Awareness of screening programmes and primary care initiatives Flashcards
What is population screening
the process of identifying people who appear healthy but may be at increased risk of a disease or condition so that ‘early treatment can be offered or information given to help them make informed decisions’
Healthcare screening (2)
- Illness
- Been on the receiving end of screening
What are the international differences in screening (2)
- Cultural and political differences, in other countries-not always evidence-based
- Variation in how health services are delivered and funded
What are the people we are testing (3)
- Healthy
- Well
- Symptom-free
What is the purpose of screening (2)
- Reducing risk
- Improving outcomes
What are the benefits of screening (5)
- Screening can detect a problem early before you have any symptoms
- Finding out about a problem early can mean that treatment is more effective
- Finding out you have a health problem or are at increased risk of a health problem can help people make better-informed decisions about their health
- Screening can reduce the risk of developing a condition or its complications
- Screening can save lives
How is screening a programme (2)
- Not just a test e.g. mammogram (breast x-ray)
- A sequence of events – e.g. a well woman aged 65 having a routine mammogram
What are the stages of a generic screening pathway (7)
- Identify the people to invite
- Discuss and offer screening
- Carry out Test
- Provide and discuss results/options
- Carry out diagnostic/confirmatory test if required
- Provide and discuss results/options
- Offer Advice/treatment
What is the screening process (4)
- People invited undergo screening test
- ‘low risk’ people walk away
- ‘high risk’ people undergo further tests
- Following further tests ‘high-risk’ people receive advice and support, treatment or no further action
What are screening disadvantages (4)
- Not 100% accurate
- False negative/positives
- Not diagnostic (tells high or low risk)
- Lead to difficult decisions
What is the female Lifetime Screening Pathway (4)
- 12 years old - screening for diabetic retinopathy (in patients with diabetes) - once every 2 years
- 25 years old - cervical screening, testing for HPV (SMEAR test) - 24.5 to 49 years old receive every 3 years, 50 to 64 years old receive every 5 years
- 50-53 years old - breast screening (mammogram) - every 3 years till 71st birthday
- 60 years old - bowel cancer screening (FIT kit testing bowels for blood) - every 2 years until 75th birthday
What is the prevalence of a screening test
the proportion of people with the target condition at a point in time
What is the sensitivity of a screening test
the screen’s ability to find people who have the target condition
What is the specificity of a screening test
the screen’s ability to exclude people who do not have the target condition
What is a true positive result of a screening test
someone with a positive screening result who does have the target condition
What is a false positive result of a screening test
someone with a positive screening result who does not have the target condition
What is a true negative result of a screening test
someone with a negative screening result who does not have the target condition
What is a false negative result of a screening test
someone with a negative screening result who does have the target condition
What are screening limitations (5)
- Screening does not guarantee protection
- Low risk result does not prevent the person from developing the condition at a later date
- False positive and false negative results
- False positive: wrongly reported as having the condition
- False negative: wrongly reported as not having the condition
What is the UK National Screening Committee (UK NSC) (2)
- Independent expert group
- Advises the NHS in all four countries on which screening programmes to offer
What is Abdominal aortic aneurysm screening (3)
- Offered to men in their 65th year to detect abdominal aortic aneurysms
- a dangerous swelling in the aorta
- Men over 65 can self-refer.
How is screening in pregnancy done (3)
- Screening for infectious diseases (hepatitis B, HIV and syphilis)
- NHS Fetal Anomaly Screening Programme (screening for Down’s syndrome, patau’s syndrome and Edwards’ syndrome & 9 serious physical conditions like anencephaly)
- Screening for sickle cell disease and thalassaemia
What is screening for newborn babies (3)
- a physical examination, which includes the eyes, heart, hips and testes
- a hearing test
- a blood spot test to check if the baby has any of 9 rare conditions
What is the diabetic eye screening (2)
- From the age of 12
- all people with diabetes are offered an annual diabetic eye test to check for early signs of diabetic retinopathy
What is cervical screening
Checking the health of cells in the cervix
What is bowel cancer screening
Two types
What is the population screening timeline (6)
- newborn - newborn screening
- 12 - diabetic eye screening
- 25 - cervical screening
- 50 - breast screening
- 60 - bowel cancer screening
- 65 - Abdominal aortic aneurysm (AAA) screening
What are the disease criteria for screening programmes (2)
- Prevalent
- Results in death or serious illness
What are the screening test criteria for screening programmes (4)
- Readily available
- Cost-effective
- Safe
- Acceptable
What are the risk marker criteria for screening programmes
Reliable indicator
What are the treatment criteria for screening programmes (3)
- Well-established
- Effective
- Available
What are the evaluation criteria for screening programmes
Ongoing
What are the harms of screening (5)
- Further investigations can cause harm (e.g. 1 in 1700 chance of perforated bowel with colonoscopy)
- Overdiagnosis (i.e. treatment for abnormal results but disease may have never caused symptoms or shortened life expectancy)
- Psychological harm if positive screening result
- Negative results lead to false reassurance
- Screening tests carry a small risk of harm (e.g. X rays)
What happened to the Japanese screening programme for childhood cancer neuroblastoma (4)
- screening did not reduce the number of children dying from the disease
- it identified children with tumours which would have never produced symptoms or which would have gone away on their own
- Children were undergoing unnecessary operations and chemotherapy, with all the suffering and risks attached
- The screening programme was stopped
How does the Bowel Cancer screening program achieve the screening programme criteria for the disease (4)
- 43,000 diagnosed each year
- 8/10 are over 60 years old
- 4th most common cancer
- 2nd biggest cancer killer
How does the Bowel Cancer screening program achieve the screening programme criteria for the screening test (4)
- Readily available
- Sensitive to small amounts of blood in a single faecal sample
- Non-invasive
- Acceptable, own home
How does the Bowel Cancer screening program achieve the screening programme criteria for the risk marker (3)
- Not 100%
- Does not diagnose bowel cancer
- Identifies patients for tests
How does the Bowel Cancer screening program achieve the screening programme criteria for the treatment (7)
- Early treatments
- More effective
- Over 90% chance of survival
- Surgery
- Chemotherapy
- radiotherapy
- Prolong life
How does the Bowel Cancer screening program achieve the screening programme criteria for evaluation
Reduces risk by 16%
