Cancer Screening and Prevention BCOP Flashcards
What are the learning objectives related to cancer risk factors?
To outline modifiable and non-modifiable risk factors, provide recommendations for interventions, and differentiate cancer screening recommendations for general versus high-risk populations.
What was the estimated number of new cancer diagnoses in the US in 2019?
1.7 million new cancer diagnoses.
What percentage of newly diagnosed cancers are potentially avoidable?
42%.
What are the two leading causes of avoidable cancers?
- Smoking (20%)* Diet and lack of physical activity (20%).
What cancer has the highest preventable cases and deaths?
Lung cancer.
What is the estimated direct medical cost of cancer care in 2015?
$80.2 billion.
Define cancer prevention.
Reductions in cancer mortality by means of reductions in the incidence of cancer itself.
What are some strategies for cancer prevention?
- Avoiding carcinogens* Altering their metabolism* Pursuing lifestyle changes* Medical interventions* Early detection and removal of precancerous lesions.
What is the strongest risk factor associated with cancer?
Cigarette smoking or tobacco use.
What percentage of all cancer deaths is attributed to cigarette smoking?
30%.
What percentage of cancers globally are due to infections?
15%.
What type of radiation is associated with cancer risk?
- Ultraviolet radiation* Ionizing radiation.
True or False: There is a known dose of radiation considered completely safe.
False.
Name two environmental exposures that are associated with cancer.
- Air pollutants* Asbestos.
What is the relationship between obesity and cancer?
Some studies suggest an association between body mass index and certain cancers.
How does diabetes affect cancer mortality risk?
Patients with diabetes have a higher risk of mortality if cancer develops.
What is the role of the oncology pharmacist in cancer prevention?
Focus on education about risk factors, primary and secondary prevention, and counseling on adherence to chemo prevention.
What are cancers with no known prevention primarily related to?
Genetics, family history, age, or ethnicity.
What are potentially modifiable risk factors for cancer?
- Radiation* Environmental carcinogens* Certain infectious diseases* Past chemotherapy exposure.
Name a cancer associated with medication-related risk factors.
Ovarian cancer.
What did the 2017 American Institute for Cancer Research survey reveal about public awareness of cancer risk factors?
Less than 50% recognized inactivity, alcohol, diet, and processed meats as risk factors.
What is the National Cancer Institute’s role in cancer prevention?
Provides guidelines and evaluations of studied interventions for cancer prevention.
What organization outlines guidelines on nutrition and physical activity for cancer prevention?
American Cancer Society (ACS).
What is the significance of the NIH, AARP Diet and Health Study?
Demonstrated that higher adherence to ACS guidelines correlates with reduced cancer incidence and mortality.
What does the American Institute for Cancer Research focus on in its guidelines?
Diet, nutrition, physical activity, and their link to cancer risk.
Fill in the blank: The World Health Organization provides guidelines for effective _______ programs.
cancer control.
What are the main focuses regarding diet, nutrition, and physical activity?
Consumption, how you eat, what you eat, importance of maintaining a healthy weight.
What is the single greatest avoidable risk factor for cancer worldwide?
Tobacco.
What does the WHO cancer control guidelines focus on?
Worldwide risk factors and implementation of risk reduction programs.
Which organization provides breast cancer risk reduction guidelines?
National Comprehensive Cancer Network (NCCN).
What types of interventions do the NCCN breast cancer guidelines include?
- Lifestyle modifications
- Genetic counseling recommendations
- Medical interventions (prophylactic surgery and medications)
What does ASCO focus on in their cancer prevention guidelines?
Specific topics such as chemo prevention and pharmacologic interventions.
What is the main focus of the United States Preventative Services Task Force (USPSTF) guidelines?
Recommendations for the primary care provider population and general population.
True or False: The USPSTF guidelines recommend colorectal cancer risk reduction through aspirin use.
True.
What percentage of all cancers are associated with smoking or tobacco use?
About 19%.
What is the associated percentage of lung cancer deaths related to smoking?
About 81%.
Fill in the blank: Smoking cessation decreases the incidence of lung cancer by ______ within 10 years.
50%.
What are the three major guidelines for smoking cessation in cancer prevention?
- ASCO
- NCCN
- USPSTF
What is the recommended dual therapy for smoking cessation according to NCCN?
- Nicotine replacement
- Varenicline (Chantix)
According to the American Cancer Society, when should direct sun exposure be avoided?
Between 10am and 4pm.
What is the minimum recommended SPF for sunscreen?
