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FM4 Family Medicine
Periodic Health Examination Toronto Notes 2019
Mammography
• age40-49:routinescreeningwithmammographynotrecommended(weakrecommendation- moderate quality evidence)
• age50-74:routinescreeningq2-3yr(age50-69:weakrecommendation;moderatequalityevidence,age 70-74: weak recommendation; low quality evidence)
• age75+:screenifbenefitsoutweighharm,musttakeoverallhealthintoaccount
Magnetic Resonance Imaging
• noroutinescreeningwithMRIscans(weakrecommendation-lowqualityevidence)
Clinical Breast Examination
• noroutineCBEaloneorinconjunctionwithmammographytoscreenforbreastcancer(weak recommendation - low quality evidence)
Breast Self-Examination
• recommendagainstroutineself-examination
• formoreinformationonbenignbreastlesionsandbreastcancer,seeGeneralSurgery,GS56
Lung Cancer Screening Guidelines
2016 Canadian Task Force on Preventative Health Care
• applytoadultsaged18andolderwhoarenotsuspectedofhavinglungcancer
• annualscreeningwithlowdoseCTforadultsaged55-74withatleasta30pack-yearsmokinghistory
who currently smoke or quit less than 15 years ago, up to three consecutive times
• chest x-ray is not recommended to screen for lung cancer, with or without sputum cytology
Colorectal Cancer Screening Guidelines
• applytoaverageriskindividuals(asymptomatic,nofamilyhistoryofUC,polyps,orCRC)
• averagerisktestingshouldbeginatage50,butassessmentforriskfactorsshouldbeginearlierto
identify high-risk individuals
• FOBT(eitherhighsensitivityFOBTorFIT-fecalimmunochemicaltesting)q2yrORflexible
sigmoidoscopy q10yr
• nocolonoscopyasascreeningtest
• noscreeningafterage75isrecommendedforaverageriskpatients,butitmaybeassessedonan
individual basis for ages 76-85
• formoreinformationoncolorectalneoplasms,seeGeneralSurgery,GS33
Men and Women
Symptomatic
Diagnostic Workup
Asymptomatic regardless of age but positive family history
HNPCC or FAP
One first-degree relative with cancer or adenomatous polyp at age <60 or
Two or more first-degree relatives with polyp or colon cancer at any age
One first-degree relative with cancer or adenomatous polyp affected at age >60 or
Two or more second-degree relatives with polyps or colon cancer
One second-degree relative or third-degree relative affected
Polyps found at colonoscopy
Genetic counselling and special screening
Average risk screening
Begin at age 50
1-2 tubular adenomas <1 cm: colonoscopy in 5 yr
>2 adenomas: colonoscopy in 3 yr
Incomplete examination, numerous polyps, advanced adenoma, malignant or large sessile adenoma: colonoscopy after a short interval based on clinical judgment
HNPCC Colonoscopy every 1-2 yr
Begin at age 20
or 10 yr younger than the earliest case in the family, whichever comes first
FAP Sigmoidoscopy annually Begin at age 10-12
AAPC Colonoscopy annually Begin at age 16-18
Average risk screening
Begin at age 40
Colonoscopy every 5 years
Begin at age 40 or 10 yr younger than the earliest case of polyp or cancer in the family, whichever comes first
Figure 1. Approach to higher risk screening
AAPC = attenuated adenomatous polyposis; FAP = familial adenomatous polyposis; HNPCC = hereditary nonpolyposis colorectal cancer; 1st degree relatives: parents, siblings, children; 2nd degree relatives: grandparents, aunts, uncles; 3rd degree relatives: great grandparents or cousins. Figure printed with permission from Can J Gastroenterol 2004;18:93-99. Also see: Colorectal Screening for Cancer Prevention in Asymptomatic Patients, March 2013. Available from http://www.bcguidelines.ca/ pdf/colorectal_screening.pdf