AFP Clinical Answers
Breast Cancer Screening, Plantar Warts, IUD Insertion, Osteoporosis, Anal Fissures
Am Fam Physician. 2021 Feb 15;103(4):207.
What is the most effective breast cancer screening strategy in women at average risk?
According to the American College of Physicians, the most significant breast cancer screening benefit for women at average risk is from biennial mammograms in women 50 to 74 years of age, which can decrease breast cancer–related deaths without affecting overall longevity. Annual mammography increases false-positive results by 45% with little to no difference in outcomes. Starting screening at age 40 has a small effect on breast cancer mortality at the cost of increasing false-positive results by more than 60%. There is no mortality benefit to screening women 75 years or older or with a life expectancy less than 10 years because screening benefits are not seen for 11 years.
Is cryosurgery more effective than salicylic acid in the treatment of plantar warts?
Cryosurgery is as effective as daily treatment with salicylic acid in the treatment of plantar warts, with higher reported patient satisfaction.
Do preprocedure medications affect the pain of IUD insertion?
A meta-analysis of randomized controlled trials found that topical lidocaine preparations including gels, creams, and sprays modestly decrease pain with tenaculum placement but not during intrauterine device (IUD) insertion. The use of a paracervical block with unbuffered lidocaine does not decrease pain with either step. However, a paracervical block using buffered lidocaine may decrease pain with uterine sounding and IUD placement, and overall pain. Tramadol and naproxen administered one hour before the procedure decrease pain with IUD placement.
How should osteoporosis be monitored in adults with cerebral palsy?
In patients 18 years or older with cerebral palsy, the Fracture Risk Assessment Tool or the QFracture tool can be used to determine whether the patient's risk of osteoporosis merits treatment.
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