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Review Question - QID 109631

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QID 109631 (Type "109631" in App Search)
A 43-year-old woman presents to her primary care physician for a general wellness appointment. Sometimes she has headaches and is ashamed of her body habitus. Otherwise, the patient has no complaints. The patient's 90-year-old mother recently died of breast cancer. She smokes 1 pack of cigarettes per day and drinks 2-3 glasses of red wine per day with dinner. She has been considering having a child as she has just been promoted to a position that gives her more time off and a greater income. The patient's current medications include lisinopril, metformin, and a progesterone intrauterine device (IUD). Her temperature is 98.5°F (36.9°C), pulse is 70/min, blood pressure is 118/76 mmHg, and respirations are 13/min. On physical exam, you note a normal S1 and S2 heart sound. A pulmonary exam is clear to auscultation bilaterally. The patient's abdominal, musculoskeletal, and neurological exams are within normal limits. The patient is concerned about her risk for breast cancer and asks what she can do to reduce her chance of getting this disease. Which of the following is the most appropriate recommendation for this patient?

Begin breastfeeding



Exercise and reduce alcohol intake



Recommend monthly self breast exams



Switch to oral contraceptive pills for contraception



Test for BRCA1 and 2



Select Answer to see Preferred Response

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This patient is requesting information on how to reduce her risk of breast cancer. Given her history, the most appropriate recommendation is to reduce alcohol intake and to begin an exercise program.

Patients concerned about breast cancer should have mammography beginning at age 50. Other preventive measures that reduce the incidence of breast cancer are smoking cessation, reducing/eliminating alcohol consumption, and exercising. Breastfeeding also reduces the risk of breast cancer. Patients with a family history of early-onset breast cancer may also require testing for genetic mutations such as BRCA 1 & 2. Self-performed breast exams have not been found to be efficacious as a screening method.

Rojas and Stuckey review the evidence regarding the risk factors for breast cancer. They discuss how less than 10% are attributable to genetic mutations. They recommend modifying risk factors such as exercise and alcohol consumption.

Incorrect Answers:
Answer 1: Beginning breastfeeding is not plausible in this patient. Though breastfeeding does reduce the risk of breast cancer, she is not currently pregnant, has an IUD, and is not lactating.

Answer 3: Recommending monthly self-breast exams is no longer recommended for patients. These exams were not sensitive or specific for the diagnosis of breast cancer.

Answer 4: Switching to oral contraceptive pills for contraception could actually increase the risk of breast cancer, particularly if the breast cancer is estrogen/progesterone receptor positive. This patient's progesterone IUD is an appropriate method of contraception.

Answer 5: Testing for BRCA-1 and 2 would not be indicated in a patient with no increased risk for breast cancer. The patient's mother died at the age of 90 from breast cancer, but having a relative diagnosed with breast cancer at that advanced age does not increase her risk for breast cancer.

Bullet Summary:
Smoking cessation, reduction of alcohol intake, exercise, and breastfeeding can reduce the risk of breast cancer.

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