Preventive Medicine
1 Cover all but the left-hand column, and give the appropriate screening recommendations. Although other guidelines for cancer screening are in clinical use, the recommendations from the American Cancer Society (below) are a good guideline to use for the USMLE
CANCER
PROCEDURE
AGE
FREQUENCY
Colorectal
Colonoscopy or
>50 yr for all studies
Every 10 yr
Flexible sigmoidoscopy or
Every 5 yr
Double contrast barium enema or
Every 5 yr
Computed tomography (CT) colonography or
Every 5 yr
Fecal occult blood test or
Annually
Fecal immunochemical test or
Annually
Stool DNA test
Interval uncertain
Colon, prostate
Digital rectal examination
>40 yr
Annually
Prostate
Prostate specific antigen test
>50 yr∗
Controversial, but offer annually
Cervical
Pap smear
Beginning at age 21 years regardless of sexual activity
If conventional Pap test is used, test annually, then every 2-3 yr for women 30 yr or older who have had three negative cytology test results
If Pap and HPV testing are used, test every 3 years if both HPV and cytology results are negative
Gynecologic
Pelvic examination
21-64 yr
Annually; every 2-3 yr after 3 normal examinations
≥65 yr
Annually; when to stop is not clearly established
Endometrial
Endometrial biopsy
Menopause
No recommendation for routine screening in the absence of symptoms
Breast
Breast self-examination
>20 yr
Benefits and limitations should be discussed, but breast self-examination is no longer recommended by the American Cancer Society
Breast
Physical exam by doctor
20-40 yr
Every 3 yr
>40 yr
Annually
Breast
Mammography
>40 yr
Annually
Lung
Sputum, chest x-ray
CT scan
Testing is not recommended for asymptomatic individuals, even if they are high-risk
Annual CT scan is controversial but may be indicated for smokers and former smokers aged 55-74 yr who have smoked at least one pack of cigarettes per day for at least 30 yr
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