A 45-year-old woman presents to your office to establish care. She has been watching television programs hosted by doctors recommending various screening tests, and she wishes to have “everything done.” She has a history of gastroesophageal reflux and seasonal allergies, and no family history of diabetes or cancer. Her best friend was recently diagnosed with ovarian cancer, so she would like to be tested for that.
Which of the following recommendations (based on the United States Preventive Services Task Force) would be appropriate?a. DXA bone density scan
(www.uspreventiveserevicestaskforce.org/recommendations.htm; Fife pp 316-317.) The USPSTF recommends screening for alcohol use disorder in all adults. Maximum recommended consumption is one or less standard drink per day for adult women, and two or fewer standard drinks per day for adult men. On average, women have higher blood alcohol levels than men after ingestion of the same amount of alcohol. Evidence also supports that women have accelerated development of fatty liver, hypertension, malnutrition, and GI hemorrhage with excessive alcohol use. A meta-analysis of studies examining the association between all-cause mortality and average alcohol consumption found that men averaging at least four drinks per day and women averaging two or more drinks per day experienced increased mortality relative to nondrinkers. Bone density screening by DXA is recommended for all women over 65 years of age or for women whose fracture risk is equivalent to that of a 65-year-old woman. Risks for low bone mass include early menopause, long-term use of systemic prednisone or other bone-toxic medications, cigarette smoking, rheumatoid arthritis, and family history of osteoporosis. The newest recommendations for screening frequency for cervical cancer for a woman age 30 and older are every 2 to 3 years due to the improved sensitivity of the ThinPap technology. CA-125 and pelvic sonogram are not recommended for screening of ovarian cancer because of their low sensitivity. Mammogram screening is recommended every-other-year for a normal-risk woman beginning at age 50.