Clinician's Guide Menopause Practice Chapter 9 Flashcards
(185 cards)
1
Q
What is the lifetime chance of women developing cancer?
A
One-in-three chance
This statistic highlights the significant risk of cancer in women.
2
Q
Name three cancers that are unique to women.
A
- Cervical
- Uterine
- Ovarian
These cancers have specific implications for women’s health.
3
Q
What are the most commonly diagnosed cancers in women?
A
- Breast
- Lung
- Colorectal
- Uterine
Skin cancers like squamous and basal cell are excluded from tumor registries.
4
Q
What two factors primarily increase a woman’s lifetime risk of developing cancer?
A
- Aging
- Obesity
These factors are significant contributors to cancer incidence.
5
Q
What percentage of adult Americans are considered obese according to the 2015-2016 National Health and Nutrition Examination Survey?
A
39.8%
This statistic underscores the obesity epidemic in the United States.
6
Q
Which groups of women have the highest incidence of obesity?
A
- Non-Hispanic black women: 54.8%
- Hispanic women: 50.6%
- Non-Hispanic white women: 38%
These disparities highlight the varying risk levels among different demographics.
7
Q
How does obesity relate to breast, uterine, ovarian, and colorectal cancers?
A
Obesity increases the risk for these cancers
Initially attributed to higher estrogen levels produced by fat, but more complex metabolic changes are involved.
8
Q
What impact has increased awareness of cancer symptoms had on diagnosis?
A
More women are diagnosed with early stage cancers
This has led to improved cancer-specific outcomes and increased survivorship.
9
Q
What is the most common cancer in women?
A
Breast cancer
This cancer is prevalent both in the United States and worldwide.
10
Q
What effect did the Women’s Health Initiative (WHI) have on hormone therapy use?
A
The use of hormone therapy declined
This was linked to an increased incidence of breast cancer in postmenopausal women.
11
Q
What are the three categories of risk factors for developing breast cancer?
A
- Nonmodifiable
- Modifiable
- Treatment-associated
These categories help in understanding the different influences on breast cancer risk.
12
Q
What are examples of nonmodifiable risk factors for breast cancer?
A
- Sex
- Age
- Prolonged menstrual life
- Genetic predisposition
- High breast density
These factors cannot be changed and are intrinsic to the individual.
13
Q
What are modifiable risk factors for breast cancer?
A
- Obesity
- Alcohol intake
These factors can be altered to potentially reduce the risk of breast cancer.
14
Q
What treatment-associated factor is linked to an increased risk of breast cancer?
A
Hormone therapy
The use of estrogen and progestin as hormone therapy has been associated with breast cancer risk.
15
Q
At what age should women at average risk begin screening mammography according to the ACS?
A
Age 45
Screening guidelines vary among organizations.
16
Q
What is the significance of the Oncotype Recurrence Score in breast cancer treatment?
A
It helps determine the need for chemotherapy
A score below 25 indicates no benefit from chemotherapy.
17
Q
What is the recommended duration of adjuvant endocrine therapy for women diagnosed with HR-positive breast cancer?
A
- Tamoxifen: 10 years for premenopausal women
- Aromatase inhibitor: 5 years for postmenopausal women
This therapy is crucial for reducing recurrence risk.
18
Q
What are common vasomotor symptoms experienced by breast cancer survivors?
A
- Hot flashes
- Night sweats
These symptoms can be influenced by menopause or endocrine therapies.
19
Q
What is a common side effect of aromatase inhibitors in breast cancer treatment?
A
Musculoskeletal pain
This syndrome can lead to noncompliance in treatment.
20
Q
What is the importance of bone health in postmenopausal women with ER-positive breast cancer?
A
Assessment of bone mineral density is essential
This is crucial due to the risk of osteoporosis and fractures.
21
Q
What is recommended for women with postmenopausal ER-positive and/or PR-positive breast cancer?
A
Empiric bone-directed therapy as adjuvant treatment
Attention to bone health and assessment of bone mineral density with dual-energy X-ray absorptiometry should be included in the follow-up.
