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BCOP > Cancer Screening and Prevention BCOP > Flashcards

Cancer Screening and Prevention BCOP Flashcards

1
Q

What are the learning objectives related to cancer risk factors?

A

To outline modifiable and non-modifiable risk factors, provide recommendations for interventions, and differentiate cancer screening recommendations for general versus high-risk populations.

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2
Q

What was the estimated number of new cancer diagnoses in the US in 2019?

A

1.7 million new cancer diagnoses.

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3
Q

What percentage of newly diagnosed cancers are potentially avoidable?

A

42%.

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4
Q

What are the two leading causes of avoidable cancers?

A
  • Smoking (20%)* Diet and lack of physical activity (20%).
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5
Q

What cancer has the highest preventable cases and deaths?

A

Lung cancer.

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6
Q

What is the estimated direct medical cost of cancer care in 2015?

A

$80.2 billion.

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7
Q

Define cancer prevention.

A

Reductions in cancer mortality by means of reductions in the incidence of cancer itself.

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8
Q

What are some strategies for cancer prevention?

A
  • Avoiding carcinogens* Altering their metabolism* Pursuing lifestyle changes* Medical interventions* Early detection and removal of precancerous lesions.
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9
Q

What is the strongest risk factor associated with cancer?

A

Cigarette smoking or tobacco use.

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10
Q

What percentage of all cancer deaths is attributed to cigarette smoking?

A

30%.

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11
Q

What percentage of cancers globally are due to infections?

A

15%.

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12
Q

What type of radiation is associated with cancer risk?

A
  • Ultraviolet radiation* Ionizing radiation.
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13
Q

True or False: There is a known dose of radiation considered completely safe.

A

False.

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14
Q

Name two environmental exposures that are associated with cancer.

A
  • Air pollutants* Asbestos.
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15
Q

What is the relationship between obesity and cancer?

A

Some studies suggest an association between body mass index and certain cancers.

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16
Q

How does diabetes affect cancer mortality risk?

A

Patients with diabetes have a higher risk of mortality if cancer develops.

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17
Q

What is the role of the oncology pharmacist in cancer prevention?

A

Focus on education about risk factors, primary and secondary prevention, and counseling on adherence to chemo prevention.

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18
Q

What are cancers with no known prevention primarily related to?

A

Genetics, family history, age, or ethnicity.

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19
Q

What are potentially modifiable risk factors for cancer?

A
  • Radiation* Environmental carcinogens* Certain infectious diseases* Past chemotherapy exposure.
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20
Q

Name a cancer associated with medication-related risk factors.

A

Ovarian cancer.

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21
Q

What did the 2017 American Institute for Cancer Research survey reveal about public awareness of cancer risk factors?

A

Less than 50% recognized inactivity, alcohol, diet, and processed meats as risk factors.

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22
Q

What is the National Cancer Institute’s role in cancer prevention?

A

Provides guidelines and evaluations of studied interventions for cancer prevention.

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23
Q

What organization outlines guidelines on nutrition and physical activity for cancer prevention?

A

American Cancer Society (ACS).

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24
Q

What is the significance of the NIH, AARP Diet and Health Study?

A

Demonstrated that higher adherence to ACS guidelines correlates with reduced cancer incidence and mortality.

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25
Q

What does the American Institute for Cancer Research focus on in its guidelines?

A

Diet, nutrition, physical activity, and their link to cancer risk.

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26
Q

Fill in the blank: The World Health Organization provides guidelines for effective _______ programs.

A

cancer control.

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27
Q

What are the main focuses regarding diet, nutrition, and physical activity?

A

Consumption, how you eat, what you eat, importance of maintaining a healthy weight.

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28
Q

What is the single greatest avoidable risk factor for cancer worldwide?

A

Tobacco.

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29
Q

What does the WHO cancer control guidelines focus on?

A

Worldwide risk factors and implementation of risk reduction programs.

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30
Q

Which organization provides breast cancer risk reduction guidelines?

A

National Comprehensive Cancer Network (NCCN).

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31
Q

What types of interventions do the NCCN breast cancer guidelines include?

A
  • Lifestyle modifications
  • Genetic counseling recommendations
  • Medical interventions (prophylactic surgery and medications)
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32
Q

What does ASCO focus on in their cancer prevention guidelines?

A

Specific topics such as chemo prevention and pharmacologic interventions.

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33
Q

What is the main focus of the United States Preventative Services Task Force (USPSTF) guidelines?

A

Recommendations for the primary care provider population and general population.

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34
Q

True or False: The USPSTF guidelines recommend colorectal cancer risk reduction through aspirin use.

A

True.

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35
Q

What percentage of all cancers are associated with smoking or tobacco use?

A

About 19%.

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36
Q

What is the associated percentage of lung cancer deaths related to smoking?

