278: Cancer Screening

Question 1

Answer 1

D - Routine screening is not recommended

Question 2

Answer 2

C

• People 55 - 80 with 20 pack year smoking hx who currently smoke or quit <15 years ago*
• Screen with low dose CT*

Question 3

Who should be screened for colon cancer?

Answer 3

• Age 45*-75
  
  • *Previously 50
• Earlier if family hx is suggestive

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 recommeded against!

Question 6

Who should be screened for cervical cancer?

Answer 6

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

Question 7

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

Answer 7

A or B

C means individualized

D don’t do it

Question 8

What kind of bias:

People live longer after diagnosis, but it’s because they were diagnosed early in the course of the diseae (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

• Start at age 50
  
  • Individualize decision for 40-49
• Stop at age 74

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:

• 55 - 80 years old
• 20+ pack year smoking hx who currently smoke or quit <15 years ago

Question 15

What are the recommended age ranges for breast, cervical, colon and lung cancer screening?

Answer 15

• Breast: 50-74 (individualized for women age 40-49
• Cervical: 21-65
• Colon: 45-75
• Lung: 55-80