22
Q
What is the recommended dosage of zoledronic acid for postmenopausal women undergoing adjuvant therapy?
A
4 mg intravenous zoledronic acid every month for 6 months
This is also applicable for premenopausal women who become postmenopausal due to chemotherapy.
23
Q
What is the association between T-scores less than -1.5 at the initiation of an AI and osteoporosis?
A
Increased risk for developing osteoporosis over the subsequent 5 years
Administration of a bisphosphonate like zoledronic acid is associated with an improvement in T-score.
24
Q
True or False: Women with breast cancer are more likely to die from cardiovascular disease than from breast cancer.
A
True
Early menopause secondary to AIs requires lipid-profile assessment annually.
25
What does the American College of Obstetrics and Gynecology recommend regarding tamoxifen and endometrial biopsies?
Pretamoxifen ultrasound should be considered; follow-up care in low-risk women should be the same as those not taking tamoxifen.
26
What are common sequelae of natural aging and chemotherapy-induced menopause?
Decreased libido and dyspareunia
## Footnote
Topical agents may help in treating dyspareunia.
27
What is the recommended exercise duration for women after breast cancer treatment?
At least 30 to 60 minutes, three to five times per week.
28
What is the US Preventive Services Task Force's recommendation for lung cancer screening?
Annual low-dose computerized tomography for persons aged 55 to 80 years with a significant smoking history.
29
What is the Gail model used for?
Risk-prediction model for estimating a person's risk for breast cancer
## Footnote
It estimates both 5-year and lifetime risk.
30
What is the lifetime risk of breast cancer for women with BRCA1 or BRCA2 mutations?
As high as 72%
## Footnote
Bilateral risk-reducing breast surgery significantly decreases the incidence of breast cancer.
31
What is the reduction in breast cancer incidence associated with 5 years of tamoxifen for women with a Gail model risk of at least 1.7%?
48% reduction
## Footnote
This applies to premenopausal and postmenopausal women aged 35 years and older.
32
How does the toxicity profile of raloxifene compare to tamoxifen?
Raloxifene has a favorable toxicity profile with no deleterious effects on the uterus.
33
What is the risk reduction associated with exemestane in women with a Gail model risk of 1.7%?
65% reduction in breast cancer risk.
34
What are the two types of endometrial cancer?
Type 1 and Type 2
## Footnote
Type 1 tumors are usually low grade and HR-positive, while Type 2 tumors are HR-negative and aggressive.
35
What is the precursor of type 1 endometrial cancer?
Endometrial hyperplasia
## Footnote
15% to 50% of atypical hyperplasia specimens are associated with invasive endometrial cancer.
36
What are the main histologic features of type 2 endometrial cancer?
Papillary serous or clear cell
## Footnote
These tumors arise in atrophic endometrium and spread intraperitoneally.
37
What is the estimated 5-year survival rate for type 1 endometrial cancer?
>85%
38
What factors are associated with an increased risk of developing type 1 endometrial cancer?
Obesity, nulliparity, and low progestinic activity.
39
What are the routes of Type 2 Endometrial Cancer metastases?
* Contiguous extension
* Hematogenous dissemination
* Lymphatic embolization
* Exfoliation with intraperitoneal spread
## Footnote
These routes are associated with different disease characteristics and stages.
40
What is the association of Type 1 endometrial cancer with estrogen?
Type 1 endometrial cancer is associated with exposure to estrogen, leading to endometrial cell proliferation, inhibition of apoptosis, and promotion of angiogenesis.
## Footnote
Mitogenic stimuli in the endometrium are associated with estrogen receptor-alpha (ER-α).
41
True or False: Type 2 endometrial cancers are affected by the estrogen receptor pathways.
False
## Footnote
Type 2 endometrial cancers are unrelated to hyperestrogenism and do not involve ER pathways.
42
Fill in the blank: Estrogen-like effects bypass the ______ mechanism.
ER mechanism
## Footnote
This includes effects mediated by hyperinsulinemia and type 2 diabetes mellitus.
43
What factors contribute to obesity as a risk for endometrial cancer?