15.
What are the four point guidelines for skin protection by the American Cancer Society?
- Slip on a shirt
- Slop on some sunscreen
- Slap on a hat
- Wrap on some sunglasses
What is the most common sexually transmitted infection in the US?
Human Papillomavirus (HPV).
What types of cancer are associated with HPV?
- Cervical
- Oropharyngeal
- Anal
- Vaginal
- Valvular
- Penile
What is the effectiveness of the HPV vaccination before sexual contact?
Most effective if given before initiation of sexual contact.
What percentage of cervical intraepithelial neoplasia incidence has the HPV vaccination reduced?
From 3.6% to 0.2%.
True or False: The HPV vaccination is FDA approved for the prevention of head and neck cancers.
False.
What is the effect of the HPV vaccine on cervical intraepithelial neoplasia (CIN)?
It can reduce the incidence of CIN from 3.6% to 0.2%.
What is the reduction rate of various types of cancer and premalignant lesions with HPV vaccines?
Upwards of 89 to 100%.
What is the coverage expansion achieved by the nine-valent HPV vaccine?
Coverage expands to 90% of cases associated with HPV.
What are the CDC recommendations for HPV vaccination doses based on age?
Two doses for those starting before age 15; three doses for those aged 15-26 or immunocompromised.
What is the recommended vaccination schedule for children aged 9 to 14?
Two doses about 6 to 12 months apart.
What is the recommended vaccination schedule for those aged 15 to 26 or immunocompromised?
Three doses at 0, 1-2, and 6 months.
Which selective estrogen receptor modulators (SERMs) are studied for breast cancer risk reduction?
Tamoxifen and Raloxifene.
How much does Tamoxifen reduce breast cancer incidence in postmenopausal women?
By about 30 to 50% over five years.
What is the duration of breast cancer risk reduction benefit after stopping Tamoxifen?
About 11 years.
Which SERM is better tolerated, Tamoxifen or Raloxifene?
Raloxifene.
What is the number needed to treat (NNT) with Exemestane for breast cancer risk reduction?
94 at three years; 26 at five years.
What is the primary benefit of Anastrozole according to the Ibis 2 trial?
It decreases the risk of invasive and non-invasive breast cancers.
What is the NNT for Anastrozole at five years?
50.
What do the NCCN guidelines recommend for women over 35 at higher risk of breast cancer?
Bilateral mastectomy, oophorectomy, or hormonal treatments.
What effect do oral contraceptives have on ovarian cancer risk?
They can decrease the risk by up to 50% after at least five years of use.
How long can the protective effect of oral contraceptives last after discontinuation?
Up to 30 years.
What is the effect of aspirin and NSAIDs on esophageal cancer risk?
They decrease risk, with more frequent use yielding better effects.
What is the recommended use of low-dose aspirin according to USPSTF?
In adults aged 50 to 69 for cardiovascular protection.
What is the relationship between vitamin D deficiency and cancer risk?
Linked to breast, colon, and prostate cancer risk.
What is the effect of Metformin on cancer risk according to recent studies?
Mixed data, with no conclusive benefit shown in larger trials.
What is the association between Helicobacter pylori (H. pylori) and gastric cancer?
H. pylori eradication may reduce gastric cancer incidence.
What is the impact of beta carotene on lung cancer incidence in smokers?
Increased risk of lung cancer incidence and mortality in high-intensity smokers.
What is the impact of beta carotene on lung cancer risk for high intensity smokers?
Increased risk of lung cancer incidence and mortality
High intensity smokers taking pharmacologic doses of beta carotene show increased lung cancer risk, while non-smokers show no impact.
What is the effect of selenium and vitamin E on prostate cancer?
Selenium has no benefit; vitamin E may increase prostate cancer risk by 17% in certain trials
The SELECT trial indicated a trend of increased prostate cancer incidence in the vitamin E alone group.
What are key priorities in cancer prevention?
- Smoking cessation
- UV protection
- Diet and exercise
These factors are fundamental in reducing cancer risk.
What is a common misconception about cancer prevention?
That doing everything right guarantees cancer prevention
Many patients believe a healthy lifestyle ensures they won’t get cancer, but other unknown factors can contribute to cancer risk.
What is the recommended starting age for breast cancer screening according to most guidelines?
Around the age of 40
Most guidelines suggest annual or biennial mammograms starting at this age.
Which organizations recommend breast self-exams?
NCCN
Other major organizations do not recommend breast self-exams due to variability and lack of survival benefit.
