Ca- Screening Integrating Perspectives

Question 1

what does public health do

Answer 1

identify how society protects the health of the population.

Question 2

who is screening offered to

Answer 2

– offered to all people within an identified target population; based on age and/or sex.

Question 3

why is screening only offered to a target population

Answer 3

Purposeful application of tests to an asymptomatic population in order to classify people into those who are unlikely to have or develop a disease and those who are likely to have or develop a disease.

Question 4

how much does breast cancer screening cost

Answer 4

Breast Cancer £96million per year in UK 2012

Question 5

How much does cervical cancer screening cost

Answer 5

Cervical Cancer £157million per year in 2012

Question 6

What is the underlying principle

Answer 6

• screening must do more harm than good

Question 7

what are the negatives of all screening programmes

Answer 7

• false positives and negatives

Question 8

what is a false positive

Answer 8

a false positive is an error in data reporting in which a test result improperly indicates presence of a condition

Question 9

What is a false negative

Answer 9

a test result which wrongly indicates that a particular condition or attribute is absent.

Question 10

why should you have screening and why you shouldnt have screening

Answer 10

Positives

• saves lives
• lives are saved as cancers are diagnosed and treated earlier than they would have been without screening

Negatives

• screening finds breast cancers that would never have caused harm, this can cause unnecessary worry
• cant tell if the cacner will be deadly or not eventually - therefore they offer treatment to all women with breast cancer and this means that some women are offered treatment that they do not need

Question 11

how many lives does screening save in breast cancer

Answer 11

Screening saves about 1 life from breast cancer for every 200 women who are screened.

This adds up to about 1,300 lives saved from breast cancer each year in the UK.

Question 12

how many non life threatening breast cancer does screening find

Answer 12

About 3 in every 200 women screened every 3 years from the age of 50 up to their 71st birthday are diagnosed with a cancer that would never have been found without screening and would never have become life-threatening.

Question 13

How many women is breast cancer treatment offered to that do not need ti

Answer 13

This adds up to about 4,000 women each year in the UK who are offered treatment they did not need.
Overall, for every 1 woman who has her life saved from breast cancer, about 3 women are diagnosed with a cancer that would never have become life-threatening.

Question 14

in breast cancer

• what is the survival for 10 or more years
• age of survival
• improvement

Answer 14

• 78% survival breast cancer for 10 or more years
• 60-69 years = age that breast cancer survival is the highest
• breast cancer survival has doubled in the last 40 years

Question 15

what happens if you are registered with a GP as a male for breast screening

Answer 15

If you are registered with a GP as male, you will not be invited for breast screening. If you have not had chest reconstruction (top surgery) and are aged 50 or over we suggest you talk to your GP about screening. They can arrange a referral to a breast screening unit to have a mammogram. If you have had chest reconstruction (top surgery) and you still have breast tissue, you can talk to your GP who can arrange a referral to breast screening for you.

Question 16

what can cause the worse health outcomes

Answer 16

• deprivation
• age
• poverty
• gender
• ethnicity
• health literacy

Question 17

describe the population that experiences breast cancer the most (ferris et al)

Answer 17

• 1.5 fold increase in breast cancer in ashkenazim compared with the non jewish white population when adjusted to age
• nto observed in the sephardic population
• the proportion of premenopausal breast cancer and this was over double that of the general population

Question 18

describe what morris et al did (ethnicity, deprivation and breast cancer survival)

Answer 18

• it was a retrospective cohort study 20 283 women aged 50–70 years, diagnosed between 1989–2011 and invited for screening, were linked with screening and ethnicity data.

We examined Asian, Black and White groups, less deprived and middle/more deprived women. Net survival was estimated using ethnic- and deprivation-specific life tables. Estimates were corrected for leadtime bias and over-diagnosis.

Results: Net survival varied by screening history. Screening benefitted all ethnic and both deprivation groups. Whether screen-detected or not, more deprived women had significantly poorer outcomes: 5-year net survival was 78.0% (76.7–79.2%) for deprived women who were not screen-detected compared with 94.0% (93.1–95.1%) for less deprived women who were screen-detected.

Conclusions: The three ethnic groups differed little in their breast cancer survival. Although screening confers a survival benefit to all, there are still wide disparities in survival by deprivation.

Question 19

what was the difference in prognosis by ethnicity (chlebowski et al)

Answer 19

Differences in breast cancer incidence rates between most racial/ethnic groups were largely explained by risk factor distribution except in African Americans.

However, breast cancers in African American women more commonly had characteristics of poor prognosis, which may contribute to their increased mortality after diagnosis

Our data show important inequality in breast cancer screening uptake, not attenuated by potential confounding factors.

Ethnic inequalities in breast screening attendance are of concern especially given evidence that the traditionally lower breast cancer rates in South Asian groups are converging towards the risks in the White UK population.

Notwithstanding the forthcoming review of breast cancer screening, these data call for urgent action. Why may different ethnic groups respond differently to invitation to be screened for Breast CA?

Question 20

what have ethnicity studies shown

Answer 20

Ethnicity Studies of UK and Australian residents have shown that the incidence rate of breast cancer for immigrants lies between the rate from their country of birth and their country of residence

Question 21

Who has the lowest incident of breast cancer

Answer 21

For every age group South Asian women and men have a lower incidence than the rest of the UK population.