Physician Assistant Exam: Preventive Screenings
For Physician Assistant Exam (PANCE) purposes, you should be familiar with routine health prevention screening measures. Many of the cancer screening recommendations, especially for breast and prostate cancer, have been debated. Here are the current general preventive medicine guidelines for cancer and other conditions:
Breast cancer screening: Women under 40 should have a breast examination performed every 3 years by a licensed medical professional and annually after they turn 40. Between ages 40 and 49, based on a consultation with a medical professional who knows their health history, mammograms should be obtained every 1 to 2 years. For women aged 50 to 74, a mammogram should be done every 2 years.
Prostate cancer screening: African-American men aged 40 to 45 should be screened for prostate cancer with a digital rectal examination and a prostate-specific antigen test. If a man has a family history of prostate cancer, especially in a family member younger than 65, he should also discuss screening between the ages of 40 and 45 with his healthcare provider.
If any man is known or likely to have the BRCA1 or BRCA2 mutations, he should discuss prostate cancer screening at ages 40 to 45.
All men over 50 should speak with their healthcare provider concerning their risk of acquiring prostate cancer and whether they should be tested. It’s debatable whether men over the age of 74 should be tested for prostate cancer on an annual basis.
Cervical cancer screening: Women should start getting cervical cancer screenings at the age of 21 or 3 years after the onset of sexual activity. The woman should have a Pap smear done annually until age 30. If the woman has normal Pap tests 3 years in a row, this examination can be done every 3 years. The recommendation is that screening can stop after the age of 70.
Aneurysm screening: A man who has a history of smoking should have an abdominal ultrasound done once between the ages of 65 and 75. It’s not recommended that women be screened for any type of abdominal aneurysm.
Osteoporosis screening: Screening for osteoporosis should begin for women over age 65 with no risk factors via a DEXA scan. If a woman has other risk factors (such as prior steroid use), then the screening should begin by age 60.
You’re evaluating a 38-year-old female who has a family history of cancer. She asks you about testing for breast cancer because her friend was just diagnosed. Her breast self-examinations have been normal. Which of the following would you recommend?
(B) Breast ultrasound
(C) Breast examination by a medical professional
(D) PET scan
(E) CA 27.29 level
The correct answer is Choice (C). The current recommendations state that unless there’s a significant family history of breast cancer, mammography should begin after the age of 40. The recommendation of a breast examination by a medical professional every 3 years still stands in this case.
Choice (B), breast ultrasound, would be used as an adjunctive test to evaluate an abnormal finding as seen on a mammogram or in a young patient with concerning findings. Choice (D), PET scans evaluate the activity of malignancies after they’ve been diagnosed. Choice (E) is a tumor marker for breast cancer. A tumor marker is used only to measure disease activity after diagnosis.