278 - Cancer Screening

Question 1

Answer 1

D - Routine screening is not recommended

For men 55-69 yo, prostate screening is an individual decision (Grade C for prostate test every 2 years)

Question 2

Answer 2

C

People 50 - 80 with 20+ pack year smoking hx who currently smoke or quit <15 years ago (Grade B for a low dose CT screening test)

Question 3

Who should be screened for colon cancer?

Answer 3

• Age 45-49 –> any screening strategy (Grade B)
  
  • earlier if family history is suggestive
• Age 50-75 –> any screening strategy (Grade A)
• Age 75-84 –> individual decision (Grade C)
• Age 85+ –> not recommended (Grade D)
• No one screening method is recommended over another
  
  • FOBT or FIT yearly
  • FIT-DNA every 3 years
  • Colonoscopy every 10 years
  • CT colonography or flexible sigmoidoscopy every 5 years

Question 4

Answer 4

C

Question 5

Is it recommended to teach patients how to do breast self-exams?

Answer 5

No

In fact, it is recommended against! (Grade D)

Question 6

Who should be screened for cervical cancer?

Answer 6

People 21-65 (Grade A)

• Age 21-29 –> PAP every 3 years
• Age 30-65: (1 of the following)
  
  • PAP every 3 years
  • hrHPV alone every 5 years
  • CO-testing (PAP + hrPHV) every 5 years
• Stopping at age 65 relies on normal PAP for the last 10 years

New guidelines are suggesting starting screening at 25 instead of 21

Question 7

Which USPSTF grades recommend that we should “offer or provide this service”?

Answer 7

A or B

Question 8

What kind of bias:

“People live longer after diagnosis, but it’s because they were diagnosed early in the course of the disease (not because the treatment works)”

Answer 8

Lead-time bias

Question 9

What are the current guidelines for breast cancer screening?

Answer 9

Mammogram every 2 years from 50-74 (Grade B)

• Individualize decision for 40-49 (Grade C)

Question 10

What is the best way to avoid lead time and lenth time bias in cancer screening trials?

Answer 10

Use cancer-specific mortality rates

Instead of survival rates, rates of dx

Question 11

Answer 11

A

Can use any of the following:

• FOBT or FIT yearly
• FIT-DNA every 3 years
• Colonoscopy every 10 years
• CT colonography or flexible sigmoidoscopy every 5 years

Question 12

What kind of bias:

People with aggressive disease present with symptoms and die quickly, while people with indolent disease are detected on screening - this makes it look like screening is effective, when in reality it’s just detecting cancers with better prognosis

Answer 12

Length time bias

Question 13

Answer 13

D

Screen people 21-65

• 21-29
  
  • PAP every 3 years
• 30-65 (1 of the following)
  
  • PAP every 3 years
  • CO-testing every 5 years
  • hrHPV alone every 5 years
• Stopping at age 65 relies on normal PAP for the last 10 years

New guidelines are suggesting starting screening at age 25 instead of 21`

Question 14

Who should be screened for lung cancer?

Answer 14

People with all of the following:

• 50 - 80 years old
• 20+ pack year smoking hx who currently smoke or quit <15 years ago