1.1.3: Obtain, interpret, assess, and/or evaluate results from instruments and screening strategies used to assess patients
TT is a 52-year-old African American man concerned about colorectal cancer screening. He inquires about screening recommendations for someone of his age. What information should the pharmacist discuss with the patient?
(A) CT/PET of chest, abdomen, and pelvis
(B) Digital rectal examination
(C) Flexible sigmoidoscopy
The advantages of colonoscopy (D) are that the full colon is visualized and any abnormal polyps can be removed for a biopsy. The disadvantages include the invasiveness, cost, and need for sedation.
Whole body scans (A) have not shown to be an effective monitoring tool for colorectal or any cancer. Unnecessary imaging studies also expose the patient to unnecessary levels of radiation and put a financial burden on the health care system. In contrast, CT colonography is an accepted tool for screening, but is limited by the need for a follow up colonoscopy if any abnormalities like adenomas are discovered. However, TT should get a digital rectal examination (B) and PSA blood test to detect prostate cancer if he has not gotten one this year. Flexible sigmoidoscopy (C) only images the lower part of the colon and requires a follow up full colonoscopy if any abnormalities are found. However, this is a valid screening method for colorectal cancer and an option for TT if he should want it. CEA (E) may be elevated in other malignant and benign conditions and is not considered a valid screening method for colorectal cancer. The level may be helpful to determine extent of disease already diagnosed by other means, evaluate treatment response, and for recurrence surveillance.
According to national guidelines, what is the recommended age to begin screening for colorectal cancer in a person with average risk?
(A) No later than 21 years old
The recommended age to begin screening for colorectal cancer in a person with average risk is 50 years old (D). The frequency of screening tests depends on the method of screening.
Average risk women should receive Pap tests beginning 3 years after first vaginal intercourse, but no later than 21 years old (A). Average risk women should receive annual mammograms starting at age 40 (B). High-risk men, such as African Americans, should be offered prostate cancer screening ...