Preventive Care and Health Maintenance
A 71-year-old G2P2 presents to your gynecology office for a routine examination. She says she is very healthy and denies taking any medication. She has no history of abnormal Pap smears and has only had one sexual partner in her lifetime. She is a nonsmoker and has an occasional cocktail with her dinner. She does not have any complaints. In addition, she denies any family history of cancer. The patient tells you that she is a widow and lives alone in an apartment in town. Her grown children have families of their own and live far away. She states that she is self-sufficient and spends her time visiting friends and volunteering at a local museum. Her blood pressure is 140/70 mm Hg. Her height is 5 ft 4 in and she weighs 130 lb. Which of the following are the most appropriate screening tests to order for this patient?
a. Pap smear and mammogram
b. Pap smear, mammogram, and colonoscopy
c. Mammogram, colonoscopy, and bone densitometry
d. Mammogram, colonoscopy, bone densitometry, and TB skin test
e. Mammogram, colonoscopy, bone densitometry, TB skin test, and auditory testing
The answer is c. In postmenopausal women, routine screening for colon cancer is recommended with a colonoscopy to be performed every 10 years. Alternatively, flexible sigmoidoscopy can be performed every 5 years along with a yearly fecal occult blood test. Mammography should be performed every 1 to 2 years in all women 50 to 74 years of age. Postmenopausal women, who are not on hormone replacement therapy, and all women 65 years or older should be screened for osteoporosis with a DEXA scan to determine bone mineral density. Screening for cervical cancer with Pap smears may be discontinued after the age of 65 years in women with adequate negative prior screening results and no history of CIN II or higher. Adequate prior screening is defined as three consecutive negative Pap smears or two consecutive negative HPV co-test results within the previous 10 years, with the most recent test performed in the last 5 years. Women with a history of CIN II, CIN III, or adenocarcinoma in situ should continue screening for a total of 20 years after treatment. Tuberculosis skin testing need to be performed only in individuals with HIV infection, those who have close contact with individuals suspected of having TB, who are IV drug users, who are residents of nursing homes or long-term-care facilities, or who work in a profession that is health care related. This patient does not have any risk factors that would necessitate TB testing. Auditory testing is not a routine screening test.