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Preventative health > Cancer screening > Flashcards

Cancer screening Flashcards

1
Q

What is relative risk?

A

Ratio of event occurring in the exposed group compared to the non-exposed group.

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2
Q

What are the accepted risks for developing prostate cancer?

A

Increasing age
Family history of prostate ca

….that’s it!

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3
Q

Who should be offered PSA testing for asymptomatic screening?

A

In short, nobody!

It can be performed, on males 50-69 (earlier if family history) if requested and risks / benefits discussed

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4
Q

Should PSA testing be performed on males under 40?

A

No

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5
Q

Should PSA testing be performed on males over 70?

A

No

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6
Q

Should DRE be performed as part of screening?

A

No

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7
Q

Should you test PSA with life expectancy < 7 years?

A

No

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8
Q

Even if requested, in which situations is PSA testing for asymptomatic prostate cancer not indicated?

A

< 7 years life expectancy
age < 50 with no family history
age < 40 and family history
age > 70

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9
Q

Why is PSA testing not recommended?

What is involved in the pre-test counselling discussion?

A

Minimal to no benefits from testing

  • Despite large trials - prostate cancer screening does not save lives (no significant decrease in mortality)

Multiple harms from testing

  • False positive (positive PSA, negative biopsy) = 19%
  • Over diagnosis - pick up cancer that would have never caused an issue in 2% of patients
  • Complications of biopsy e.g. sepsis
  • Complications related to the diagnosis: feelings of ‘vitality’ are lost in about 10% of men, suicide and cardiovascular disease (CVD) increase enormously (eight and 11 times more respectively) in the week after men are given their diagnosis of prostate cancer
  • Complications related to prostatectomy: erectile dysfunction (most common), urinary incontinence.
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10
Q

What is the biopsy threshold for PSA (i.e a high PSA reading)?

A

PSA > 3ng/mL

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11
Q

If PSA = 3.5 in an asymptomatic patient on first sampling, what do you do?

A

Repeat 1-3 months.
Measure free to total PSA at same time.

If PSA > 5.5 - biopsy
If PSA 3-5.5 + F/T < 25% - biopsy

By inference: lower % of free PSA = increased risk prostate ca

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12
Q

What is the positive predictive value that an asymptomatic patient, with a a single PSA reading of 3ng/mL has prostate cancer confirmed on biopsy?

A

25%

This means that 3 in 4 will have negative biopsies

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13
Q

In patient who ask about PSA testing, and have made a decision that they would like testing, who should be tested?

A

50-69 with no family history
- test every 2 years

45-69 with RR 2-3
- test every 2 years

40- 69 with RR 9-10
- test every 2 years

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14
Q

Who is at high risk of developing prostate cancer?

A

Men with first degree relative with BRCA1 or 2 breast cancer

Men with one or more first-degree relative diagnosed with prostate Ca < 65 years of age

  • One first degree relative RR 2-3
  • Two first degree relatives RR 3-6 (higher end if 2 brothers)
  • Three first degree relatives RR 9-10
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15
Q

When should you perform FOBT screening?

A

Every 2 years, on asymptomatic patients, starting aged 50 until age 75

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16
Q

Why is FOBT performed?

A

Non-invasive
Leads to early detection of cancer
Reduces CRC mortality by 16%

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17
Q

Who is at moderately increased risk of CRC , and how should this population be screened?

A

First degree relative w/ CRC < 50

2 first degree relatives (or one first and one second degree relative on the same side) w/ CRC diagnosed at any age

Screen: colonoscopy every 5 years; from age 50, or 10 years younger than age of first diagnosis of CRC in the family - whichever comes first.

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18
Q

Who is at high risk of developing CRC (RR 4-20%)?

A

Three first-degree or second‑degree relatives with CRC (at least one diagnosed aged <55 years)

Three or more first-degree relatives with CRC diagnosed at any age.

Suspected HNPCC (aka Lynch Syndrome): 3 or more 1st degree or 2nd degree relatives on the same side with CRC OR 2 or more 1st, or 2nd degree relatives on the same side with CRC with any of the following high-risk features ( multiple CRC in one person
CRC < 50 years) OR a family member with Lynch syndrome

First or second degree relative with CRC due to familial adenomatous polyposis (FAP)

Somebody in the family with APC gene mutation, or another miss-match repair gene mutation.

19
Q

How should people at risk for FAP be managed?

A

Referral to specialist (gastro +/- genetics)

For FAP with no APC mutation identified - colonoscopy/flexisig every 12 months starting age 12-15

20
Q

How should people at risk for Lynch Syndrome (HNPCC) be managed?

A

Referral - gastro +/- genetics

Colonoscopy: 1-2 yearly, starting age 25, or five years earlier than youngest affected family member; which ever is sooner.

Daily aspirin - 100mg

21
Q

What is the screening interval and tool for a patient with one or two small (< 10mm) tubular ademonas?

A

Repeat colonoscopy in 5 years

If repeat colonoscopy is normal

  • either repeat again in a further 5 years
  • return to 2 yearly FOBT
22
Q

What is the screening interval and tool for a patient with high risk adenomas (3 or more adenomas, size > 10mm, villous or tubulovillous histology, or high-grade dysplasia)?

A

Colonoscopy every 3 years

23
Q

What is the screening interval and tool for a patient with a very large or sessile polyp removed endoscopically?

A

Colonoscopy at 3-6 months, and again at 12 months, to ensure complete removal

24
Q

What is the screening interval and tool for a patient with multiple adenomas?

A

5 or more - colonoscopy in 12 months

10 or more - colonoscopy in < 12 months

25
Q

What is the screening interval and tool for a patient with a non-cancerous polyp > 75 years old

A

No surveillance - will take 10-20 years for cancer to develop

26
Q

What are major risk factors for breast cancer?

