Risky Business
USPSTF recommends against screening for pancreatic cancer in asymptomatic adults (Grade D)
Who gets a one-time abdominal ultrasound for AAA?
men aged 65-74 years old who have ever smoked (Grade B)
A healthy 66-year-old woman has had adequate negative cervical cancer screening. When is her next screening due?
Never.
Grade D - recommends against screening in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer
Per ACOG: three consecutive negative cytology results or two consecutive negative co-testing results within 10 years before stopping screening, with the most recent test occurring within 3 years for cytology alone or 5 years if co-testing is used
If they do not meet this, then screening continues
Who should receive HIV screening?
1) Pregnant patients
2) Persons age 15-65
3) Younger/older if they are at high risk
(Grade A)
Routine screening with EKG should be performed in low-risk asymptomatic patients
FALSE - Class D; recommends against - asymptomatic adults with low CVD events
What age range does USPSTF recommend prediabetes/diabetes screening in?
Adults aged 35 to 70 years who have overweight or obesity (Grade B)
a 65 year old healthy female comes in for her AWV with no other complaints. When discussing screenings, should you screen for carotid artery stenosis?
No - The USPSTF recommends against screening for asymptomatic carotid artery stenosis in the general adult population (adults without a history of stroke or neurologic signs) (Grade D)
Who should receive osteoporosis screening regardless of risk factors?
Women aged 65 or older (Grade B)
Who should receive Hepatitis C screening?
Persons aged 18-79 - including pregnant patients
(Grade B)
Routine Vitamin D screening is recommended for all adults
FALSE - Class I; evidence is insufficient
What are the USPSTF recommendations for Prostate Cancer screening?
Class C - For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening.
A 67-year-old quit smoking 12 years ago after a 25-pack-year history - Do they need lung cancer screening with low dose CT?
No
Recs:
Adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. (Grade B)
A 29 year old female asks you when breast cancer screening will start and when will they will stop
Should we be screening for Herpes routinely?
No - Grade D - recommends against routine screening in asymptomatic individuals including pregnant patients
Routine thyroid screening is recommended for all asymptomatic adults
FALSE - Class I; insufficient evidence
What do the Recommendation Grades (A/B/C/D/I) mean? (at least 4)
A - USPSTF recommends the service. There is high certainty that the net benefit is substantial
B - The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.
C - The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small.
D - The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.
I - The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
What are the USPSTF recommendations to start statins for primary prevention of CVD
- Adults aged 40 to 75 years
- Have 1 or more CVD risk factors (i.e. dyslipidemia, diabetes, hypertension, or smoking)
- An estimated 10-year risk of a cardiovascular event of 10% or greater
(Grade B)
When does the USPSTF recommend gestational diabetes screening?
24 weeks GA or after (Grade B)
Should a healthy 29 year old woman in a mutually monogamous relationship with no risk factors be screened for G/C?
Screening is not completely age-dependent. Must assess individual risk.
Rec: all sexually active women under age 24 and in women who are 25 years old or older who are high risk for infection (Grade B)
a 40 year old male comes in for his annual physical. His father was diagnosed with colon cancer at age 50. He states his PCP in North Dakota said that he was not due for a colonoscopy.
FALSE - He is due for screening
Colon cancer screening is from ages 45-75 y/o (Grade B) (previously rec was 50 y/o)
but when you're high risk -
Individuals who have a first-degree relative with colorectal cancer or advanced adenoma diagnosed before 60 years of age or two first-degree relatives diagnosed at any age should be advised to start screening colonoscopy at 40 years of age or 10 years younger than the earliest diagnosis in their family, whichever comes first. In individuals with ulcerative colitis or Crohn disease with colonic involvement, colonoscopy should begin eight to 10 years after the onset of symptoms and be repeated every one to three years. Individuals who have a first-degree relative with hereditary nonpolyposis colorectal cancer should begin colonoscopy at 25 years of age and repeat colonoscopy every one to two years. (per AAFP)
Name at least 3 colon cancer screening tests and their testing intervals!
FOBT - yearly
FIT - yearly
FIT-DNA - 3 years
Flexible Sigmoidoscopy - Every 5 years, or every 10 years with a FIT every year
Colonoscopy - 10 years
A 50 year old male is confused why his cardiologist recommended low dose aspirin. He wants to know what it is being used for and if you recommend it.
Class C - The decision to initiate low-dose aspirin use for the primary prevention of CVD in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one. Evidence indicates that the net benefit of aspirin use in this group is small. Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit.
EXTRA:
The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults 60 years or older (Class D)
What are the age/intervals for cervical cancer screening?
Including: cytology alone vs cotesting
Age 21-29: cytology alone every 3 years
Age 30-65: cytology alone every 3 years, or every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting)
(Grade A)
Extra:
Screening before age 21 or in women who have had hysterectomies with removal of the cervix and do not have a history of a high-grade precancerous lesion (ie, cervical intraepithelial neoplasia [CIN] grade 2 or 3) or cervical cancer is Grade D
What infections should every pregnant patient be screened for early on in pregnancy regardless of risk?
1) Syphillis (Grade A)
2) Hepatitis C (Grade B)
3) HIV (Grade A)
4) Hepatitis B (Grade A)
5) G/C (Grade B)
Extra - asymptomatic bacteriuria (Grade A)
Bonus: Screening for bacterial vaginosis in an asymptomatic patient not at risk for preterm delivery is grade D
Routine screening for ovarian cancer in asymptomatic women
FALSE - Class D; recommends against - for asymptomatic women who are not known to have a high risk hereditary cancer syndrome