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2.2 Cellular Pathology > Cancer Screening Programme > Flashcards

Cancer Screening Programme Flashcards

1
Q

What is the national cancer screening strategy currently in Ireland

A

National Cancer Strategy 2017-2026

Follows on from the National Cancer Strategy, A strategy for cancer control in Ireland 2006

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2
Q

What are some downfalls of the national cancer strategy

A

New challenges with increased incidence, lack of infrastructure and emerging therapies

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3
Q

What are the key goals of the national cancer strategy?

A

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

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4
Q

Write about the 6th chapter of the national cancer strategy

A

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

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5
Q

What is the main goal of the national cancer strategy?

A

All cancer screening service should carry out an active research programme to inform improvements in approach, methodology and testing technologies

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6
Q

Write about screening

A

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

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7
Q

What are the principles behind cancer screening

A

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

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8
Q

Write about screening programmes

A

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

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9
Q

What are the two types of cancer screening?

A

Detection of cancer
Screening for risk factors/markers

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10
Q

Write about the detection of cancer type of cancer screening

A

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

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11
Q

Write about the screening for risk factors/markers type of cancer screening programme

A

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

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12
Q

Write about implementing a detecting the cancer test

A

 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

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13
Q

What tests can be used for a screen

A

Blood tests: PSA, Ca125, genetic analysis

Cytology samples: Cervical smears, Molecular HPV testing, Urinalysis

Faecal analysis

Imaging techniques
- Mammography, colonoscopy, X-ray, barium

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14
Q

What different target populations can be used

A

Prevalence of the cancer
Age range
Sex
Ethnic groups
Familial clusters

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15
Q

Write about research in screening programmes

A

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

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16
Q

Write about best practice in screening programmes

A

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

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17
Q

How would you monitor a screening test

A

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

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18
Q

Why would you measure sensitivity and specificity

A

To monitor effectiveness of the test

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19
Q

What two values are used to monitor effectiveness of a test

A

Positive predictive value

Negative predictive value

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20
Q

Why is monitoring effectiveness of screening important

A

Reduced mortality/morbidity
High uptake (population coverage)
Audit

21
Q

What are the three existing programmes

A

Breast screening (BreastCheck)
Cervical screening (CervicalCheck)
Colorectal screening (BowelScreen)

22
Q

What are three potential future screening programmes

A

Prostate
Lung
Ovarian

23
Q

What are three potential future screening programmes

A

Prostate
Lung
Ovarian

24
Q

Write about the current breast screening programmes

A

Pre-clinical/asymptomatic detection
Epidemiology/aetiology
High prevalence of disease
Treatable
Early detection reduces mortality by 20-30%
Organised call/recall

25
Q

What tests are used for breast screening

A

Mammography detected
Trucut bx of suspicious lesions
- For therapy markers

26
Q

What populations are involved in the breast screen

A

Post-memopausal
initially 50-64 years
Extended to women 65-69 in 2015

27
Q

Write about the histopathology for breast screening

A

Investigation of suspicious lesions
- Biopsies - morphological assessment
- Excision - frozen sections

Biomarkers of prognosis and therapy
- Oestrogen/progesterone receptor status
- HER2 -> FISH

28
Q

Write about cervical screening

A

Pre-clinical/asymptomatic
Epidemiology/aetiology
High prevalence of disease
Treatable (pre-malignant phase)
Early detection reduces mortality by up to 80%

HPV test as primary screening test

29
Q

What populations are involved in the cervical screen

A

25-60 years
3 or 5 year recall

30
Q

What tests are used in the cervical screen

A

Was cervical smear test
HPV test as primary screening test

31
Q

Write about the HPV test

A

Primary screening test for cervical screening
Test of risk for cervical cancer

Cytology triage
- test of disease

32
Q

What are the colposcopy - HIV positive specimens

A

Histology

Tissue removed at colposcopy
- LLETZ
- LEEP
- Cone biopsy

Further surgery
- hysterectomy/ total hysterectomy

33
Q

Write about colorectal cancer screening

A

A strategy for cancer control in Ireland - DoHC, 2006

A colorectal cancer screening programme should be established

DoHC should establish a working group to address range of implementation issues

34
Q

What are the two types of colorectal screening

A

Population based (50-74+)
Groups at high risk (family history)

35
Q

What tests are used in the colorectal cancer screening

A

Faecal occult blood (poor sensitivity/specificity)
Faecal immunochemical test (FIT)
Colonoscopy (more invasive)

36
Q

Write about colorectal screening

A

Publication of report on Colorectal screening
Announcement of National Colorectal Screening Service
National programme by 2012

37
Q

What test is used for colorectal screening

A

Faecal immunochemical test (FIT)

38
Q

What is the screening cycle for colorectal screening

A

2 year screening cycle
Colonoscopy following positive test

39
Q

What are the target populations in colorectal screening

A

55-74 years
Initial roll out for 60-69 year age group
3 year time-frame
500,000 screens by 2015

40
Q

Write about prostate cancer

A

A strategy for cancer control in Ireland (2006) Stated insufficient evidence to recommend the introduction of a prostate screening programme
This issue should be reassessed when the results of RCT’s are available
No recommendations in NCS 2017-26

41
Q

What are some issues with the prostate cancer screening

A

Natural history not well understood
Optimal treatment for localised prostate cancer is controversial
Treatment options have both benefits and side effects
Ongoing large randomised controlled trials to determine most appropriate treatment

42
Q

What are the screening tests used for prostate cancer screening

A

Digital rectal examination
Serum tumour markers (PSA)
Transrectal ultrasound

No direct evidence of effectiveness of these tests in reducing overall mortality

43
Q

Write about lung cancer screening

A

High incidence
Smoking related
Very little evidence to support screening programme
Some work in USA
Over diagnosis

44
Q

What work has been done in the USA for lung cancer screening?

A

Sputum and x-ray do not reduce mortality -> not good screening tests
Low dose helical computed tomography (LDCT)
- 20% relative reduction in heavy smokers
- 25% FP rate
- Invasive procedure

45
Q

What other future screening tests are there

A

Bladder screening
Ovarian screening

46
Q

Write about possible bladder screening

A

Dye industry provide urinalysis for employees
Microscopy based

47
Q

Write about possible ovarian screening

A

Ca125 - sensitivity/specificity
Other markers being studied

48
Q

Write about the use of biomarkers in screening

A

High risk groups screened
Can be used for familial cancers

Breast
- BRCA1
- BRCA2

Colon
- HNPCC

Genetic testing

2.2 Cellular Pathology (29 decks)

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