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causes and consequences > cancer screening > Flashcards

cancer screening Flashcards

1
Q

what is screening

A

tests done among people who are apparently well to identify those at an increased risk of a disease or a disorder

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2
Q

is screening diagnostic

A

no

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3
Q

WHO’s 10 screening principles

A
  1. Condition should be an important health risk
  2. natural history should be understood
  3. recognisable early stage
  4. must be beneficial to treat it early
  5. needs to be a suitable test
  6. acceptable test
  7. need adequate facilities for diagnosis and treatment
  8. repeat screening at interval for disease of insidious onset
  9. physical and psych harm should be less than the benefit of detection
  10. balance costs against benefits
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4
Q

how do you calculate % of patients with the disease that test postiive

A

sensitivity = Test Pos / (Test Pos + False Negative)

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5
Q

how do you calculate the % of patients without the disease that test negative

A

specificity = Test neg / (Test neg + false pos)

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6
Q

how do you calculate the % of patients with positive tests that actually have the disease?

A

positive predictive value of a positive test result (PPV) = Test Pos / (Test pos + False pos)

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7
Q

how do you calculate percentage of patients with negative test who do not have disease

A

Negative predictive value of a negative test result (NPV) = Test N / (Test N + False N)

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8
Q

how to calculate prevalence

A

disease present / total population

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9
Q

8 features for the ideal screening test

A
  1. simple
  2. cheap
  3. easily repeatable
  4. easy and unambiguous to interpret
  5. no false pos
  6. no false neg
  7. acceptable
  8. benefits outweigh the harms
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10
Q

5 additional factors for successful screening programmes

A
  1. training
  2. education
  3. mass awareness
  4. quality assurance
  5. finances
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11
Q

downside to screening (6)

A
  1. person is labelled as increased risk of cancer
  2. psychological impact
  3. impact of turnaround times
  4. successes depends on uptake
  5. impact of social media
  6. financial considerations for people attending screening
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12
Q

what is the only technique which has been shown to reduce breast cancer mortality in the population?

A

mammographic screening

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13
Q

facts: NHS breast screening programme (3)

A
  1. for women 50 and over
  2. includes a fully funded training programme
  3. mammograms are double read
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14
Q

what does an abnormal mammogram pick up?

A

lumps, calcification including micro calcification

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15
Q

stats for two-view mammography

A

42% more small invasive cancers detected, 3% more in situ cancers detected

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16
Q

what happens after an abnormal mammography

A

biopsy for a diagnosis, MDT (multi-disciplinary team) discussion for correlations

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17
Q

Facts: Cervical screening programme (4)

A
  1. method of treating early abnormalities which could lead to invasive cancer
  2. 1st stage is HPV primary screening and liquid based cytology
  3. sample of cells is taken from the cervix for analysis
  4. early detection and treatment can prevent 75% of cancers developing
18
Q

when do you start cervical screening

A

25yrs - every 3 years until 49 and then every 5 years until 64

19
Q

as of Jan 2020 what is now the 1st test on a cervical screening sample

A

high risk HPV testing, then its cytology triage

20
Q

Primary HPV screening

A

uses HR-HPV (high risk HPV) testing as the 1st test, cytology becomes the triage test - only used when HR-HPV is found. 1 report issued with all the results

21
Q

what is dyskaryosis

A

the changes in a cervical cell

22
Q

out of the women screened annually what % have moderate or severe dyskaryosis?

A

0.7%

23
Q

what do the majority (70-90%) of bowel cancers develop from

A

benign adenomatous polyps lining the bowel wall

23
Q

what happens after an abnormal HPV triage

A

LBC, if that is also abnormal then a biopsy for diagnosis

24
Q

what is the sequence in which a benign polyp develops into bowel cancer

A

the adenoma-adenocarcinoma sequence - it takes 10 years

25
Q

aims of bowel cancer screening (3)

A
  1. detect bowel cancer at an early stage when treatments is more effective
  2. look for occult blood in stool
  3. detect polyps
26
Q

when is bowel cancer screening offered

A

every 2 years to people aged 60-74, there’s also a one off test called bowel scope screening which is at 55

27
Q

what is the FIT test

A

Faecal Immunochemical test

28
Q

what does the FIT test do

A

uses antibodies that recognise human haemoglobin

29
Q

Advantages of FIT test

A
  1. detects only human blood
  2. associated with higher programme uptake
  3. objective numerical result
  4. 1 sample required
  5. more sensitive than gFOB
30
Q

gFOB as a test for bowel cancer compared to FIT

A

recognises haem component of any haemoglobin: tests for pseudo-peroxidase activity

31
Q

what is the gFOB test

A

guaiac test which the participant smears small samples of stool from 3 different bowel movements onto the FOB test card

32
Q

why are 3 bowel movements needed for the gFOB test

A

bowel cancer bleeds intermittently

33
Q

Bowel scope screening

A

thin, flexible tube with a camera is used to look inside bowel (flexible sigmoidoscopy)

34
Q

what happens after an abnormal FIT test

A

colonoscopy and biopsy interpretation, double contrast barium enema

35
Q

PSA test for prostate cancer

A
  1. organ specific
  2. product of prostatic epithelium
  3. minute amounts found in serum
  4. normal range 0-4ng/ml
36
Q

what does PSA stand for

A

prostate specific antigen

37
Q

how useful is raised PSA

A

for cancer: 80% of those w cancer have raised PSA, shows tumours of large vol and that are well differentiated

for benign prostatic hyperplasia: 25-30% of men with BPH have raised PSA

38
Q

how useful is low PSA

A

20-40% of patients with organ-confined prostate cancer have a low PSA

39
Q
A

causes and consequences (15 decks)

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