Aquifer Case 1: 45 yo Female Wellness Visit Flashcards
should women perform regular breast exams?
no
breast self examination increases the number of biopsies with no reduction in mortality
even doctor-performed exams in asymptomatic patients are unnecessary
which fingers do you use to palpate breast tissue?
finger pads of the middle 3 fingers
go in a ladder pattern and vary pressure; light, medium and deep
include axillary and supraclavicular lymph nodes
is a bimanual exam used to screen for ovarian cancer?
no it’s not recommended
but it’s what you should use in a symptomatic patient
1) put lube on the index and middle fingers of your nondominant gloved hand and insert them into the patients vagina
2) move cervix side to side to check for tenderness and mobility
3) put dominant hand on the abdomen superior to symphysis pubic to feel for uterus and ovaries
what are the cervical cancer screening guidelines?
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 cotesting (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 three consecutive normal Pap tests with cytology alone or two normal Pap tests if combined with HPV testing
patient with a total hysterectomy for benign reasons don’t need cervical cancer screening
BUT certain risk groups need more frequent screening –> compromised immunity, HIV (+), h/o CIN 2/3 or cancer, exposed to DES in utero
what is DES?
DES = diethylstilbestrol
a nonsteroidal estrogen that was given to pregnant females to prevent miscarriages.
however, it was linked to clear cell adenocarcinoma of the vagina and its use was discontinued in 1971
what are the risk factors for developing cervical cancer?
- smoking
- early onset of sexual intercourse
- immunosuppression
- multiple partners
- DES exposure in utero
what are the characteristics of a good screening test?
- accuracy –> high sensitivity and specificity
- able to detect disease in an asymptomatic phase
- minimal associated risk
- reasonable cost
- acceptable to patient
- available treatment for disease
do you screen for skin cancer?
no
while skin cancer is the most common type of cancer, the USPSTF currently reports that there is insufficient evidence to recommend for or against skin cancer screening
do you screen for ovarian cancer?
no
everyone recommends against routine screening for ovarian cancer in asymptomatic patients
what are the lung cancer screening recommendations?
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, or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery
what is the USPSTF recommendation for breast cancer screening and mammography?
biennial screening mammography for females aged 50 to 74 years
starting before 50 should be an individual decision and take into account patient factors
what is the American Cancer Society recommendation for breast cancer screening and mammography?
females aged 45 to 54 should get mammograms every year
females aged 55 and older should switch to mammograms every two years, or have the choice to continue yearly screening
females aged 40 to 44 should have the choice to start annual breast cancer screening with mammograms if they wish to do so – the risks of screening, as well as the potential benefits, should be considered.
what is the American College of Radiology recommendation for breast cancer screening and mammography?
for females at average risk, < 15% lifetime risk of breast cancer, annual screening with mammography or digital breast tomosynthesis is recommended starting at age 40.
as of 2018, The American College of Radiology (ACR) has classified African American females as high risk
what are the risks associated with mammography?
potential for false positive or false negative
sensitivity is only 60-90% so low sensitivity = more false negative results; especially I younger females with dense breast tissue
when are breast MRIs used for in breast screening?
not recommended for screening the general population of asymptomatic, average-risk females
may be indicated in the surveillance of females with more than a 20% lifetime risk of breast cancer
contrast-enhanced breast MRI may be indicated in the evaluation of patients with breast augmentation in whom mammography is difficult
