A 45-year-old G3P3 presents for her yearly examination. She last saw a doctor 7 years ago after she had her last child. She had three vaginal deliveries, the last of which was complicated by gestational diabetes and preeclampsia. She has not been sexually active in the past year. She once had an abnormal Pap smear for which she underwent cryotherapy. Her cycles are every 35 days and last for 7 days. She describes the flow as heavy for the first 2 days and occasionally passes blood clots the size of quarters. She reports no medical problems. Her family history is significant for coronary artery disease in her dad at the age of 65 years and a maternal aunt who developed ovarian cancer at the age of 67 years. She is normotensive, and her breast and pelvic examinations are normal.
Along with a Pap smear, mammogram, fasting glucose, and lipid profile, what other screening test is recommended for this patient?
A. CA-125Hemoglobin level assessment is warranted in women with excessive menstruation as described in her history. Mammography is indicated for her age. Measuring CA-125 levels has not been shown to be effective in population-based screening for ovarian cancer. Hepatitis C screening should occur in those with risk factors such as intravenous drug use, dialysis, partner with hepatitis C, multiple partners, and received blood products prior to 1990. She is not diabetic or hypertensive and has no urinary symptoms so urinalysis is not indicated. Thyroid testing is reserved for symptoms, strong family history of thyroid disease or autoimmune disease.