Screening Recommendations
This 35-year-old woman should begin annual mammography NOW (not wait until age 40) and undergo colonoscopy at age 35-40, given her mother's breast cancer diagnosis at age 43 and father's colon cancer diagnosis at age 53-57.
Breast Cancer Screening
Begin annual mammography immediately at age 33-35 rather than waiting until age 40, as the standard screening age does not apply to women with her family history 1.
- Women with a first-degree relative diagnosed with breast cancer before age 50 should begin screening 10 years earlier than the affected relative's age at diagnosis 1
- Since her mother was diagnosed at age 43, screening should start at age 33 (10 years earlier), making current initiation at age 35 appropriate 1
- Annual mammography is the appropriate modality for high-risk patients—clinical breast examination alone is insufficient 1
Clinical breast examination alone (Option A) is inadequate for someone with her level of familial risk and would miss the opportunity for early detection 1.
Colorectal Cancer Screening
Colonoscopy should be initiated at age 35-40 (meaning she should undergo her first colonoscopy now or within the next 5 years), not delayed until age 55 1.
- Individuals with one first-degree relative diagnosed with colorectal cancer before age 55-60 should begin colonoscopy at age 35-40 years 1, 2
- Her father's diagnosis at age 53-57 falls into this early-onset category, triggering earlier screening recommendations 1, 2
- Full colonoscopy is essential (not sigmoidoscopy) because approximately 30% of neoplasms in patients with family history are proximal and would be missed by sigmoidoscopy 1
- After the initial colonoscopy at age 35-40, repeat colonoscopy should occur every 5 years 2
Genetic Counseling Consideration
Refer for genetic counseling given the combination of early-onset breast cancer and colon cancer in first-degree relatives 1.
- This family history pattern warrants evaluation for hereditary cancer syndromes, including Lynch syndrome 1
- Genetic testing results could further refine screening intensity and intervals 1
Why the Provided Options Are Inadequate
- Option A (annual breast examination only): Insufficient—mammography is required for high-risk patients 1
- Option B (annual mammogram starting now): Correct for breast screening but incomplete—ignores colon cancer risk
- Option C (annual mammogram from age 40): Too late—she needs to start now at age 35 1
- Option D (mammogram at 40, colonoscopy at 55): Both components are delayed beyond recommended timelines for her risk level 1, 2
The correct approach is annual mammography starting immediately and colonoscopy at age 35-40 with repeat every 5 years thereafter.