OSCE Flashcards
What is the USPSTF recommendation regarding screening for Abdominal Aortic Aneurysm?
- USPSTF recommends one-time screening for AAA with ultrasonography in men ages 65-75 years who have ever smoked (Grade B)
- USPSTF recommends selectively offering screening for AAA with ultrasonography in men ages 65-75 years ho have NEVER smoked (Grade C)
- USPSTF recommends against screening for women who have never smoked (Grade D)
- Grade I - women 65-75 years who have ever smoked
What is the likelihood that a 65-75 y/o male who has ever smoked and has a normal screening U/S dies from a AAA?
AAA-associate mortality over 5-12 years is low (0-2.4%) in men with normal U/S results
What if the patient only smoked a little bit as a young adult?
Occasional tobacco use for a short time in the past is unlikely to have a pronounced biological effect. However, observational studies have found that even a relatively modest smoking history (half-pack or less/day for fewer than 10 years) does increase the likelihood of developing a large AAA.
Which 65-75 y/o male patients with no smoking history should be screened for a AAA?
Important risk factors: older age, first degree relative with a AAA
Other risk factors: history of other vascular aneurysms, CAD, cerebrovascular disease, atherosclerosis, hypercholesterolemia, obesity, HTN
Reduced risk: African American race, Hispanic ethnicity, diabetes
What is the USPSTF recommendation regarding screening for Breast Cancer?
- USPSTF recommends biennial screening mammography for women aged 50-74 (Grade B)
- The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years (Grade C).
- Grade I - using adjunctive screening methods in women with dense breasts
- Grade I - screening women 75+ years
- Grade I - screening with digital breast tomosynthesis (DBT)
What is the most important risk factor for breast cancer in most women?
Advancing age
Having a first-degree relative with breast cancer is associated with an approximately ___ increased risk for breast cancer in women aged 40-49 years.
2x
Of all of the age groups, which group is most likely to avoid breast cancer death through mammography screening?
Women 60-69 y/o
What are some of the risks of screening mammography?
False positive results, unnecessary biopsies, diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to their health or even apparent during their lifetime
Who do the breast cancer screening recommendations NOT apply to?
Symptomatic women, women with pre-existing breast cancer of a previously diagnosed high-risk breast lesion, known underlying genetic mutation, history of chest radiation at a young age
What is the USPSTF recommendation regarding screening for Cervical Cancer?
- Screen women aged 21-29 every 3 years with cytology; screen women aged 30-65 every 5 years with cytology and HPV co-testing (preferred) or every 3 years with cytology alone (acceptable) - Grade A
- USPSTF recommends against HPV testing in women younger than 30 years - Grade D
- USPSTF recommends against screening for cervical cancer in women younger than 21 - Grade D
- USPSTF recommends against screening in women older than 65 who have had adequate prior screening and are not otherwise at high risk for cervical cancer - Grade D
- USPSTF recommends against screening in women who have had a hysterectomy with removal of the cervix and who do not have a history of CIN2 or 3 or cervical cancer
Should women who have never been sexually active be screened for cervical cancer?
Yes, the grade A recommendation applies regardless of sexual history
To whom does the cervical cancer screening NOT aply?
Women who have received a diagnosis of a high-grade precancerous cervical lesion or cervical cancer, women with in utero exposure to DES, or women who are immunocompromised.
What has been the effect of cervical cancer screening?
Cervical cancer deaths in the US have decreased dramatically since the implementation; most cases occur in women who have not been appropriately screened
What is the USPSTF recommendation regarding screening for Colorectal Cancer?
- USPSTF recommends screening for colorectal cancer starting at age 50 and continuing until age 75 years. (Grade A)
- The decision to screen for colorectal cancer in adults aged 76-85 years should be an individual one, taking into account the patient’s overall health and prior screening history. (Grade C)
To whom does the grade A colorectal cancer screening recommendation apply?
Asymptomatic adults 50 years and older who are at average risk of colorectal cancer and who do not have a family history of known genetic disorders that predispose them to a high lifetime risk of colorectal cancer (Lynch syndrome, FAP), a personal history of inflammatory bowel disease, a previous adenomatous polyp, or previous colorectal cancer
What is the most important risk factor for colorectal cancer for the majority of adults?
Older age
A positive family history (excluding known inherited familial syndromes) is thought to be linked to about ___% of cases of colorectal cancer.
20
What are two additional factors associated with higher colorectal cancer incidence and mortality?
Male sex and black race
Who is more likely to benefit from colorectal cancer screening from age 76-85 years? When is screening most appropriate in this group?
Those who have never been screened for colorectal cancer; those healthy enough to undergo treatment if colorectal cancer is detected and those who do not have comorbid conditions that would significantly limit their life expectancy
List the direct visualization screening test for colorectal cancer.
- Colonsocopy - every 10 years
- CT colonography - every 5 years
- Flexible sigmoidoscopy - every 5 years (or every 10 years with FIT every 1 year)
List the stool-based tests for colorectal cancer.
- gFOBT - every year
- FIT - every year
- FIT-DNA - every 1 or 3 years
What is the USPSTF recommendation regarding screening for Lung Cancer?
Screen adults 55-80 y/o who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years with low-dose CT; 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
What are important risk factors for lung cancer? Other risk factors?
Important risk factors include age, total exposure to tobacco smoke, and years since quitting smoking; other risk factors include specific occupational exposures, radon exposure, family history, and history of pulmonary fibrosis or COPD.
