From the Guidelines
The nurse practitioner should prioritize breast cancer screening with biennial mammography, as well as address other key preventative and health promotion concerns, including cervical cancer screening, colorectal cancer screening, bone density screening, and immunization status, during the clinical visit for a 52-year-old female. During a well exam for a 52-year-old female, the nurse practitioner should address several key preventative and health promotion concerns.
- Blood pressure screening, lipid panel, and diabetes screening are essential at this age.
- The patient should receive a mammogram every 1-2 years, as the USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years 1.
- Cervical cancer screening should continue with Pap tests every 3 years or HPV co-testing every 5 years until age 65, as recommended by the American Cancer Society 1.
- Colorectal cancer screening should be initiated, with options including colonoscopy every 10 years, annual FIT testing, or other approved methods, as recommended by the American Cancer Society 1.
- Bone density screening should be considered, especially if risk factors for osteoporosis exist.
- Immunization status should be reviewed, including Tdap/Td booster, influenza vaccine annually, and consideration of shingles vaccination (Shingrix, two doses 2-6 months apart). The visit should include assessment of lifestyle factors such as:
- Diet
- Exercise (recommending 150 minutes of moderate activity weekly)
- Smoking status
- Alcohol consumption
- Mental health screening for depression and anxiety Menopause symptom management may be relevant, potentially including discussion of hormone replacement therapy for severe symptoms. These preventative measures are important as the patient enters a life stage with increasing risk for chronic diseases, cancers, and bone density loss.
From the Research
Preventative Concerns
The nurse practitioner should address the following preventative concerns during the clinical visit:
- Osteoporosis screening: The patient's age (52 years) puts her at a higher risk for osteoporosis, and a DEXA scan may be recommended to assess her bone mineral density 2.
- Breast cancer screening: Annual mammography screening is recommended starting at age 40, and the patient should continue screening past age 74 unless severe comorbidities limit life expectancy 3, 4.
- Cervical cancer screening: The patient should have a Pap smear every 3 years, as recommended by national guidelines 5, 6.
- Colorectal cancer screening: The patient should be screened for colorectal cancer using a home fecal occult blood test, sigmoidoscopy, or colonoscopy, depending on her individual risk factors and preferences 5.
Health Promotion Concerns
The nurse practitioner should also address the following health promotion concerns:
- Healthy behaviors: The patient should be encouraged to engage in healthy behaviors such as not smoking, participating in physical activity, and receiving a flu shot, as these are associated with higher percentages of screening 5.
- Risk assessment: The patient should undergo risk assessment for breast cancer, including genetic risk factors and family history, to determine if she needs more intensive screening 4.