What cancer and osteoporosis screenings are recommended for a 73-year-old female?

Recommended Cancer and Osteoporosis Screenings for a 73-Year-Old Female

For a 73-year-old female, recommended screenings include biennial mammography, consideration for discontinuing cervical cancer screening if criteria are met, colorectal cancer screening, and bone mineral density testing for osteoporosis.

Breast Cancer Screening

Recommendations:

• Continue biennial mammography screening until age 74
• The European Commission Initiative on Breast Cancer (ECIBC) suggests mammography screening for women aged 70-74 years with average risk for breast cancer 1
• After age 70, women in good health may choose to continue screening if they have had no abnormal/positive cytology tests within the 10-year period prior to age 70 1
• The decision to continue screening beyond age 74 should be based on overall health status and life expectancy

Key Considerations:

• Mammography screening in this age group reduces breast cancer mortality 1
• The time until mortality benefits are observed is shorter in older women (3-4 years) compared to younger women (8 years) 1
• For women with dense breasts or other high-risk factors, supplemental screening with MRI may be considered 2

Cervical Cancer Screening

Recommendations:

• May discontinue cervical cancer screening if:
  1. She has had three or more documented, consecutive, technically satisfactory normal/negative results
  2. No abnormal/positive results within the preceding 10 years 1

Key Considerations:

• Women with a history of cervical cancer, in utero DES exposure, or who are immunocompromised should continue screening as long as they are in reasonably good health 1
• Screening is not indicated for women who have had a total hysterectomy for benign gynecologic disease 1

Colorectal Cancer Screening

Recommendations:

• Continue colorectal cancer screening with one of these options:
  1. Annual fecal occult blood test (FOBT)
  2. Flexible sigmoidoscopy every 5 years
  3. Annual FOBT plus flexible sigmoidoscopy every 5 years
  4. Double-contrast barium enema every 5 years
  5. Colonoscopy every 10 years 1

Key Considerations:

• More intensive surveillance is recommended for patients with:
  • History of adenomatous polyps
  • History of colorectal cancer
  • Inflammatory bowel disease of significant duration
  • Family history of hereditary syndromes or colorectal cancer/adenomas diagnosed in a first-degree relative before age 60 1

Osteoporosis Screening

Recommendations:

• Bone mineral density (BMD) testing is recommended for all women aged 65 and older 1
• Treatment should be initiated for:
  • Women with prior fragility fractures
  • Women with a BMD T-score ≤ -2.5 1

Key Considerations:

• Low body weight (<70 kg) and prior fracture history are strong risk predictors 1
• Fundamental measures for bone health include:
  • Adequate calcium intake (1,200 mg/day)
  • Vitamin D intake (400-800 U)
  • Regular exercise
  • Avoidance of smoking 1
• Bone density measured at the femoral neck by dual-energy x-ray absorptiometry is the best predictor of hip fracture 1

Endometrial Cancer Screening

• Routine screening is not recommended for women at average risk 1
• Women should be informed about risks and symptoms of endometrial cancer and encouraged to report any unexpected bleeding or spotting 1

Important Caveats

• The benefit-to-harm ratio of screening should be considered, as some screenings may lead to false positives, unnecessary procedures, and anxiety
• False-positive mammograms may require additional testing or invasive procedures such as breast biopsy 1
• The cumulative risk of a false-positive mammogram result after 10 mammograms was estimated to be 49% 1
• For women with limited life expectancy due to age or comorbidities, the benefits of screening may be outweighed by potential harms