Cancer screening

Question 1

Risk factors for breast Ca

Answer 1

BRCA1/2
Ashkenazi Jews (risk of BRCA)
Early menarche
Obesity
High breast density
Irradiation prior 30yo
Late age first live birth / menopause

Question 2

Ways to reduce breast Ca risk

Answer 2

Exercise
Dietary folate
Mediterranean diet
Normal BMI
Reduce ETOH

Question 3

Breast Ca screening - average risk

Answer 3

Mammogram 2 yearly 50-74yo
- 1x FDR dx >=50yo
- 1x SDR any age
- 2x SDR on same side dx >=50
- 2x FDR or SDR >=50yo but different sides

Question 4

Breast Ca screening - moderate risk

Answer 4

Annual mammogram from 40yo if has FDR <50yo
“At least” 2 yearly from 50-74
FDR dx <50
2x FDR same side
2x SDR same side, with one aged <50yo

Question 5

Breast Ca screening - high risk

Answer 5

Referral to family cancer clinic
Woman at high risk of ovarian Ca
2x FDR or SDR w/ breast or ovarian Ca same side PLUS one or more of ;
- additional relative with Breast/ovarian Ca
- Breast Ca dx <40yo
- Bilat breast Ca
- Breast PLUS Ovarian Ca in same woman
- Ashkenazi Jew
- Breast Ca in male
Fhx of high-risk breast Ca gene mutation

Question 6

High risk of melanoma

Answer 6

6-12 month examinations
Prev hx of melanoma
>5 dysplastic naevi

Question 7

High risk NMSC

Answer 7

prev NMSC
Immunosuppression
Past exposure to arsenic

Question 8

Increased risk melanoma

Answer 8

FDR
Fair complexion / freckles / high neavus count >100, light eye colour
Actinic damage
Phx NMSC
Childhood UV exposure and sunburn hx

Question 9

Bowel Ca risk reduction

Answer 9

Cease smoking
Limit Etoh <2std daily
Normal BMI
Diet; low fat, high fibre, limit processed meats
Low dose aspirin
Exercise

Question 10

Bowel Ca - Category 1 Average risk

Answer 10

50-74yo 2 yearly FOBT
If 1 FDR or FDR AND SDR >=55 - consider aspirin for at least 2.5years from 50 until 70yo

Question 11

Bowel Ca - Category 2 Moderate risk

Answer 11

FOBT 2 yearly 40-49 -> colonoscopy 5 yearly 50-74y
Aspirin from 50yo
FDR <55y
2x FDR
1x FDR and at least 2 SDR

Question 12

Bowel Ca - Category 3 High risk

Answer 12

Refer family Ca clinic
FOBT 2yearly 35-44 -> colonoscopy 5yrly 45-74
Aspirin
- >=3 FDR/SDR, with at least 1 dx <55
- Lynch syndrome
- FAP

Question 13

High risk ovarian Ca

Answer 13

BRCA1/2, Lynch
Fhx of high-risk ovarian Ca gene
FDR with Ovarian Ca <60yo

Question 14

Risk factors testicular Ca

Answer 14

Cryptorchidism
Orchidopexy
Testicular atrophy
Prev testicular Ca

Question 15

HPV screening indications

Answer 15

5 yearly from 25yo or 2 years post sexual debut - whichever is later
Early sexual debut <14yo or before HPV vax
Unexplained inter-menstrual bleeding
post-coital bleeding
unexplained PV discharge - espec if bloody or offensive