A

About 81%.

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37
Q

Fill in the blank: Smoking cessation decreases the incidence of lung cancer by ______ within 10 years.

A

50%.

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38
Q

What are the three major guidelines for smoking cessation in cancer prevention?

A
  • ASCO
  • NCCN
  • USPSTF
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39
Q

What is the recommended dual therapy for smoking cessation according to NCCN?

A
  • Nicotine replacement
  • Varenicline (Chantix)
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40
Q

According to the American Cancer Society, when should direct sun exposure be avoided?

A

Between 10am and 4pm.

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41
Q

What is the minimum recommended SPF for sunscreen?

A

15.

42
Q

What are the four point guidelines for skin protection by the American Cancer Society?

A
  • Slip on a shirt
  • Slop on some sunscreen
  • Slap on a hat
  • Wrap on some sunglasses
43
Q

What is the most common sexually transmitted infection in the US?

A

Human Papillomavirus (HPV).

44
Q

What types of cancer are associated with HPV?

A
  • Cervical
  • Oropharyngeal
  • Anal
  • Vaginal
  • Valvular
  • Penile
45
Q

What is the effectiveness of the HPV vaccination before sexual contact?

A

Most effective if given before initiation of sexual contact.

46
Q

What percentage of cervical intraepithelial neoplasia incidence has the HPV vaccination reduced?

A

From 3.6% to 0.2%.

47
Q

True or False: The HPV vaccination is FDA approved for the prevention of head and neck cancers.

A

False.

48
Q

What is the effect of the HPV vaccine on cervical intraepithelial neoplasia (CIN)?

A

It can reduce the incidence of CIN from 3.6% to 0.2%.

49
Q

What is the reduction rate of various types of cancer and premalignant lesions with HPV vaccines?

A

Upwards of 89 to 100%.

50
Q

What is the coverage expansion achieved by the nine-valent HPV vaccine?

A

Coverage expands to 90% of cases associated with HPV.

51
Q

What are the CDC recommendations for HPV vaccination doses based on age?

A

Two doses for those starting before age 15; three doses for those aged 15-26 or immunocompromised.

52
Q

What is the recommended vaccination schedule for children aged 9 to 14?

A

Two doses about 6 to 12 months apart.

53
Q

What is the recommended vaccination schedule for those aged 15 to 26 or immunocompromised?

A

Three doses at 0, 1-2, and 6 months.

54
Q

Which selective estrogen receptor modulators (SERMs) are studied for breast cancer risk reduction?

A

Tamoxifen and Raloxifene.

55
Q

How much does Tamoxifen reduce breast cancer incidence in postmenopausal women?

A

By about 30 to 50% over five years.

56
Q

What is the duration of breast cancer risk reduction benefit after stopping Tamoxifen?

A

About 11 years.

57
Q

Which SERM is better tolerated, Tamoxifen or Raloxifene?

A

Raloxifene.

58
Q

What is the number needed to treat (NNT) with Exemestane for breast cancer risk reduction?

A

94 at three years; 26 at five years.

59
Q

What is the primary benefit of Anastrozole according to the Ibis 2 trial?

A

It decreases the risk of invasive and non-invasive breast cancers.

60
Q

What is the NNT for Anastrozole at five years?

A

50.

61
Q

What do the NCCN guidelines recommend for women over 35 at higher risk of breast cancer?

A

Bilateral mastectomy, oophorectomy, or hormonal treatments.

62
Q

What effect do oral contraceptives have on ovarian cancer risk?

A

They can decrease the risk by up to 50% after at least five years of use.

63
Q

How long can the protective effect of oral contraceptives last after discontinuation?

A

Up to 30 years.

64
Q

What is the effect of aspirin and NSAIDs on esophageal cancer risk?

A

They decrease risk, with more frequent use yielding better effects.

65
Q

What is the recommended use of low-dose aspirin according to USPSTF?

A

In adults aged 50 to 69 for cardiovascular protection.

66
Q

What is the relationship between vitamin D deficiency and cancer risk?

A

Linked to breast, colon, and prostate cancer risk.

67
Q

What is the effect of Metformin on cancer risk according to recent studies?

A

Mixed data, with no conclusive benefit shown in larger trials.

68
Q

What is the association between Helicobacter pylori (H. pylori) and gastric cancer?

A

H. pylori eradication may reduce gastric cancer incidence.

69
Q

What is the impact of beta carotene on lung cancer incidence in smokers?

A

Increased risk of lung cancer incidence and mortality in high-intensity smokers.

70
Q

What is the impact of beta carotene on lung cancer risk for high intensity smokers?

A

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.

71
Q

What is the effect of selenium and vitamin E on prostate cancer?

A

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.

72
Q

What are key priorities in cancer prevention?

