Cancer/adolescent screen, prevention Flashcards
Ideal screening program. disease characteristics? 4
common
serious
LONG ASYMPTOMATIC PHASE
CORRECTABLE if identified early
Ideal screening program. patient characteristics? 2
HIGH PREVALENCE in screened population
Appropriate age range and gender
Ideal screening program. test characteristics? 3
LOW COST relative to disease severity
High sensitivity and specificity
ACCEPTABLE to broad range of patients
Ideal screening program. program characteristics? 4
Identifies population to be screened
Avoids ,,overdiagnosis” (detects benign/indolent disease)
Avoids ,,lead-time” bias (detects disease early but does not alter ultimate prognosis)
IMPROVES OUTCOMES of screened vs nonscreened population
Primary prevention prevents what?
prevent the onset of disease
Primary prevention aim?
Aim is to reduce exposure
Primary prevention examples to reduce exposure?
For example:
* Weight loss, smoking, alcohol, eating better.
* Vaccination.
Secondary prevention ,,prevents” what?
early detection to delay progression
Secondary prevention screening tests what are?
Screening tests with high sensitivity.
Secondary prevention: positive screening tests?
If positive –> intervene with lifestyle and medications.
Tertiary prevention prevents what?
preventing complications.
Tertiary prevention. ka darom sitoj prevencijoj?
Treatment of disease; lifestyle modifications and drugs.
More responsive than preventive.
Cancer screening. Colon: Age to start? 2
a) 50
b) 10 year before diagnosis of a parent
Cancer screening. Colon. How to do? 3
FKS every 10 year
OR
Flexible sigmoidoscopy every 5 year + FOBT every 3 years
OR
FOBT every year
Cancer screening. Colon. at what age to stop?
75
Cancer screening. Breast. age to start?
50
Cancer screening. Breast. how to screen?
mammography every 2 years
Cancer screening. Breast. age to stop?
75 years of age
Cancer screening. cervical. age to start?
21
Cancer screening. cervical. how to screen? 2
PAP every 3 years
OR
PAP every 5 + HPV testing every 5 years
Cancer screening. cervical. age to stop? 2
65 years of age + 3 consecutive normal PAP
Total abdominal hysterectomy
Cancer screening. lung. age to start?
55-80 yo + >= 30 pack years + quit smoking < 15 year
Cancer screening. lung. how to screen?
low dose CT every year
Cancer screening. lung. when to stop? 2
80 yo
quit smoking > 15 years
Cancers which you do not screen for? 3
- PROSTATE CANCER
- OVARIAN CANCER
- ENDOMETRIAL CANCER
Cancers which you do not screen. why not prostate?
Because of lead time bias, screening for it is useless
Cancers which you do not screen. in what exception ovarian?
a. Normally we do not screen for it
b. However, screening should be done if the patient is BRCA positive
US preventive service task force rec. for breast cancers screening.
Definitely beneficial: recommended?
mammogram every 2 years for women 50-74
US preventive service task force rec. for breast cancers screening.
Possibly beneficial: individualize?
mammogram in women 40-49
US preventive service task force rec. for breast cancers screening.
Uncertain benefit?
mammogram in women >= 75 y/o.
Screen medical condition. abdominal aneurysm. WHO?
Male + >=65y + ever smoked in their lifetime
Screen medical condition. abdominal aneurysm. how?
1-time abdomen UG
CT scan of abdomen done for some other condition
Screen medical condition. osteoporosis. who?
Female + >=65
Screen medical condition. osteoporosis. how?
DEXA scan (start bisphosphonates if positive)
Screen medical condition. HCV. who?
baby boomers (1945-1965)
Screen medical condition. HCV. how?
HC antibodies
Screen medical condition. HIV. who?
everyone once OR anyone who ask for it
Screen medical condition. HIV. how?
elisa
Screen medical condition. HTN. who?
everyone at every visit
Screen medical condition. HTN. how?
ambulatory monitoring
Screen medical condition. DM. who?
hypertensive patients
Screen medical condition. DM. how?
HbA1c
Screen medical condition. hyperlipidemic disease. who? 3
Male >= 35
female >=45
Anyone >=20 with risk factors for CAD
Screen medical condition. hyperlipidemic disease. how?
lipid panel
Screen medical condition. depression. who?
geriatric
Screen medical condition. depression. how?
PHQ-9
Screen medical condition. mobility. who?
geriatric
Screen medical condition. mobility. how?
Get up and go
Routine adolescent screening. how often?
annually, unless otherwise indicated
Routine adolescent screening. mental health. method?
Validated depression questionnaire
Routine adolescent screening. sexual health. 3 methods?
Confidential discussion about sexual activity
Gonorrhea and chlamydia testing if sexually active
HIV testing (once at age <18)
Routine adolescent screening. substance use? 1
confidential discussion about exposure use, abuse
Routine adolescent screening. dyslipidemia? 1
lipid panel once between age 17 and 21
Routine adolescent screening. safety 2
Inquiry about bullying
Inquiry about seabelt and helmet use
Routine adolescent screening. MCC of death?
suicide –> screen for depression
Routine adolescent screening. how depression can present?
o Depression can present as irritability, failure to gain an expected
amount of weight, and academic decline. Also, abdominal pain
and headache.
Routine adolescent screening. screen depression, age?
All teenagers above the age of 12 should be screened.