What is the most appropriate screening test for a 67-year-old asymptomatic woman with normal (milligrams per deciliter - mg/dL) serum cholesterol and serum glucose levels, and a history of normal mammography, Pap smear, and flexible sigmoidoscopy results?

Mammography is the Most Appropriate Screening Test for a 67-Year-Old Woman

For this 67-year-old asymptomatic woman with normal previous screening tests, mammography is the most appropriate screening test at this time.

Rationale for Mammography

The American College of Radiology (ACR) and other major medical organizations recommend annual mammography for women over 40 years of age, with no specific upper age limit as long as the woman remains in good health 1. This recommendation is based on evidence showing that:

• Annual screening mammography reduces breast cancer mortality by 40% in women aged 40-84 years 1
• Mammography is the gold standard screening modality for breast cancer detection in average-risk women 2
• Early detection through mammography decreases breast cancer death 3

Timing of Mammography

For this patient:

• Her last mammogram was 1 year ago with normal findings
• Current guidelines recommend annual mammography for women in her age group
• At 67 years old, she falls within the age range (50-74 years) where there is strongest evidence for mortality benefit from mammography screening 1, 4

Analysis of Other Screening Options

Pap Smear

• The patient had a normal Pap smear 1 year ago
• Most guidelines recommend Pap tests every 3 years for women who have had normal results 1
• Some organizations recommend discontinuing regular Pap testing after age 65 if previous results have been consistently normal 1

Serum Cholesterol Measurement

• Her serum cholesterol level was normal (180 mg/dL) 1 year ago
• Her BMI is normal at 23.1 kg/m² (63 kg, 165 cm)
• She exercises regularly and has normal blood pressure (120/80 mm Hg)
• Given these factors, annual cholesterol screening is not indicated

Serum Glucose Measurement

• Her fasting serum glucose was normal (80 mg/dL) 1 year ago
• She has no apparent risk factors for diabetes
• Annual screening is not necessary with previous normal results and no risk factors

Flexible Sigmoidoscopy

• She had a normal flexible sigmoidoscopy 2 years ago
• Guidelines recommend flexible sigmoidoscopy every 3-5 years after age 50 1
• Therefore, she is not due for repeat sigmoidoscopy at this time

Special Considerations

Dense Breasts

• If this patient has dense breasts (which is not mentioned in the case), supplemental screening might be considered
• The ACR notes that dense breast tissue decreases mammography sensitivity and is an independent risk factor for breast cancer 1
• However, mammography remains the primary screening tool even for women with dense breasts 1

Age Considerations

• While some guidelines suggest individualized screening decisions for women over 75 years, this patient is 67 and in good health
• The ACR recommends continuing screening mammography as long as a woman remains in overall good health and has a life expectancy of at least 5-7 years 1

Conclusion

Based on the patient's age, health status, and timing of previous screening tests, mammography is the most appropriate screening test at this time. Her other screening tests (Pap smear, cholesterol measurement, glucose measurement, and flexible sigmoidoscopy) were all recently performed with normal results and do not need to be repeated at this visit according to current guidelines.