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an
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a 42 yr old woman comes to office for periodic health maintenance exam. she has no specific complaints. she has been ur patient since she was 23 yrs old and comes for a check-up every few yrs. Her last Pap smear was 1 yr ago and normal. She has no family history of breast cancer, and has never had a mammogram. She wants to know what she is due for today and since u follow the recommendations of the US preventive services task force u make sure that u
a.advise her to floss daily and brush her teeth with a flouride-based toothpaste
b.ask her bout suicidal intent
c.perform fecal occult blood testing
d.schedule a mammogram
e.tell her to take low-dose aspirin daily
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| kingsofke
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d. shedule a mammogram
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| karusmle
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hi kingsofke , nice to see u in this forum ...........
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| an
Forum Guru
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ans is a.
i put this qu coz strong medicine(and some other bks) mention to start mammograms at yearly intervals starting at 40yrs...but the US preventive services task force guidelines are different..they state to do yearly mammograms after 50, at 35 if high-risk(obtain a base-line)
for this woman, recommended screening is BP and BMI, Pap smear at 1-3 yrs till 65yrs; recommended counselling is dental hygiene, smoking, alcohol use, exercise, fat consumption,
Edited by an on 05/12/06 - 10:05 PM
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| msyamp
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http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm
The U.S. Preventive Services Task Force (USPSTF) recommends screening mammography, with or without clinical breast examination (CBE), every 1-2 years for women aged 40 and older.
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| AAAAA
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Dr. Msyamp,
Please read the USPSTF very carefully. It is a B recommendation.
For pt without any risk factors, USPSTF recommends mammography at age 50 not 40.
THE B recommendation is not an absolute recommendation. So answer is A
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| AAAAA
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Screening for Breast Cancer
Release Date: February 2002
Summary of Recommendations / Rating: B recommendation.
Rationale: The USPSTF found fair evidence that mammography screening every 12-33 months significantly reduces mortality from breast cancer. Evidence is strongest for women aged 50-69, the age group generally included in screening trials. For women aged 40-49, the evidence that screening mammography reduces mortality from breast cancer is weaker, and the absolute benefit of mammography is smaller, than it is for older women. Most, but not all, studies indicate a mortality benefit for women undergoing mammography at ages 40-49, but the delay in observed benefit in women younger than 50 makes it difficult to determine the incremental benefit of beginning screening at age 40 rather than at age 50.
The absolute benefit is smaller because the incidence of breast cancer is lower among women in their 40s than it is among older women. The USPSTF concluded that the evidence is also generalizable to women aged 70 and older (who face a higher absolute risk for breast cancer) if their life expectancy is not compromised by comorbid disease. The absolute probability of benefits of regular mammography increase along a continuum with age, whereas the likelihood of harms from screening (false-positive results and unnecessary anxiety, biopsies, and cost) diminish from ages 40-70. The balance of benefits and potential harms, therefore, grows more favorable as women age. The precise age at which the potential benefits of mammography justify the possible harms is a subjective choice. The USPSTF did not find sufficient evidence to specify the optimal screening interval for women aged 40-49 (see Clinical Considerations).
The USPSTF concludes that the evidence is insufficient to recommend for or against routine CBE alone to screen for breast cancer
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| AAAAA
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Task Force Ratings Strength of Recommendations
The U.S. Preventive Services Task Force (USPSTF) grades its recommendations according to one of five classifications (A, B, C, D, I) reflecting the strength of evidence and magnitude of net benefit (benefits minus harms).
A.— The USPSTF strongly recommends that clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.
B.— The USPSTF recommends that clinicians provide [this service] to eligible patients. The USPSTF found at least fair evidence that [the service] improves important health outcomes and concludes that benefits outweigh harms.
C.— The USPSTF makes no recommendation for or against routine provision of [the service]. The USPSTF found at least fair evidence that [the service] can improve health outcomes but concludes that the balance of benefits and harms is too close to justify a general recommendation.
D.— The USPSTF recommends against routinely
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