Ch3: Secondary Prevention Flashcards
what is hemoglobin electrophoresis used to screen for
a screening test to identify genetically-based variant hemoglobins
e.g., sickle cell anemia, sickle cell trait, beta thalassemia minor, beta thalassemia major
how to calculate smoking pack years
number of packs per day x the number of years smoked
e.g., 2PPD x 30 years = 60 pack years
males represent nearly ___% of all completed suicides
80%
compared to male suicide attempts, female attempts at suicide are ______ x more or less common
2-3x more common
males vs. females use more lethal means in attempting suicide
males
the highest rate of completed suicide is found in which age group of men
older (65+yo)
who is the stereotypical older man who completes suicide
> 65yo whose long-term partner or loved one has died
can you report abuse for a competent adult?
no, not reportable unless they are a dependent
e.g., intellectual or physical disability, cognitive impairment, dementia, elder, child
reporting is at the state-level
Prochaska’s 5As of quitting smoking
Ask Advise Assess Assist Arrange
Prochaska’s stages of Change theory
mnemonic: PCP-IAM
- precontemplation
- contemplation
- preparation
- intervention/action
- maintenance/relapse
which stage of change?
the patient is not interested in change and may not be aware that the problem exists, or minimizes the problems impact
precontemplation
which stage of change?
the patient is considering change and looking at its positive and negative aspects. at the same time, they often report feeling “stuck” with the problem
contemplation
which stage of change?
the patient exhibits some change behaviors or thoughts and often reports feeling like they do not have the tools to proceed
preparation
which stage of change?
the patient is ready to go forth with the change, often taking concrete steps to change but is inconsistent with carrying through
action
what stage of change?
the patient learns to continue the change and has adopted and embraced the healthy habit. at the same time, relapse is possible and they are learning to deal with backsliding
maintenance/relapse
what is the provider’s role if the patient is in precontemplation?
help them to move toward thinking about changing the unhealthy behavior
what is the providers role if the patient is in contemplation?
help them to examine the benefits and barriers to change
what is the providers role if the patient is in preparation?
assist in finding and using concrete tools to help with change, continuing to work to lower barriers to change
what is the providers role if the patient is in action?
work with the patient on the use of their tools, encouraging health behavior change, praising the positive, acknowledge reverting back to the former behavior as common but not insurmountable problem
what is the providers role if the patient is in maintenance?
continued positive reinforcement for the behavior change. put backsliding into perspective of a common but not insurmountable problem
top 10 leading causes of death for ALL ages in the USA
- heart disease
- cancer
- unintentional injury
- chronic lower respiratory disease (e.g., COPD)
- cerebrovascular disease (e.g., stroke)
- alzheimer’s disease
- diabetes
- influenza and pneumonia
- nephritis
- suicide
top 3 leading causes of death for folks ages 15-35
- unintentional injury
- suicide
- homicide
top 5 most prevalent cancers in adult males (excludes localized skin cancers)
- prostate
- lung
- colorectal
- bladder
- melanoma
top 5 most prevalent cancers in adult females (excludes localized skin cancers)
- breast
- lung
- colorectal
- uterine
- thyroid
top 5 most deadly cancers in adult males
- lung
- prostate
- colorectal
- pancreas
- liver/bile duct
top 5 most deadly cancers in adult females
- lung
- breast
- colorectal
- pancreas
- ovary
% of cancer deaths due to lung cancer in males and females
25%
1/4 of all cancer deaths are caused by…..
