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
When does menopause start?
On average, patients with ovaries reach menopause at age 51, but menopause can start earlier or later. A few patients start menopause as young as 40, and a very few as late as 60.
What are the benefits of Hormone Therapy in a menopausal woman?
Hormone therapy (HT) can help relieve menopausal symptoms. HT also protects against osteoporosis.
Estrogen and progestin are the two hormone supplements most often used in HT. Taking estrogen without progestin to balance the hormonal cycle may cause overstimulation of the endometrial tissue. This may lead to uncontrolled tissue growth called hyperplasia, which may lead to endometrial cancer. Progestin counteracts this risk. Therefore, patients who have an intact uterus are usually prescribed estrogen and progestin together. Estrogen has been found to be most effective at treating vasomotor symptoms, such as hot flashes, and is FDA-approved for this use. Estrogen therapy may be administered through oral, transdermal, or vaginal routes.
What are the risks of Hormone therapy?
HT also has risks. It can increase the risk of breast cancer, heart disease, blood clots, and stroke.
What are the current guidelines (USPSTF) for calcium intake in the setting of osteoporosis prevention?
USPSTF is currently recommending against 1,000 mg or less of calcium and 400 IU or less vitamin D supplementation in community-dwelling postmenopausal patients.
A USPSTF 2018 recommendation statement concluded that current evidence is insufficient to assess the risks and benefits of calcium and vitamin D supplementation for the prevention of fractures in premenopausal and noninstitutionalized postmenopausal patients.
What are the osteoporosis screening recs?
The USPSTF recommends screening with dual energy x-ray absorptiometry (DEXA) for women 65 years and older.
For women under 65, the USPSTF recommends using a formal risk assessment tool such as the University of Sheffield’s Fracture Risk Assessment Tool to calculate the 10-year probability of fracture and to determine whether DEXA screening and/or treatment is warranted.
Note that on exam, they will want you to get DEXAs on women under 65 who have at least one risk factor (fam hx of hip fracture, prior fragility fracture, smoking hx, low bmi, use of corticosteroids)
What are your risk factors for osteopororsis?
A. BMI > 30
B. Early menopause (b4 45)
C. History of previous fracture as an adult
D. Sedentary lifestyle/lack of physical activity and inadequte calcium intake
E. Smoking
Think low estrogen states.
What resources can you point patients to for healthy eating/ nutrition?
My plate
What can you use to determine the management of abnormal cervical cancer screens?
ASCCP guidelines
What are current guidelines for HPV vaccination?
The HPV vaccine is recommended for all persons through age 26, with the series starting between ages 9 and 11. A shared decision making approach is recommended for adults ages 27-45.
If the vaccine series is started before age 15, only two doses are needed. Children who start the HPV vaccine series on or after their 15th birthday need three doses, given over 6 months.
According to the 2023 draft guidelines from USPSTF, which of the following is the best recommendation to give to a 47 yo pt of avg risk of BC concerning mammography?
A. Should have started at age 40 and every year thereafter
B. Should have started at age 40 and every two years thereafter
C. Should have started at age 45 and every year thereafter
D. Start at age 50 and every year thereafter
E. Start at age 50 and every two years thereafter
B. Should have started at age 40 and every two years thereafter
When is the zoster vaccine recommended?
not recommended until age 50
What tool can you use to figure out someone’s ASCVD risk?
https://clincalc.com/cardiology/ascvd/pooledcohort.aspx
ASCVD Risk calculator
What are some signs of dyslipidemia to look for?
Changes associated with dyslipidemia:
Corneal arcus, xanthelasmas, acanthosis nigricans
What are some signs of atherosclerosis?
Changes associated with atherosclerosis:
Decreased peripheral pulses, carotid bruit
What is the pnemonic for suspicious skin lesions?
Asymmetry
Border irregularity
Color non-uniform
Diameter > 6 mm
Evolution or change over time
Currently, what is the grade USPSTF give PSA testing for males 55-69?
Its currently a C. The number needed to screen is 781 males to prevent one death from prostate cancer. There are also significant rates of complications from both follow-up testing after PSA screening (such as prostate biopsy) and treatment for prostate cancer as well as evidence of significant rates of overdiagnosis.
Recommendations you can also look at American Cancer Society and American Urology Association
What stool tests are available for colorectal screenings?
Stool tests
Guaiac-based Fecal occult blood testing (gFOBT)
Fecal Immunochemical Testing (FIT Test)
Fecal DNA Testing (Multitarget stool DNA, MT-sDNA, Cologuard®)
What increases your risk of a fragility fracture?
Fam hx of hip fracture, prior fragility fracture, smoking hx, low bmi, use of corticosteroids
Pts at AVERAGE risk for osteoperosis start DEXA at age
65
A 65 year old w/new iron deficient anemia should always be screened for
GI bleeds!
DEXA is recommended in all women age _________ or earlier for women w/what risk factors?
65!
Risk factors: family hx of hip fracture, personal hx of fragility fracture, smoking, low bmi, use of corticosteroids.
