revealed a PSA level of 4.6 ng/mL (N 0.3–4.0), and his previous result 2 years ago was normal. Which one of the following would be the most appropriate next step in management?
A) Repeating PSA testing in 4–8 weeks
B) Empiric antibiotic therapy
C) A digital rectal examination
D) Biopsy of the prostate
E) MRI of the prostate
What is ANSWER: A?
Prostate cancer screening recommendations vary, and there is little evidence that routine screening for prostate cancer improves patient-oriented outcomes.
While the American Academy of Family Physicians does not recommend routine prostate-specific antigen (PSA)–based screening for prostate cancer, the American Urology Association (AUA) recommends prostate cancer screening with PSA testing for those 45–50 years of age. For those 50–69 years of age, the AUA recommends screening every 2–4 years between ages 50-69. The AUA also recommends obtaining a follow-up PSA level for individuals with newly elevated PSA before considering additional biomarkers, imaging, or biopsy. While this is based on expert opinion, the authors note that PSA may normalize in as many as 40% of individuals. The authors also suggest a higher threshold for biopsy based on age, with 4.5 ng/mL being the upper limit of normal for this patient's age group. The Choosing Wisely AUA initiative recommends against using empiric antibiotics to treat elevated PSA levels in asymptomatic individuals. A digital rectal examination is not recommended as a screening method alone or in addition to a screening PSA.