A

Increasing age
Personal history of atypical hyperplasia or lobular carcinoma in situ
Strong family history of the breast cancer
Family history of BRCA mutation
Previous radiotherapy

27
Q

Are there any preventative interventions available for breast cancer?

A

Yes

For the general population - physical activity, adequate folate, Mediterranean diet, a normal BMI and low EtOH consumption have been associated with a reduced risk of breast cancer

For those at higher risk - interventions like risk-reducing medications and surgery are available.

28
Q

The average population, without high risk breast cancer features are

  • patients with no family history of breast cancer
  • patients with a positive family history but, in general relatives diagnosed > 50 (with some exceptions)

These women represent >95% on the population, but still have a 1:8 - 1:11 life-time risk of developing breast cancer. What is the recommended screening?

A

Breast awareness education

2 yearly mammogram from age 50-74.

29
Q

Women who have a moderately increased risk of breast cancer include:

  • first degree relative diagnosed < 50
  • 2 first degree relatives on the same side diagnosed with breast cancer at any age
  • 2 second degree relatives on the same side diagnosed with breast cancer (with at least one < 50)

These women represent ~ 4% on the population, and as a group the lifetime risk of breast cancer is between 1:8 and 1:4.

What screening is recommended?

A

Breast awareness education

2 yearly mammogram from age 50-74

Consider annual mammograms from age 40 if first degree relative diagnosed < 50 years of age.

Consider referral to family cancer clinic for further
assessment and management plan

30
Q

Women at potentially high risk of developing breast cancer are those with established mutations, or with a strong family history.

These women represent < 1% of the population, and their lifetime risk of breast cancer is 1:2 - 1:4!

Who makes up this group?

A

Two first-degree or second-degree relatives on one side of the family with breast or ovarian cancer AND one or more of the following features on the same side of the family:

  • additional relative(s) with breast or ovarian cancer
  • breast cancer diagnosed before age 40
  • bilateral breast cancer
  • breast and ovarian cancer in the same woman
  • Ashkenazi Jewish ancestry
  • breast cancer in a male relative

One first-degree or second-degree relative diagnosed with breast cancer aged <45 plus another first-degree
or second-degree relative on the same side of the family with sarcoma aged <45 years

Member of a family in which the presence of a high-risk breast cancer gene mutation has been established

Patients with high risk of ovarian cancer - based on the FRABOC risk calculator.

31
Q

How should those with high risk of developing breast cancer be managed?

A

Refer to breast cancer / genetic specialist.

Chemoprevention with SERMS (tamoxifen) or aromatase inhibitors (exemestane, anastrazole) reduces risk of cancer in women with mod-high risk of breast Ca.

Surgical prevention with prophylactic mastectomy +/- salpingo-oophorectomy.

Surveillance with annual breast imaging (mammography, MRI or ultrasound).

Obviously these decisions require careful assessment of risk and benefits for individual women, and should be tailored to the individual.

32
Q

How often should skin checks be performed for opportunistic screening?

A

On request only.

Everyone should be encouraged to be sun-smart!

Screening of asymptomatic (low-risk) people for melanoma or non-melanocytic skin cancer (NMSC) is not
recommended as there is insufficient evidence available to show that this reduces death.

33
Q

What are some features that increase risk of melanoma?

A

Moderate increase
- Family history of melanoma in first-degree relative
(relative risk [RR] = 1.7)
- Fair complexion, burn rather than tan, freckles, high naevus count (> 100), light eye / hair colour
- Presence of actinic damage (RR = 2)
- Past history of NMSC (<40 years of age higher risk)
- High levels of UV exposure / sunburn in childhood
(RR = 2)

Greatly increased
- Previous history of melanoma (RR >10)
>5 atypical (dysplastic) naevi (RR = 6)

34
Q

How often should skin checks be performed in patients at high risk of developing melanoma?

A

6-12 months

Although follow up for patients with past melanoma depends on disease stage

35
Q

Barring the presence of naevi and family history of melanoma, the risks for NMSC and melanoma are essentially the same (and include fair skin, sun exposure, evidence of sun damage etc)

There are some independent features that place people at high risk of NMSC. What are they, and how often should they be screened?

A

Previous NMSC - 60% grow another in 3 years
Immunosupression e.g. post transplant
Past arsenic exposure

Skin check every 12 months, or when patient develops new skin lesion.

36
Q

What is the CST and how often should it be performed?

A

CST = cervical screening test.

Looks for presence of the HPV virus (with the most oncogenic types being 16 and 18).

Perform every 5 years from age of 25 (or 2 years after first having sex, which ever is later) until age 70-74.

37
Q

Who is at increased risk of cervical cancer?

A

Cervical cancer needs persistent infection with high-risk HPV.

Other risk factors include, immunosupression, smoking, continual COCP use for > 5 years.

38
Q

Should pelvic examination be performed as part of screening for cervical cancer?

A

No.

39
Q

Who are at lower risk for developing ovarian cancer?

A

COCP use
Carried pregnancy to term

About half the female population

40
Q

Who are at high risk for developing ovarian cancer?

A

Family history of ovarian cancer

Presence of the genes BRCA1 or BRCA2

41
Q

What screening is offered for ovarian cancer?

A

Nothing

42
Q

Who is at high risk of developing testicular cancer?

A

Cryptorchidism - RR = 3.5 - 17.

Orchidopexy, testicular atrophy, previous testicular cancer - RR = 25-28

43
Q

What screening is offered for testicular cancer?

A

Nothing regular.

Testicular examination opportunistically.

Preventative health (4 decks)

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