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Chlamydia and gonorrhoea screening — MCCQE Part 1 MCQ

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EasyPreventive MedicineChlamydia and gonorrhoea screeningMCCQE Part 1

A 59-year-old asymptomatic smoker with type 2 diabetes asks for yearly CA 19-9 and endoscopic ultrasonography to screen for pancreatic cancer. He has no pancreatitis, hereditary cancer syndrome or family history of pancreatic cancer. What is the most appropriate recommendation?

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Correct answer: E — Do not screen; address modifiable risks and investigate promptly if concerning symptoms develop

This patient is asymptomatic and lacks a hereditary syndrome or strong familial pancreatic-cancer risk. Smoking and diabetes increase risk, but they do not create a validated population-screening pathway. The USPSTF recommends against screening average-risk asymptomatic adults because CA 19-9 is not an accurate early-detection biomarker and imaging or endoscopic strategies have not shown net benefit; false positives can lead to invasive tests or major pancreatic surgery. Counsel smoking cessation and optimize diabetes and cardiovascular prevention. New obstructive jaundice, persistent unexplained upper abdominal or back pain, unexplained weight loss or another concerning change requires diagnostic assessment rather than screening. High-risk hereditary or familial programmes are a separate population and require specialist criteria.

Reference: USPSTF Pancreatic Cancer Screening: https://www.uspreventiveservicestaskforce.org/uspstf/document/ClinicalSummaryFinal/pancreatic-cancer-screening