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A 50-year-old Hispanic woman comes to your office for an annual examination. She has a medical history of hypertension for many years. She has no complaints and is interested in having all the cancer screening tests suggested for someone of her age. She still has menstrual periods. Her last Pap smear was normal 2 years ago. She has never had an abnormal Pap. She has never had a mammogram or a breast biopsy. She is the mother of 2 healthy young adults. Her menarche was at the age of 16. Family history is positive for colon cancer in her older sister diagnosed at age 45. The review of systems and physical examination is unremarkable.

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1. Which cancers should you screen for?

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2. Which tests will you use to screen?

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Answers

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  1. At this time she should be screened for colon and breast cancer. Given her history of a first-degree relative diagnosed with colon cancer, she is considered a high-risk patient and should have started screening for colorectal cancer at the age of 40. She is an average-risk patient for breast cancer and she should start having biennial mammograms. Cervical cancer screening is still indicated but her next Pap smear should be done in 1 year (3 years after the last normal one).

  2. To screen for colon cancer she should have a colonoscopy as she is considered a high-risk patient. For breast cancer film mammography is the test of choice.

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Cancer Screening

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Breast Cancer

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Breast cancer is the second leading cause of cancer-related death among women in the United States. Risk factors include older age, family history of breast cancer, early menarche, older age at the time of first childbirth, and a history of breast biopsy. A family history might suggest the presence of BRCA1 or BRCA2 mutations. Women with possible BRCA mutations should be referred for counseling.

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Screening mammography reduces breast cancer mortality in women 50 to 70 years of age. There is ongoing debate about the benefit for women of ages 40 to 49.

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The American College of Physicians (ACP) released guidelines on screening women in 2007 and they can be summarized as follows: clinicians should perform individualized assessment of risk factors for breast cancer periodically (1–2 years) to help guide the decision about screening. Women should be informed about potential benefits and harms related to screening mammography. Benefits and harms of screening, a woman's preferences, and breast cancer risk profile should guide the decision to screen.

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The U.S. Preventive Service Task Force (USPSTF) also recommends an individualized decision based on a patient's values and the benefits and harms of screening in women younger than 50. The USPSTF recommends biennial screening mammography for women 50 to 74 years old. They state there is insufficient evidence ...

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