* Insulin resistance
* Ovarian androgen excess
* Anovulation
* Chronic progesterone deficiency
## Footnote
Obesity is associated with excess white adipose tissue, which metabolizes and stores steroid hormones.
44
List the risk factors for endometrial cancer.
* Age (>50 years)
* Hyperestrogenic endometrial milieu
* Obesity and high caloric intake
* Physical inactivity and sedentary lifestyle
* Diabetes mellitus
* Genetic factors and familial traits
## Footnote
Conditions like polycystic ovary syndrome (PCOS) also contribute to these risk factors.
45
What is the relationship between diabetes mellitus and endometrial cancer?
Diabetes mellitus increases the risk of endometrial cancer via hyperinsulinemia and obesity.
## Footnote
Mechanisms include increased free estrogen levels and effects on the insulin-growth factor system.
46
How does a sedentary lifestyle affect endometrial cancer risk?
A sedentary lifestyle is correlated with increased endometrial cancer risk.
## Footnote
Physical activity has an inverse association with this risk.
47
What is Lynch syndrome?
An inherited disorder characterized by a defect in mismatch repair genes, associated with a high risk of several cancers, including endometrial cancer.
## Footnote
Lynch syndrome has a high penetrance (80-85%) and early age of onset.
48
What is the association between alcohol consumption and endometrial cancer risk in postmenopausal women?
Alcohol consumption of two drinks per day is associated with a relative risk of 2.01 for endometrial cancer.
## Footnote
No increased risk was found with fewer drinks per day.
49
True or False: Cigarette smoking increases the risk of endometrial cancer.
False
## Footnote
The risks for endometrial hyperplasia with atypia appear to be lower in smokers.
50
What role does obesity play in the production of estrogen?
Adipose tissue is a primary source of extragonadal estrogens via aromatase-induced conversion of androgens.
## Footnote
This increases blood concentrations of estrogens and the risk of endometrial cancer.
51
What is the significance of the FIGO staging system for endometrial cancer?
The revised FIGO staging system better predicts a woman's stage-dependent prognosis and incorporates surgical findings.
## Footnote
It emphasizes the need for surgery in management staging and planning.
52
What is the treatment for hyperplasia without atypia?
Women should be treated with a progestin, either cyclically or continuously.
## Footnote
Progestin-releasing intrauterine devices have higher regression rates compared to oral therapies.
53
What is the treatment with a progestin-releasing intrauterine device associated with?
Higher regression rate and lower relapse rate than oral progestogen therapy
## Footnote
Progestin-releasing intrauterine devices are used for treating endometrial conditions.
54
What are the outcomes of fertility-sparing treatments using progestin?
Similar outcomes with or without a progestin-releasing intrauterine device.
55
What is the association of the progestin-releasing intrauterine device alone in pregnant women?
Poorer obstetric outcome compared to those using both progestin and a progestin-releasing intrauterine device.
56
What can perimenopausal women with oligo-ovulatory or anovulatory cycles be prescribed?
Oral contraceptives (OCs) if there is no contraindication.
57
How often should follow-up endometrial evaluation be recommended for women at high risk for endometrial cancer?
Every 3 to 6 months until regression to normal endometrium occurs.
58
What should be done if abnormal vaginal bleeding resumes in at-risk women?
Perform endometrial evaluation more often.
59
What is the recommended treatment for women with atypical hyperplasia?
Hysterectomy and bilateral adnexal removal.
60
What is the estimated risk of developing invasive carcinoma in women with atypical hyperplasia?
30% risk.
61
What percentage of women with atypical hyperplasia may already have invasive carcinoma?
About one-third.
62
What is the chance of recurrence with conservative treatment using high-dosed progestin therapy?
30% chance of recurrence.
63
What is the complete response rate of atypical hyperplasia and stage I endometrial cancer based on a meta-analysis?
71% complete response.
64
What are the pregnancy rates after treatment with a levonorgestrel-releasing IUD, progestin therapy, and both?
* 18% with IUD
* 34% with progestin therapy
* 40% with both.
65
What is the standard therapy for endometrial cancer?
Surgery, including hysterectomy and removal of adnexal structures.
