What is the highest recommended screening for a 47-year-old female with hypertension (HTN) and a body mass index (BMI) of 37?

Fasting Blood Glucose Screening is the Highest Priority

For this 47-year-old sexually active woman with hypertension, obesity (BMI 37), and multiple risk factors, fasting blood glucose screening for type 2 diabetes represents the highest recommended screening priority among the options listed, as she meets multiple high-risk criteria requiring immediate diabetes screening.

Rationale for Diabetes Screening Priority

This patient has four major risk factors for type 2 diabetes that mandate screening 1:

• Age 47 years (screening recommended for adults aged 35-70 years) 1, 2
• Obesity with BMI 37 (screening specifically recommended for adults aged 40-70 years who are overweight or obese) 1, 2
• Hypertension (a recognized diabetes risk factor requiring screening) 1
• Age >45 years (American Diabetes Association recommends screening all adults ≥45 years regardless of other factors) 1

The 2015 USPSTF guidelines specifically recommend screening for prediabetes and type 2 diabetes in adults aged 35-70 years who have overweight or obesity (Grade B recommendation) 1, 2. This patient falls squarely within these criteria with her age of 47 and BMI of 37.

Why Other Screening Options Are Lower Priority

Pap Smear

• While cervical cancer screening remains important for sexually active women, standard guidelines recommend Pap smear every 3 years (ages 21-65) or every 5 years with HPV co-testing (ages 30-65) 1
• This is not an annual screening and therefore not the "highest recommended" option

Annual Fecal Blood Testing

• Colorectal cancer screening typically begins at age 45-50 years 1
• While this patient is at the threshold age, diabetes screening takes precedence given her multiple high-risk factors and the immediate morbidity/mortality implications of undiagnosed diabetes 1, 2

CT Chest

• There is no indication for routine CT chest screening in this patient
• Lung cancer screening with low-dose CT is reserved for adults aged 50-80 years with ≥20 pack-year smoking history 1
• This option is not applicable

Screening Methodology

Acceptable screening tests include 1:

• Fasting plasma glucose (≥126 mg/dL indicates diabetes; 100-125 mg/dL indicates prediabetes)
• Hemoglobin A1C (≥6.5% indicates diabetes; 5.7-6.4% indicates prediabetes)
• Oral glucose tolerance test (2-hour value ≥200 mg/dL indicates diabetes)

Fasting plasma glucose is preferred due to ease of administration, convenience, patient acceptability, and lower cost 1.

Screening Interval Recommendations

• If results are normal: Repeat screening every 3 years 1, 2
• For high-risk patients (like this patient with multiple risk factors): Consider more frequent screening 1
• The American Diabetes Association recommends annual screening for adults ≥45 years 1

Critical Importance for Morbidity and Mortality

Undiagnosed diabetes leads to severe complications 1, 2:

• Leading cause of kidney failure and new blindness in adults
• Increased cardiovascular disease risk (particularly critical given her existing hypertension)
• Seventh leading cause of death in the US
• Nonalcoholic fatty liver disease

Early detection allows for preventive interventions that can reduce progression from prediabetes to diabetes and decrease cardiovascular complications 1, 2.

Common Pitfalls to Avoid

• Do not delay diabetes screening in obese patients with hypertension, even if they are younger than 50 years 1, 2
• Do not rely solely on symptoms to trigger screening, as type 2 diabetes is often asymptomatic in early stages 1
• Do not overlook the combination of risk factors: This patient's constellation of obesity, hypertension, and age creates substantially elevated diabetes risk 1