Master the board step 3

Section 2
Preventive Medicine
Cancer Prevention
The single most important oncology question on Step 3 is about prevention.
While what you need to know in terms of volume is extremely small, it is very
highly tested.
Breast Cancer Screening
The cancer screening test that lowers mortality the most is the mammogram.
The mortality benefit is greatest in patients > 50 years old. The test should be
started in all women > 50.
Routine breast self-examination has no proven benefit.
Cervical Cancer Screening
Cervical cancer screening with Pap smear also lowers mortality. The Pap smear
should start at age 21. This is regardless of the onset of sexual activity, whichever
comes first. Pap smears should be done at least every 3 years until age 65,
when they can be stopped.
Mammography guidelines
are controversial at this
time. Benefit is greatest
above age 50.
HPV testing is right for
ASCUS. If ASCUS is HPVpositive,
do colposcopy.
Breast cancer
Summary of Cancer Screening Guidelines
Mammography at age 50, then every
1–2 years
Colon cancer Colonoscopy at age 50, then every 10
years
Cervical cancer Pap smear at age 21, then every 2–3
years; stop at age 65 unless no
previous screening
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