Screening

Question 1

Breast Cancer

Answer 1

40-49: Not recommended
50-74: Routine q2-3yrs
75+: Screen if benefits outweigh harm

Question 2

Lung Cancer

Answer 2

Annual screening with low dose CT for adults aged 55-74 with at least 30 pack year smoking hx who currently smoke or quit less than 15 yrs ago, up to 3 consecutive times

Question 3

Colorectal Cancer - average risk

Answer 3

> /= 50yo
FOBT q2yo OR flexible sigmoidoscopy q10y
No colonoscopy as a screening test
No screening after age 75 for average risk pts

Question 4

Colorectal Cancer - first degree relative with cancer or adenomatous polyp at age <60 OR two or more 1st degree relatives with polyp or colon cancer at any age

Answer 4

Colonoscopy every 5 years

Start at age 40 or 10 yr younger than earliest case in family

Question 5

Colorectal cancer - first degree relative with cancer or adenomatous polyp at age >60 or 2 or more 2nd-degree relatives with polyps of colon cancer

Answer 5

Average risk screening

Start at age 40

Question 6

Colorectal cancer - one second degree or third degree relative affected

Answer 6

Average risk screening

Start at age 50

Question 7

Cervical cancer

Answer 7

All women >/= 25yo q3y

If >/= 70yo, 3 normal tests in a row and no abnormal tests in last 10 yrs can discontinue screening

Question 8

Cervical cancer - pregnant women, women who have sex with women

Answer 8

Routine screening

Question 9

Cervical cancer - complete hysterectomy

Answer 9

Discontinue screening if for benign disease, swab vaginal vault if hx of malignancy/dysplasia

Question 10

Cervical cancer - subtotal hysterectomy

Answer 10

Continue screening

Question 11

Prostate cancer

Answer 11

Screening for prostate CA with PSA is NOT recommended

Question 12

BRCA 1

Answer 12

• 65% for breast CA

* 40% for ovarian CA by age 70

Question 13

BRCA 2

Answer 13

• 45% for breast CA

* 10% for ovarian CA

Question 14

Vaccination for shingles

Answer 14

50+ yo with Shingrix (recombinant zoster vaccine)

preferred to 60+ yo with Zostavax (live zoster vaccine)

Question 15

Colorectal cancer screening for IBD

Answer 15

Involves majority of colon for over 8 yrs or left colon for over 15 yrs –> colonoscopy q1-2 yrs with biopsies

Question 16

Screening for aortic aneurysms

Answer 16

Smoking men >60-75yo should have an U/S
If risk of HTN, Marfan’s, Ehlers-Danlos syndrome or an affected first degree relative, screening should start earlier or at age 60

Question 17

Screen men age 45-50 with PSA if…

Answer 17

FHx of prostate CA in 1st or 2nd deg relative

African American

Question 18

PSA screening for men age 50-70 with >10yr life expectancy result/course of action

Answer 18

Shared decision
PSA >3 –> more frequent PSA and possible biopsy
PSA 1-3 –> Repeat q2yr
PSA <1 –> Repeat q4yr or if theyre 6yo, don’t screen

Question 19

PSA screening for men age 50-70 with <10yr life expectancy

Answer 19

Don’t screen

Question 20

Pts who still require pap smear even after hysterectomy are:

Answer 20

Those who had partial hysterectomy
Those who had hysterectomy for tx of cancer
Those whose previous cervical cancer screening revealed CIN2, CIN3 or worse
Those who never had pap test done

Question 21

F/O after total hysterectomy for fibroids in pt with history of HSIL in previous pap

Answer 21

HPV DNA testing at least once and vaginal colposcopy q6mo x 2yr

Question 22

When to screen lipids

Answer 22

Men >/40
Women >/=50
All pts with pre-existing risk related conditions (ie. HTN, DM, CKD)
All pts with known fam hx of premature CVD (men <55 and women <65 in first degree relative)
Rescreen q1-5yrs depending on results