lung cancer
most common way for endometrial cancer to present
postmenopausal irregular bleeding
USPSTF recommendations on using prostate-specific antigen (PSA)-based screening for prostate cancer
AGES 55-69:
- shared decision making based on risk factors and patient preference. small potential benefit in reducing risk of prostate cancer in some men, but is also associated with harms
AGES 70+:
- recommends AGAINST PSA-screening
the USPSTF actively recommends against using PSA-screening in men of which age group
> 70yo
USPSTF recommendations on BRCA mutation testing for breast and ovarian cancer susceptibility
- use a familial risk assessment tool (e.g., Tyrer Cruzik model, Gail model) with women who have a personal or family history of breast/ovarian/tubal/peritoneal cancer OR who have ancestral susceptibility to BRCA1/2
- if positive on the risk assessment tool, refer to genetic counseling and possible genetic testing
- recommends AGAINST routine risk assessment for those who do not have this personal or family history
consensus among ACS & USPSTF guidelines for colorectal cancer screening
- initiate screening by 50yo (45yo ACS, 50yo USPSTF)
- screening modalities may include ….
\+ gFOBT q1 year \+ FIT q1 year \+ stool DNA or FIT DNA q3 yrs \+ colonoscopy q10 yrs \+ flexible sigmoidoscopy q5 yrs \+ CT colonoscopy q5 yrs
- continue routine screening through age 75yo if in good health
- ages 75-85yo should be individualized and shared-decision making
- discontinue screening >85yo
ACS recommendations for endometrial cancer screening (USPSTF has none)
- inform all women at time of menopause of risks/symptoms of endometrial cancer
- report any AUB post-menopause at which time an endometrial biopsy is used as screening
- folks with hereditary non-polyposis colon cacner (HNPCC; Lynch Syndrome), annual endometrial biopsy screening should be offered starting at 35yo
endometrial cancer screening for folks with hereditary non-polyposis colon cancer (HNPCC; Lynch Syndrome)
ACS recommends offering annual endometrial biopsy starting at age 35yo as screening for endometrial cancer
consensus among ACS & USPSTF on lung cancer screening guidelines
- annual LDCT for individuals who meet the following criteria:
+ >30 pack year smoking history
+ currently smoke or have quit within the last 15 years
+ in reasonably good health
+ ages 55 through 74 (ACS) or 80 (USPSTF)
- discontinue screening once they have not smoked for 15 years or they develop a health problem that substantially limits life expectancy
- suggest they enter an organized screening program with experience in LDCT (high rates of false positives requiring further management)
consensus among ACS, USPSTF, and AGS on breast cancer screening guidelines
- start by age 50yo (per ACS, can offer the option for those 40-44yo, and recommend starting at 45yo. per USPSTF, recommend at age 50yo)
- perform annually or biennially until at least 75yo or they become in poor health (per ACS, annually from ages 45-54, then biennial thereafter. per USPSTF, biennial from 50-74 and then stop. per AGS, every 1-2 years until age 85yo)
- when to discontinue has significant variation.
+ ACS = until they are no longer in good health or they have life expectancy less than 10 years
+ USPSTF = until age 75yo
+ AGS = until age 85yo or a life expectancy of less than 5 years, with continuing beyond 85yo in those women with excellent health and functional status or who would prefer it for peace of mind or their QOL
the immune system clears HPV in most adolescent females within ______
1-2 years
consensus among ACS, ACOG, USPSTF, and ASCCP on cervical cancer screening guidelines
- start at age 21yo. do NOT start younger than 21 based on sexual activity
- cytology alone q3 years for ages 21-29yo
- co-test q5 or cytology alone q3 for ages 30-65yo (ACS prefers co-test q5, and USPSTF additionally offers HPV-alone q5)
- certain risk factors warrant more frequent screening, which include: h/o CIN2 or greater, HIV, immunosuppressed, DES exposure in utero
- recommends AGAINST continuing screening beyond 65yo if they had adequate negative prior results and are not otherwise at high risk
- folks with h/o CIN 2 or greater should continue testing for 20 years after it was initially found
- folks with a total hysterectomy (no cervix remaining) should stop screening unless the surgery was done for CIN 2, CIN3, or cancer
- folks with a hysterectomy but cervix that remains in place should continue standard screening
- folks with HPV vaccination should continue standard screening
