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Q-6 controversial - shess
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03-02-2008, 01:41 PM
i recall this from "FISCHER's IM Qs" and i think BSE play a small role; Mammograms play a major role but it's not started untill 40. CBE (clinical breast exams) is considered equivalent to Mammo and since it can be done earlier at the age of 20 so I would support the answer B.
03-02-2008, 02:26 PM
Explanation:
The correct answer is E. The history of thoracolumbar back pain and the CT findings of a sclerotic metastasis to the right hemivertebra are diagnostic for metastatic disease. The most common cancers for women in this age group are lung and breast cancer. There is no effective screening tool for lung cancer. For breast cancer, a self breast exam picks up most breast cancers before presentation. It is estimated that more than 80% of cancerous lumps are found by women themselves. While the recommendations are controversial with many groups having different guidelines, The American Cancer Society (ACS) guidelines for the early detection of breast cancer in asymptomatic women are: (1) Women 30 years of age and older should perform breast self examination every month. (2) Women, 20-39, should have a physical examination of the breast every 3 years performed by a health care professional such as a physician, physician assistant, nurse, or nurse practitioner. (3) Women 40 and older should have a physical examination of the breast every year performed by a health care professional such as a physician, physician assistant, nurse, or nurse practitioner. (4) Women 40 years of age and older should have a mammogram every year. A chest auscultation (choice A) rarely detects lung cancer. Screening chest x-rays have not been shown to be an effective screening tool. A clinical breast exam (choice B) is an important part of screening for breast cancer, but the self breast exam picks up most cancers. A clinical thyroid exam (choice C) is important, but thyroid cancers are rare compared to breast cancer. A mammography (choice D) is an important part of screening for breast cancer, but the self breast exam picks up most cancers. Also, screening mammography is generally not recommended until age 40.
03-02-2008, 04:16 PM
A reasonable approach to breast cancer screening in average risk
women is summarized below (show table 7). We recommend that women between the ages of 50 and 70 be screened with mammography ( Grade 1A). (See "Mammography" above). We suggest that women between the ages of 40 and 50, discuss the risks and benefits of mammography with their clinician; the decision to perform mammography should be determined by individual patient values (Grade 2B). The clinician can help women with this decision by reviewing information about their risk of breast cancer and about false-positive mammography results (show figure 1A-1B) (see "Women in their 40s" above). We suggest that women over the age of 70 be screened with mammography if their life expectancy is at least 10 years (Grade 2B). Frameworks have been developed that may assist with decision making in older women (show table 5) (see "Older women" above). The ideal interval for screening mammography is not known, but we suggest screening every one to two years (Grade 2C). We recommend that women being screened for breast cancer also undergo clinical breast examination (Grade 1B). Clinical breast examination may be particularly useful in older women (see "Clinical breast examination" above). The efficacy of breast self-examination (BSE) is unproven. We suggest that BSE not be performed except by women who express a desire to do so and who have received careful instruction to differentiate normal tissue from suspicious lumps (Grade 2B). BSE should only be performed as an adjunct to mammography and clinical breast examination, not as a substitute for these screening methods |
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