Annual Wellness Flashcards
When can you stop cervical screening?
Patients older than 65 years who have had adequate screening within the last 10 years may choose to stop cervical cancer screening. Adequate screening is defined as three consecutive normal Pap tests with cytology alone, two normal Pap tests if combined with HPV testing, or two normal HPV tests alone.
What are the USPSTF guidelines for cervical cancer screening?
At age 21: cervical cancer screening should begin.
Between ages 21 and 29: screening should be performed every three years with cytology alone.
Between ages 30 and 65: screening can be done every five years with high-risk HPV (hrHPV) testing alone, every five years with co-testing (hrHPV and cytology), or every three years with cytology alone.
Patients older than 65 years who have had adequate screening within the last 10 years may choose to stop cervical cancer screening. Adequate screening is defined as three consecutive normal Pap tests with cytology alone, two normal Pap tests if combined with HPV testing, or two normal HPV tests alone.
Importantly, it should be noted that these guidelines apply to individuals with a cervix who do not have signs or symptoms of cervical cancer, regardless of sexual history or HPV vaccination status. They also stipulate that certain risk groups need to have more frequent screening. They include patients who have compromised immunity (for example, those who are HIV positive), have a history of cervical intraepithelial neoplasia grade 2, 3, or cancer, or have been exposed to diethylstilbestrol (DES) in utero.
What are the risk factors for developing cervical cancer?
Cigarette smoking ( which is strongly correlated with cervical dysplasia and cancer, independently increases the risk by up to fourfold.)
Early onset of sexual intercourse
Immunosuppression from HIV or other diseases
Multiple sexual partners
What are the possible outcomes of a pap?
Normal results
Low-grade squamous epithelial cells (LSIL)
High-grade squamous epithelial cells (HSIL)
Atypical glandular cells of undetermined significance (AGUS)
Atypical squamous cells of undetermined significance (ASC-US)
What is ‘sensitivity’ in a screening test/what is it measuring?
Measures proportion of actual positives that are correctly identified as such (e.g., percentage of sick people identified as having the condition)
The more sensitive the test, the fewer false-negative results.
What is specificity measuring?
Measures the proportion of negatives that are correctly identified as such (e.g., percentage of well people identified as not having the condition)
The more specific the test, the fewer false positives.
What is the USPSTF recommendation for lung cancer screening?
USPSTF recommends annual screening with a low-dose computed tomography (LDCT) scan to screen for lung cancer in patients aged 50 to 80 who have smoked for 20-plus years.
To be considered, the patient should also be currently smoking or have quit within the prior 15 years. Screening is no longer recommended if the patient develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.
What are the general recommendations that the USPSTF have for colon cancer screening?
As of 2021, the USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years (“B” grade recommendation). The “A” Grade recommendation applies to adults aged 50-75.
Where might you find recommendations for breast cancer screening mammography?
USPSTF, American Cancer Society, and American College of Radiology
How would you evaluate a breast lump?
First, take a good history from the patient, including:
Precise location of the lump
How it was first noticed
How long it has been present
Presence of nipple discharge
Any change in size of the lump (especially ask whether the lump changes in size according to phase of the menstrual cycle)
The next step is a thorough breast exam: Certain characteristics on physical exam increase the suspicion of malignancy.
For example, the presence of a single, hard, immobile lesion of approximately 2 cm or larger with irregular borders increases the likelihood of malignancy.
Diagnostic tests:
If under 30 years of age, ultrasound
If age 30 or older, diagnostic mammogram
Follow-up:
If the workup suggests that the lesion is benign (which the vast majority are), close follow-up with regular breast exams and mammography is indicated.
For diagnostic tests of a breast lump, what are the options and age cut offs?
Diagnostic tests:
If under 30 years of age, ultrasound
If age 30 or older, diagnostic mammogram
What is a resource to help clinicians determine the most appropriate imaging test to be used to evaluate various clinical conditions?
ACR Appropriateness criteria
What are the risk factors for developing breast cancer in the general population?
A. Age
B. Excessive alcohol intake
C. Family history of breast cancer in first-degree relative
D. Genetic factors
E. Postmenopausal obesity
F. Prolonged exposure to estrogen
COMPREHENSIVE LIST:
Nonmodifiable risk factors include:
Family history of breast cancer in a first-degree relative (e.g., parent, sibling, or child)
Prolonged exposure to estrogen, including menarche before age 12 or menopause after age 45
Genetic predisposition (BRCA 1 or 2 mutation)
Increasing age (The incidence of breast cancer is significantly greater after menopause, and age is often the only known risk factor.)
Sex assigned female at birth
Increased breast density (associated with younger age, feminizing hormones)
Prior breast biopsy with specific pathology (Atypical hyperplasia, Lobular carcinoma in situ)
Other hormonal risk factors include:
Advanced age at first pregnancy
Nulliparity
Not breastfeeding
Exposure to diethylstilbestrol
Menopausal hormone therapy with both estrogen and progestin
Environmental factors include:
Therapeutic radiation
Obesity after menopause
Excessive alcohol intake
Smoking
What are protective risk factors for breast cancer?
Pregnancy at an early age
Breastfeeding
Late menarche
Early menopause
High parity
Use of some medications, such as selective estrogen receptor modulators and, possibly, nonsteroidal anti-inflammatory agents and aspirin.
What tool can we use to determine recommendations for mammograms?
Gail criteria