66
What does surgical staging provide in the context of endometrial cancer?
Disease staging and prognosis.
67
What remains controversial in the surgical treatment of endometrial cancer?
Routine pelvic and para-aortic lymphadenectomy.
68
What is the role of pelvic and para-aortic lymph node dissection according to proponents?
* Diagnostic tool for postoperative treatment
* Staging tool for disease spread
* Therapeutic modality.
69
What may improve local control of disease in high-grade tumors postoperatively?
Vaginal brachytherapy and/or external pelvic radiotherapy.
70
What did the Post Operative Radiation Therapy in Endometrial Carcinoma-2A RCT show?
No significant differences in vaginal recurrence rates between treatments.
71
What chemotherapy agents are most active in treating endometrial cancer?
* Platinum agents
* Taxanes
* Anthracyclines.
72
What is the concern associated with estrogen therapy in young women post-bilateral salpingo-oophorectomy?
Cancer recurrence.
73
What should the decision to recommend hormone therapy for women after endometrial cancer be based on?
Prognostic indicators such as depth of invasion and degree of differentiation.
74
What lifestyle modifications can reduce the risks of endometrial cancer?
* Diet control
* Structured physical exercise.
75
True or False: Screening for uterine cancer is recommended in the absence of symptoms.
False.
76
What hormone deficiency may occur during perimenopause?
Progesterone deficiency
## Footnote
Anovulatory cycles and intermittently high estrogen levels may lead to an estrogen-dominant hormone milieu.
77
What tool can help identify hormonal imbalances during perimenopause?
Menstrual calendar
## Footnote
This can facilitate identification of progesterone deficiency and estrogen dominance.
78
What should be reserved for women who have undergone hysterectomy after menopause?
Estrogen therapy (ET) alone
## Footnote
Women with a uterus should be evaluated if they use ET.
79
What evaluation should women using ET undergo?
Endometrial evaluation
## Footnote
This should occur at baseline and periodically thereafter.
80
What is the minimum effective dose of oral progestogen for endometrial protection?
5 mg per day for 12 to 14 days each month
## Footnote
This is when combined with a standard estrogen dose.
81
What type of cancer is diagnosed in more than 13,000 US women per year?
Cervical cancer
## Footnote
It results in more than 4,000 deaths annually.
82
What is the predominant subtype of cervical cancer?
Squamous cell carcinoma
## Footnote
It accounts for 80% of cases.
83
What virus is primarily responsible for the development of invasive cervical cancer?
Human papillomavirus (HPV)
## Footnote
Persistent infection after sexual activity is a key factor.
84
How long is the latency period between HPV infection and the development of invasive cancer?
About 15 years
## Footnote
Duration of active HPV infection is associated with cervical dysplasia progression.
85
What are additional risk factors for developing cervical cancer?
* Smoking
* Use of oral contraceptives (OCs)
* Early age at first sexual intercourse
* Larger number of sexual partners
* High-risk sexual partners
* History of sexually transmitted infections
* In utero exposure to diethylstilbestrol
## Footnote
Genetic factors and chronic immune suppression also increase risk.
86
What is the purpose of the Papanicolaou (Pap) test?
To detect cervical cytologic abnormalities
## Footnote
It identifies preinvasive findings and cervical cancer.
87
At what age should women deemed at standard risk undergo cervical cytology screening?
21 to 29 years
## Footnote
Screening should occur every 3 years.
88
What is the recommended screening for women aged 30 to 65 years?
Cocontesting with cervical cytology and high-risk HPV screening every 5 years
## Footnote
Alternatively, cervical cytology every 3 years.
89
What are early symptoms of cervical cancer?
* Watery vaginal discharge
* Intermittent vaginal spotting
* Postcoital bleeding
## Footnote
Early cervical cancer is frequently asymptomatic.
90
What is the primary means for diagnosing cervical cancer?
Cervical cytology or Pap tests and cervical biopsies
## Footnote
These help identify cervical dysplasia.
91
What staging system is widely used for cervical cancer?
FIGO clinical staging system
## Footnote
It assesses primary tumor size and paracervical tissue involvement.