A
  • Smoking cessation
  • UV protection
  • Diet and exercise

These factors are fundamental in reducing cancer risk.

73
Q

What is a common misconception about cancer prevention?

A

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.

74
Q

What is the recommended starting age for breast cancer screening according to most guidelines?

A

Around the age of 40

Most guidelines suggest annual or biennial mammograms starting at this age.

75
Q

Which organizations recommend breast self-exams?

A

NCCN

Other major organizations do not recommend breast self-exams due to variability and lack of survival benefit.

76
Q

What did the USPSTF meta-analysis find regarding annual mammograms?

A

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.

77
Q

What is the current recommendation for cervical cancer screening for women aged 30 to 65?

A

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.

78
Q

What are the recommended screening methods for colorectal cancer?

A
  • Fecal immunochemical test (FIT) annually
  • Colonoscopy every 10 years
  • Sigmoidoscopy every 5 years

These methods vary by guidelines but generally start at age 50.

79
Q

What is the screening recommendation for high-risk patients with hereditary colorectal cancer?

A

Start colonoscopy much earlier, often at age 40 or 10 years before the earliest family diagnosis

Guidelines continue lifelong for high-risk patients.

80
Q

What is the only screening method shown to reduce lung cancer mortality?

A

Low dose CT (computed tomography)

This screening method is recommended for high-risk individuals based on multiple studies.

81
Q

What is the recommendation for lung cancer screening in patients aged 55 to 75 with a significant smoking history?

A

Annual low dose CT

This is applicable to those with a 30+ pack-year history who quit within the last 15 years.

82
Q

What is the current status of effective screening tests for ovarian cancer?

A

No effective screening tests currently recommended

Screening asymptomatic patients with no risk factors has shown no impact on mortality.

83
Q

What is the controversy surrounding prostate cancer screening?

A

Risks of overdiagnosis and treatment make long-term survival outcomes questionable

PSA testing has many false positives and altered results due to medications.

84
Q

What is the specificity of PSA when levels are greater than 10?

A

About 67%

Lower specificity when PSA is less than 10 contributes to uncertainty in screening guidelines.

85
Q

What is the focus of recent changes in prostate cancer screening?

A

PSA velocity, or the rise in PSA levels over time

This approach aims to improve reliability over single PSA measurements.

86
Q

What factors can alter PSA levels, making it less reliable as an indicator?

A

Blockers and other factors

Common medications and conditions can affect PSA levels, leading to variability in results.

87
Q

What is the specificity of PSA when it is greater than 10?

A

About 67%

Specificity refers to the test’s ability to correctly identify those without the disease.

88
Q

What is PSA velocity and why is it significant?

A

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.

89
Q

What is the general recommendation for starting prostate cancer screening?

A

Around 50 years of age

High-risk individuals may start screening up to 10 years earlier.

90
Q

Which organization currently recommends the Digital Rectal Exam (DRE)?

A

NCCN

Even NCCN’s recommendation for DRE is weak and it is not widely endorsed.

91
Q

What is the recommended frequency for PSA testing if results are normal?

A

Every 2 to 4 years

This is in contrast to the previous recommendation of annual testing.

92
Q

At what age or under what condition should prostate cancer screening typically stop?

A

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.

93
Q

What do the ACS and American Academy of Dermatology recommend regarding skin assessments?

A

Periodic self-assessment and clinician assessment

They do not provide specific guidelines for frequency but emphasize the importance of regular checks.

94
Q

What does the acronym ABCDE stand for in skin cancer screening?

A

Asymmetry, Border, Color, Diameter, Evolving

This helps in identifying suspicious moles or lesions.

95
Q

What is the significance of the Ugly Duckling sign in skin assessments?

A

It refers to any nevus that looks different from others

This sign emphasizes the importance of clinician judgment in skin assessments.

96
Q

What is the ACS 2035 challenge goal?

A

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.

97
Q

What is the estimated percentage decline in cancer death rates by 2035 if current screening and risk factors improve?

A

26.4%

Additionally, a 20.5% drop could be achieved if screening rates match those of college graduates.

98
Q

What cancers are projected to decline substantially according to recent studies?

A

Lung, colorectal, female breast, and prostate cancer

These cancers account for about 50% of all cancer deaths.

99
Q

What is the recommendation for patients with known genetic mutations associated with cancer risk?

A

Increased screening and follow-up

Guidelines outline specific cancer types and screening recommendations based on genetic testing.

100
Q

True or False: The guidelines for cancer screening are static and do not change frequently.

A

False

Guidelines are updated regularly, necessitating ongoing education for healthcare providers.

101
Q

Fill in the blank: The _______ is a method for identifying suspicious moles based on characteristics like asymmetry and irregular borders.

A

[ABCDE method]

This method is widely used in dermatology for skin cancer screening.

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