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
What tests are used for breast screening
Mammography detected
Trucut bx of suspicious lesions
- For therapy markers
What populations are involved in the breast screen
Post-memopausal
initially 50-64 years
Extended to women 65-69 in 2015
Write about the histopathology for breast screening
Investigation of suspicious lesions
- Biopsies - morphological assessment
- Excision - frozen sections
Biomarkers of prognosis and therapy
- Oestrogen/progesterone receptor status
- HER2 -> FISH
Write about cervical screening
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
What populations are involved in the cervical screen
25-60 years
3 or 5 year recall
What tests are used in the cervical screen
Was cervical smear test
HPV test as primary screening test
Write about the HPV test
Primary screening test for cervical screening
Test of risk for cervical cancer
Cytology triage
- test of disease
What are the colposcopy - HIV positive specimens
Histology
Tissue removed at colposcopy
- LLETZ
- LEEP
- Cone biopsy
Further surgery
- hysterectomy/ total hysterectomy
Write about colorectal cancer screening
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
What are the two types of colorectal screening
Population based (50-74+)
Groups at high risk (family history)
What tests are used in the colorectal cancer screening
Faecal occult blood (poor sensitivity/specificity)
Faecal immunochemical test (FIT)
Colonoscopy (more invasive)
Write about colorectal screening
Publication of report on Colorectal screening
Announcement of National Colorectal Screening Service
National programme by 2012
What test is used for colorectal screening
Faecal immunochemical test (FIT)
What is the screening cycle for colorectal screening
2 year screening cycle
Colonoscopy following positive test
What are the target populations in colorectal screening
55-74 years
Initial roll out for 60-69 year age group
3 year time-frame
500,000 screens by 2015
Write about prostate cancer
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
What are some issues with the prostate cancer screening
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
What are the screening tests used for prostate cancer screening
Digital rectal examination
Serum tumour markers (PSA)
Transrectal ultrasound
No direct evidence of effectiveness of these tests in reducing overall mortality
Write about lung cancer screening
High incidence
Smoking related
Very little evidence to support screening programme
Some work in USA
Over diagnosis
What work has been done in the USA for lung cancer screening?
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
What other future screening tests are there
Bladder screening
Ovarian screening
Write about possible bladder screening
Dye industry provide urinalysis for employees
Microscopy based
Write about possible ovarian screening
Ca125 - sensitivity/specificity
Other markers being studied
Write about the use of biomarkers in screening
High risk groups screened
Can be used for familial cancers
Breast
- BRCA1
- BRCA2
Colon
- HNPCC
Genetic testing