92
What is the preferred surgical approach for early stage cervical cancer?
Radical hysterectomy
## Footnote
It includes wide paracervical margins and bilateral pelvic lymph node dissection.
93
What type of chemotherapy is preferred for women with bulky, local disease?
Cisplatin-based chemotherapy
## Footnote
It is combined with external-beam radiotherapy.
94
What is the recommended vaccination for preventing invasive cervical cancer?
Gardasil (quadrivalent HPV vaccine)
## Footnote
It prevents infection by HPV associated with invasive cancer.
95
How many HPV serotypes can infect genital mucosa?
Approximately 40 HPV serotypes
## Footnote
Of these, 15 are known to be oncogenic.
96
What are the two HPV subtypes found in more than 70% of all cervical cancers?
Subtypes 16 and 18
## Footnote
These subtypes are known to be oncogenic.
97
What is the FDA-approved HPV vaccine that prevents infection associated with invasive cancer?
Gardasil
## Footnote
This vaccine works through antibody-mediated immunity.
98
At what age does the Advisory Committee on Immunization Practices recommend vaccinating children against HPV?
11 or 12 years old
## Footnote
Young women through age 26 are also recommended to be vaccinated.
99
What is the predicted reduction in cervical cancer incidence due to HPV vaccination?
73%
## Footnote
Mortality is predicted to reduce by 49%.
100
What is the leading cause of death from gynecologic cancer in the United States?
Epithelial ovarian cancer (EOC)
## Footnote
It is also the fifth most common cause of cancer mortality in women.
101
What is the 5-year survival rate for all stages of EOC?
47%
## Footnote
This rate drops to less than 30% for patients with distant metastases.
102
What classification system was revised in 2014 for EOC?
The classification recognizes serous, mucinous, seromucinous endometrioid, clear cell, and Brenner tumors
## Footnote
These subtypes account for more than 95% of EOC cases.
103
What genetic mutations are common in the high-grade serous subtype of EOC?
BRCA1 and BRCA2 mutations
## Footnote
Many of these tumors likely develop from tubal precancerous lesions.
104
What are common risk factors associated with EOC?
* Germline mutations in BRCA1 or BRCA2 genes
* Lynch syndrome
* Reproductive history
* Aging
* Endometriosis
## Footnote
Factors such as nulliparity or infertility are more important than the age of menarche and menopause.
105
How does oral contraception usage affect EOC risk?
Decreases EOC risk by 50%
## Footnote
This is compared to women who have never used this method of contraception.
106
What is the role of CA125 in EOC diagnosis?
It is a standard tumor biomarker
## Footnote
A normal value is less than 35 IU/mL, but high levels can be seen in other cancers or benign conditions.
107
What is the primary treatment for EOC?
Aggressive surgical staging followed by platinum/taxane-based chemotherapy
## Footnote
At least 60% to 80% of newly diagnosed women with EOC are expected to respond to platinum-based chemotherapy.
108
What distinguishes platinum-sensitive from platinum-resistant EOC?
Platinum-sensitive patients relapse 6 months or more after initial chemotherapy
## Footnote
Platinum-resistant patients relapse within 6 months.
109
What emerging treatment class is effective for EOC, especially for high-grade ovarian carcinoma with a BRCA mutation?
Poly(ADP-ribose) polymerase inhibitors
## Footnote
These inhibitors cause apoptosis of BRCA-deficient cells.
110
What is the estimated number of new lung cancer cases in 2018 in the United States?
234,030 new cases
## Footnote
Lung cancer is the leading cause of cancer mortality.
111
What percentage of lung cancers are classified as non-small cell lung cancer?
Approximately 85%
## Footnote
This subtype includes adenocarcinoma, squamous cell, and large cell types.
112
What percentage of lung cancer deaths are attributed to smoking?
80%
## Footnote
Lung cancer is largely preventable, providing opportunities for discussions about smoking cessation.
113
What are the two major subtypes of lung cancer?
Small cell and non-small cell lung cancer
## Footnote
Non-small cell lung cancer accounts for approximately 85% of cases.
