SCREENINGs FOR USMLE STEP 2 CK

Contents
CANCERs ................................................................................................................................................. 2
A. Lung cancer screening ................................................................................................................. 2
B. Cervical cancer screening ............................................................................................................ 3
C. Breast Cancer ............................................................................................................................ 11
CANCERs

A. Lung cancer screening

Screening should be discontinued once a person has not smoked for 15 years or
develops a health problem that substantially limits life expectancy or the ability or
willingness to have curative lung surgery.
B. Colon cancer

Up to 75 years of age
Primary Sclerosing Cholangitis:

▪ Candidate: diagnosed patient of primary sclerosing cholangitis

▪ Method and frequency: Colonoscopy at age of diagnosis and every 1-2 years
Lynch Syndrome (Candidates for screening) — Screening for Lynch-associated cancers should be
performed in the following individuals:

▪ Candidate: diagnosed patient of Lynch Syndrome

▪ Method and frequency: We suggest that individuals with Lynch syndrome undergo CRC
screening with colonoscopy every 1-2 years beginning at age 20 to 25 years OR 2 to 5 years
prior to the earliest age of CRC diagnosis in the family (whichever comes first).
▪ For Endometrial Cancer:
o For endometrial cancer screening, we perform yearly endometrial sampling starting
at age 30 to 35 or 5 to 10 years prior to the earliest age of Lynch-associated cancer in
the family.
o For ovarian cancer screening, we perform an annual pelvic examination and
transvaginal ultrasound (TVUS) examination, with or without cancer antigen 125 (CA
125), every 6 to 12 months starting at age 30 to 35 or 5 to 10 years prior to the
earliest age of Lynch-associated cancer of any kind in the family.
o However, not screening is also reasonable given that no screening strategy (CA 125,
TVUS, or multimodal testing) has been shown to reduce mortality, and all
surveillance strategies are associated with a high rate of false-positive tests and a risk
of harm from invasive testing.
o For patients with Lynch syndrome who have completed childbearing, we continue
to suggest risk-reducing total hysterectomy with bilateral salpingo-oophorectomy
(TH-BSO) rather than surveillance and/or chemoprevention
Familial Adenomatous Polyposis:

▪ Candidate: Screening for tumors associated with familial adenomatous polyposis (FAP)
should be performed in individuals with a pathogenic Adenomatous Polyposis Coli mutation.

▪ Method and frequency: In individuals at risk for classic FAP, we begin CRC screening around
age 10 to 15 years with colonoscopy. The number, size, and distribution of polyps should be
noted during the colonoscopy to define the extent of the polyposis and the plan for
colectomy. Several polyps should also be sampled to confirm histology. Patients should
continue to undergo annual CRC surveillance with colonoscopy while awaiting colectomy.

▪ Colectomy — Colectomy is recommended for patients with classic FAP, since the risk for
developing CRC is considered to be 100 percent, and the high polyp number makes
endoscopic control unrealistic. In patients with AFAP in whom endoscopic control is feasible,
surveillance can obviate or delay the need for colectomy.
C. Surveillance after colon cancer resection

FOR ALL COLONOSCOPY* IN 1 YEAR AND THEN EVERY 3-5 YEARS

Stage II and III ADD

•Periodic CEA testing
•Annual CT scan of chest, abdomen ± pelvis

Stage IV ADD
More frequent CT scans
*Colonoscopy is the most accurate diagnostic test for surveillance
Specifier Next colonoscopy in

≤20 Small (<1cm) hyperplastic polyp anywhere 10 years

Hyperplastic polyp >1cm 3-5 years

Sessile serrated polyp 3-5 years

1 or 2 small (<1cm) tubular adenomas 7-10 years

•3-10 adenomas 3 years

•Any adenoma >1cm
•Adenoma with high grade dysplasia or villous features

More than 10 adenomas 1 year

Consider familial syndromes

Large (>2cm) sessile polyp removed by piecemeal excision 6 months

Polyp with adenocarcinoma (must have minimal invasion and ≥2mm margin) 2-3 months
D. Breast cancer screening

▪ Average risk individuals

▪ Average risk individuals

▪ Age 25-29: Annual Breast MRI
▪ Age more than 30: Annual MRI with mammogram
E. Cervical cancer screening

F. Breast Cancer