Cancer Screening Programme Flashcards
What is the national cancer screening strategy currently in Ireland
National Cancer Strategy 2017-2026
Follows on from the National Cancer Strategy, A strategy for cancer control in Ireland 2006
What are some downfalls of the national cancer strategy
New challenges with increased incidence, lack of infrastructure and emerging therapies
What are the key goals of the national cancer strategy?
Reduce the cancer burden
Provide optimal care
Maximise patient involvement and the quality of life of those living with and beyond cancer
Enable and assure change
Write about the 6th chapter of the national cancer strategy
Early detection of cancer
3 population based screening programmes in Ireland
No recommendation for further population screening programmes
e.g. Prostate and Lung cancer screening
What is the main goal of the national cancer strategy?
All cancer screening service should carry out an active research programme to inform improvements in approach, methodology and testing technologies
Write about screening
Screening is aimed at the early detection of a life threatening disease in an asymptomatic population
There has to be set principles and criteria that the disease process has to follow to have an effective screening programme
In 1968 Wilson and Junger defined the aims and principles of screening that have provided the foundation of research into and the application of screening programmes ever since
What are the principles behind cancer screening
The disease should pose an important health problem for the individual and the community
The natural history should be well understood with a recognisable early stage
An appropriate and acceptable screening test should be available and offered at suitable intervals
Treatment at an early stage should be advantageous
There should be adequate facilities for the diagnosis and treatment of abnormalities identified
The chance of physical or psychological harm should be less than the chance of benefit
The costs of the screening programme should be balanced against the benefits it provide
Write about screening programmes
Screening programmes aim to prevent the development of the disease within the identified population
A number of programmes are in place
Future development of additional programmes with new technologies
Various screening tests
Of most significance to Histology and Cytology are cancer screening programmes
Others may impact on Histology following detection of the disease
What are the two types of cancer screening?
Detection of cancer
Screening for risk factors/markers
Write about the detection of cancer type of cancer screening
Detection of cancer before it is clinically apparent, early in it’s natural history when treatment may be effective
Treatment is curative or extends life
Breast cancer screening
Cervical cancer screening
Colorectal cancer screening
Write about the screening for risk factors/markers type of cancer screening programme
Screening for risk factors/markers that may put one at a high risk of developing cancer
Colorectal cancer (HNPCC)
Breast cancer (BRCA1/BRCA2)
Treatment may involve genetic counselling, frequent scans/screens, therapeutic removal of tissue
Write about implementing a detecting the cancer test
What are the criteria for abnormality
Is there a cut off point
What are the criteria for inadequate/equivocal/ repeat tests
Who performs the test
What are the training requirements
Quality control
IQC/EQA/Audit
What are the reporting protocols
What tests can be used for a screen
Blood tests: PSA, Ca125, genetic analysis
Cytology samples: Cervical smears, Molecular HPV testing, Urinalysis
Faecal analysis
Imaging techniques
- Mammography, colonoscopy, X-ray, barium
What different target populations can be used
Prevalence of the cancer
Age range
Sex
Ethnic groups
Familial clusters
Write about research in screening programmes
Research is best practice
Review similar programmes worldwide
Who are world leaders
What studies comparing different tests have been performed
What are the WHO/EU recommendations
Has the prevalence been effectively reduced
Write about best practice in screening programmes
Identify difficulties relating to your populations
Funding
Population identity/registry
IT- call, recall, data management
Clinical delivery of service
- Doctors, nurses, radiographers
- Treatment facilities, hospital beds
- Laboratory services
Cultural differences
How would you monitor a screening test
Sensitivity
- ability to detect all positive cases
- true positive/ true positive + false negative
Specificity
- ability to detect those without the disease
- True negative/true negative+ false positive
Positive predictive value
- The ability of the test to predict all true positivies
- True positive/true positive+ false positive
Why would you measure sensitivity and specificity
To monitor effectiveness of the test
What two values are used to monitor effectiveness of a test
Positive predictive value
Negative predictive value
Why is monitoring effectiveness of screening important
Reduced mortality/morbidity
High uptake (population coverage)
Audit
What are the three existing programmes
Breast screening (BreastCheck)
Cervical screening (CervicalCheck)
Colorectal screening (BowelScreen)
What are three potential future screening programmes
Prostate
Lung
Ovarian
What are three potential future screening programmes
Prostate
Lung
Ovarian
Write about the current breast screening programmes
Pre-clinical/asymptomatic detection
Epidemiology/aetiology
High prevalence of disease
Treatable
Early detection reduces mortality by 20-30%
Organised call/recall