114
What is the most common histologic subtype of non-small cell lung cancer?
Adenocarcinoma (40%)
## Footnote
Other subtypes include squamous cell (25-30%) and large cell (15%).
115
What is the percentage of lung cancers that are small cell lung cancers?
10% to 15%
## Footnote
Small cell lung cancer is less common than non-small cell lung cancer.
116
What is the predominant risk factor for developing lung cancer?
Smoking
## Footnote
Most lung cancers develop in persons with a history of smoking.
117
Name three environmental factors that increase the risk of lung cancer.
* Pollution
* Cooking fumes
* Asbestos
118
True or False: Most smokers develop lung cancer.
False
## Footnote
Most smokers never develop lung cancer.
119
What is the association between cooking fumes and lung cancer?
Cooking fumes are a major risk factor in developing countries
## Footnote
Bituminous coal and wood burning increase this risk.
120
What condition is the most common independent risk factor for lung cancer aside from smoking?
Chronic obstructive pulmonary disease (COPD)
## Footnote
Discerning risk caused by COPD compared to smoking is difficult.
121
What effect does beta-carotene supplementation have on lung cancer risk in smokers?
Increases risk
## Footnote
Randomized data show that beta-carotene does not decrease lung cancer risk.
122
What major finding did the National Lung Screening Trial reveal?
20% reduction in lung cancer mortality in the CT arm
## Footnote
This led to recommendations for annual low-dose CT screening.
123
At what age range are high-risk patients recommended to undergo annual lung cancer screening?
55 to 80 years
## Footnote
High-risk defined as those with a 30-pack-year smoking history.
124
What correlation has been observed between estrogen levels and lung cancer mortality in women?
Higher estrogen levels correlate with higher cancer mortality
## Footnote
Observational studies have provided mixed results.
125
How should localized non-small cell lung cancer be treated?
Surgical resection with or without adjuvant chemotherapy
## Footnote
Advanced disease may require systemic therapy.
126
What is the estimated number of new colorectal cancer cases in men and women in 2017?
71,420 in men and 64,010 in women
## Footnote
Colorectal cancer is the third most commonly diagnosed cancer.
127
What percentage of colorectal cancer cases are diagnosed in individuals aged 45 to 84 years?
82.5%
## Footnote
The median age at diagnosis is 67 years.
128
Name one inherited form of colorectal cancer.
Hereditary nonpolyposis colorectal cancer (Lynch syndrome)
## Footnote
It is caused by germline mutations in mismatch repair genes.
129
What dietary factors are associated with an increased risk of colorectal cancer?
* Intake of red and processed meat
* Obesity
* Physical inactivity
130
What is the primary screening test recommended for colorectal cancer detection?
Colonoscopy
## Footnote
It is considered the gold standard for screening.
131
What percentage of colorectal cancer deaths are attributed to better therapies and screening practices?
53% from screening practices
## Footnote
Screening has significantly reduced mortality rates.
132
What is the lifetime risk of developing colorectal cancer?
4.2%
## Footnote
This translates to approximately 1 in 24 individuals.
133
What is the expected 5-year survival rate for localized colorectal cancer?
89.8%
## Footnote
The survival rate for distant disease is significantly lower at 13.8%.
134
What are the nonmodifiable risk factors for colorectal cancer?
* Ethnicity
* Age (risk increases markedly after age 50)
* Family history of colorectal cancer
* Inherited syndromes such as familial adenomatous polyposis coli
* Personal history of inflammatory bowel disease
* Prior colon cancer
* Prior polyps
* Type 2 diabetes mellitus
* Physical inactivity
* Obesity
* Smoking
## Footnote
Nonmodifiable risk factors are those that cannot be changed or influenced by lifestyle choices.
135
What are the modifiable risk factors for colorectal cancer?
* Diet high in red meats and processed meats
* Heavy alcohol use
## Footnote
Modifiable risk factors are those that can be influenced by lifestyle changes.
136
At what age does the American Cancer Society recommend starting colorectal cancer screening for average-risk persons?
