••• Chapter 23^ Primary and Preventative Care^233
❍ How should you screen for eating disorders?
First calculate a body mass index (BMI) in every patient. Then inquire. Questions that may be helpful include:
Are you satisfied with your eating patterns?
Do you ever eat in secret?
Does your weight affect the way you feel about yourself?
Have any of your family members ever had an eating disorder?
❍ What is the lifetime risk of developing breast cancer?
The average woman has a one in eight risk of developing breast cancer.
❍ What is the ACOG recommended screening schedule for breast cancer?
A screening mammogram should be offered annually starting at age 40. Also, all women should have yearly clinical
breast exams. (A study by the National Breast and Cervical Cancer Early Detection Program found that clinical
breast examination detected 7.4 cancers per 1000 women with normal screening mammograms.)
❍ What screening schedule should be offered to patients who are at elevated (>20% in lifetime) risk of
developing breast cancer?
For women with a personal or first-degree relative with BRCA gene mutations, Li-Fraumeni syndrome, or
other genetic cancer syndromes, as well as patients with a history of radiation to the chest between ages 10 and
30, patients should be offered screening starting at age 25, or 8 to 10 years after radiation therapy, whichever
occurs later.
❍ What are appropriate options that you may offer a patient for colorectal cancer screening?
Any of the following are acceptable:
(1) Colonoscopy every 10 years.
(2) Yearly patient-collected fecal occult blood test or fecal immunochemical testing.
(3) Flexible sigmoidoscopy every 5 years.
(4) Double-contrast barium enema every 5 years.
❍ When should you initiate cholesterol screening in women?
Beginning at age 45, a lipid profile should be obtained and every 5 years thereafter. Earlier testing is warranted if
the patient has a history of heart disease, diabetes, elevated cholesterol, is a smoker, or has a family history of CAD
or hypercholesterolemia.