What did the USPSTF meta-analysis find regarding annual mammograms?
Reduces mortality from breast cancer in women aged 50 years and older
The analysis showed significant prevention of breast cancer deaths in various age groups.
What is the current recommendation for cervical cancer screening for women aged 30 to 65?
HPV DNA and cytology co-testing every five years or cytology alone every three years
This is based on updated guidelines from the American Cancer Society and USPSTF.
What are the recommended screening methods for colorectal cancer?
- Fecal immunochemical test (FIT) annually
- Colonoscopy every 10 years
- Sigmoidoscopy every 5 years
These methods vary by guidelines but generally start at age 50.
What is the screening recommendation for high-risk patients with hereditary colorectal cancer?
Start colonoscopy much earlier, often at age 40 or 10 years before the earliest family diagnosis
Guidelines continue lifelong for high-risk patients.
What is the only screening method shown to reduce lung cancer mortality?
Low dose CT (computed tomography)
This screening method is recommended for high-risk individuals based on multiple studies.
What is the recommendation for lung cancer screening in patients aged 55 to 75 with a significant smoking history?
Annual low dose CT
This is applicable to those with a 30+ pack-year history who quit within the last 15 years.
What is the current status of effective screening tests for ovarian cancer?
No effective screening tests currently recommended
Screening asymptomatic patients with no risk factors has shown no impact on mortality.
What is the controversy surrounding prostate cancer screening?
Risks of overdiagnosis and treatment make long-term survival outcomes questionable
PSA testing has many false positives and altered results due to medications.
What is the specificity of PSA when levels are greater than 10?
About 67%
Lower specificity when PSA is less than 10 contributes to uncertainty in screening guidelines.
What is the focus of recent changes in prostate cancer screening?
PSA velocity, or the rise in PSA levels over time
This approach aims to improve reliability over single PSA measurements.
What factors can alter PSA levels, making it less reliable as an indicator?
Blockers and other factors
Common medications and conditions can affect PSA levels, leading to variability in results.
What is the specificity of PSA when it is greater than 10?
About 67%
Specificity refers to the test’s ability to correctly identify those without the disease.
What is PSA velocity and why is it significant?
The rise in PSA levels over time
A PSA velocity greater than 0.35 nanogram per ml per year indicates a higher relative risk of prostate cancer death.
What is the general recommendation for starting prostate cancer screening?
Around 50 years of age
High-risk individuals may start screening up to 10 years earlier.
Which organization currently recommends the Digital Rectal Exam (DRE)?
NCCN
Even NCCN’s recommendation for DRE is weak and it is not widely endorsed.
What is the recommended frequency for PSA testing if results are normal?
Every 2 to 4 years
This is in contrast to the previous recommendation of annual testing.
At what age or under what condition should prostate cancer screening typically stop?
At age 70 to 75 or when life expectancy is less than 10 years
Most prostate cancers are slow-growing, making the risk of death low within a 10-year timeframe for older patients.
What do the ACS and American Academy of Dermatology recommend regarding skin assessments?
Periodic self-assessment and clinician assessment
They do not provide specific guidelines for frequency but emphasize the importance of regular checks.
What does the acronym ABCDE stand for in skin cancer screening?
Asymmetry, Border, Color, Diameter, Evolving
This helps in identifying suspicious moles or lesions.
What is the significance of the Ugly Duckling sign in skin assessments?
It refers to any nevus that looks different from others
This sign emphasizes the importance of clinician judgment in skin assessments.
What is the ACS 2035 challenge goal?
To address disparities in cancer care and improve screening and prevention
The challenge aims to review factors like race, ethnicity, and socio-economic status impacting cancer care.
What is the estimated percentage decline in cancer death rates by 2035 if current screening and risk factors improve?
26.4%
Additionally, a 20.5% drop could be achieved if screening rates match those of college graduates.
What cancers are projected to decline substantially according to recent studies?
Lung, colorectal, female breast, and prostate cancer
These cancers account for about 50% of all cancer deaths.
What is the recommendation for patients with known genetic mutations associated with cancer risk?
Increased screening and follow-up
Guidelines outline specific cancer types and screening recommendations based on genetic testing.
True or False: The guidelines for cancer screening are static and do not change frequently.
False
Guidelines are updated regularly, necessitating ongoing education for healthcare providers.
Fill in the blank: The _______ is a method for identifying suspicious moles based on characteristics like asymmetry and irregular borders.
[ABCDE method]
This method is widely used in dermatology for skin cancer screening.