45 years
## Footnote
This recommendation is updated from the previous guideline of starting at age 50.
137
What is the primary purpose of the FOBT?
To detect the presence of blood in the gastrointestinal tract that is not visible to the naked eye.
## Footnote
FOBT stands for fecal occult blood test.
138
What is the sensitivity percentage of the fecal immunochemical test (FIT)?
79%
## Footnote
FIT is considered to have better sensitivity for colorectal cancer compared to the guaiac-based test.
139
True or False: Colonoscopy is considered the gold standard for colorectal cancer screening.
True
## Footnote
Colonoscopy is widely recognized for its ability to visualize, sample, and remove lesions from the entire colon.
140
What are the expected perforation rates associated with colonoscopy?
0.082%
## Footnote
This rate is lower than previously estimated.
141
What is the significance of a barium enema in colorectal cancer screening?
It increases the quality of X-rays of the rectum but has a sensitivity of only 48% for polyps 1 cm and larger.
## Footnote
Barium enema has largely been replaced by CT colonography.
142
How does computed tomography colonography (CTC) assist in colorectal cancer screening?
It examines the colon and reconstructs images in a 3-dimensional format, allowing for virtual colonoscopy.
## Footnote
CTC can be used when traditional colonoscopy is contraindicated or incomplete.
143
What is the recommended screening interval for individuals with a family history of colorectal cancer?
Every 5 years starting at age 40 or 10 years younger than the age at diagnosis of the youngest affected relative.
## Footnote
This applies to those with a single first-degree relative diagnosed before age 60.
144
What is the recommended age for women at risk of familial adenomatous polyposis to start screening?
10 to 12 years
## Footnote
Annual flexible sigmoidoscopy or colonoscopy is recommended until colectomy is deemed appropriate.
145
What is the Bethesda criteria used for?
To determine if patients should have genetic testing for Lynch syndrome.
## Footnote
Lynch syndrome is associated with hereditary nonpolyposis colorectal cancer.
146
What lifestyle modifications may lower colorectal cancer risk?
* Exercise
* Lower fat intake
## Footnote
These modifications may also help prevent other comorbidities such as cardiovascular disease.
147
What are the postpolypectomy guidelines for patients with one or two small tubular adenomas?
Colonoscopy is recommended 5 to 10 years after the initial polypectomy.
## Footnote
These recommendations reflect the classification of different types of polyps.
148
What is the sensitivity of the stool DNA test approved by the FDA in 2014 for colorectal cancer detection?
92%
## Footnote
This sensitivity is higher compared to the FIT alone, but it has a higher number of false positives.
149
What is a key characteristic of serrated polyps?
They tend to be found in the right side of the colon and have a shorter progression to cancer than traditional tubular adenomas.
## Footnote
Serrated polyps can be more difficult to detect due to their flatter appearance.
150
What is the recommended follow-up for patients with one or two small tubular adenomas (≤1 cm) with low-grade dysplasia after initial polypectomy?
Colonoscopy is recommended 5 to 10 years after the initial polypectomy.
151
What is the recommended follow-up for patients with three to 10 adenomas, any adenomas with high-grade dysplasia or villous features, or a large (≥1 cm) adenoma?
Colonoscopy is recommended 3 years after polyp removal.
152
In patients with more than 10 adenomas on a single exam, what action should be considered?
Genetic testing should be considered.
153
What is the recommended follow-up for patients with sessile adenomas that are removed in pieces?
A repeat colonoscopy is recommended 2 to 6 months after removal.
154
What is the association between the use of aspirin and NSAIDs and colorectal cancer?
Use of aspirin and NSAIDs is associated with reduced risk of colorectal cancer.
155
What is the USPSTF recommendation for low-dose daily aspirin for primary prevention?
Recommended for persons aged 50 to 59 years with 10% or greater 10-year CVD risk.
156
What is the effect of estrogen-progestin therapy (EPT) on colorectal cancer risk according to randomized controlled trials?
EPT is associated with decreased risk of colorectal cancer.
157
What is the standard treatment for stage I colon and rectal cancers?
Surgery alone is the treatment.
158
What is the standard treatment for stage II and III rectal cancers?
Neoadjuvant chemoradiation followed by surgery and postoperative chemotherapy.
159
What is the treatment approach for stage IV colorectal cancer?
Combination chemotherapy with cytotoxics and biologic agents.
160
What are the three main types of skin cancers?
* Basal cell carcinoma
* Squamous cell carcinoma
* Melanoma
161
What is actinic keratosis?
A premalignant proliferation of keratinocytes resulting from cumulative sun damage.
162
What characterizes squamous cell carcinoma?
Persistent crusting and ulceration with induration and ill-defined edges.
163
What is the average lifetime risk of developing basal cell carcinoma in the United States?
28% to 33%.
164
What are the risk factors for melanoma?
* Fair skin
* Ultraviolet light exposure
* Advancing age
* Positive family history
* Presence of atypical nevi
165
What does the 'ABCDE' rule refer to in melanoma diagnosis?
* Asymmetry
* Irregular border
* Color is variable
* Diameter >6 mm
* Evolving or changing
166
What is Merkel cell carcinoma?
A rare but aggressive neuroendocrine tumor with a high mortality rate.
167
What is the typical treatment for dermatofibrosarcoma protuberans?
Wide local excision.
168
What are seborrheic keratoses?
Benign proliferations of keratinocytes with a 'stuck-on' appearance.
169
What are acquired melanocytic nevi?
Benign pigmented lesions caused by proliferation of melanocytes.
170
What are solar lentigines?
Flat brown spots caused by chronic sun exposure, also known as aging spots.
171
What is the clinical mnemonic used for Merkel cell carcinoma characteristics?
AEIOU.
172
What is the incidence of cherry angiomas?
Small, red, dome-shaped, blanching lesions.
173
What does the 'IOU' mnemonic stand for?
A: Asymptomatic, I: Immunosuppression, O: Older than 50 years, U: UV-exposed areas
## Footnote
Abbreviation: UV, ultraviolet.
174
What are cherry angiomas?
Small, red, dome-shaped, blanching vascular lesions that commonly appear on the trunk and increase in number with age
## Footnote
Treatment options include electrocautery, laser coagulation, and shave excision.
175
What characterizes lipomas?
Slow-growing adipose tumors that present as nontender, rounded, mobile subcutaneous masses with a characteristic doughy feel
## Footnote
More common in women and usually appear between ages 40 and 60.
176
What are dermatofibromas?
Firm, well-defined oval nodules with overlying pigmentation, most commonly arising on the distal lower extremities
## Footnote
25 times more common in women and can form secondary to local trauma.
177
What causes cutaneous viral warts?
Human Papillomavirus (HPV)
## Footnote
Warts are more common in children and young adults, with spontaneous resolution generally occurring in immunocompetent patients.
178
What type of sunscreen should be applied daily to sun-exposed skin?
A broad-spectrum sunscreen that blocks both UVA and UVB radiation with a sun protection factor greater than 30
## Footnote
Needs to be reapplied every 60 to 90 minutes, even with water-resistant brands.
179
What is the recommended sun protection during peak UV exposure hours?
Seek shade between 10 am and 2 pm
## Footnote
Sunburns can occur even on cloudy days.
180
What skin care advice is recommended after menopause?
Use a good emollient moisturizer daily or twice daily to maintain skin barrier function
## Footnote
Plain 100% petrolatum ointment is often recommended.
181
What should be minimized to prevent skin drying?
Soap use
## Footnote
Even gentle cleansers can cause drying of the skin.
182
What type of personal care products should be used for sensitive skin?
Fragrance- and dye-free personal care products
## Footnote
This is particularly important for patients with sensitive skin.
183
True or False: Annual skin examinations are recommended for patients with a personal or family history of skin cancer.
True
## Footnote
Suspicious lesions should be evaluated and biopsied in a timely fashion.
184
Fill in the blank: Cherry angiomas increase in number with _____.
age
185
What is a common treatment option for warts?
Duct tape, salicylic acid, imiquimod cream, and cryotherapy
## Footnote
These treatments are available for wart removal.
