Clinical Strategies for Cancer Treatment and Prevention (Part 2 of 2) Flashcards
When determining an effective screening test, what 5 pillars should you consider?
- east to administer 2. economic 3. actionable 4. sensitive 5. Widely available
What USPSTF grade is especially important to have the patient-centered conversation and informed decision making?
grade C
What is a huge problem with ovarian cancer?
~20% of ovarian cancer is diagnosed at an early stage (so it is caught late 80% of the time)
What screening do we have for ovarian cancer? (4)
physical exam, CA-125, Transvaginal ultrasound, and multimodal (CA-125 and TVUS)
discuss the physical exam as used for a screening technique for ovarian cancer?
there is no data to suggest pelvic exams are useful in screening for ovarian cancer in average risk women; large ovarian masses are easiest to detect with pelvic exam, which typically indicates advanced disease
discuss the use of CA-125 as a screening technique for ovarian cancer?
it is not specific for malignant ovarian tumors; by the time CA-125 is positive, many tumors are beyond cure; there is no improvement in mortality when using this as a technique
discuss the use of TVUS as a screening technique for ovarian cancer?
there was no improvement in mortality during screening and 6 years after; it is observer dependent
discuss the use of multimodal (CA-125 and TVUS) as a screening technique for ovarian cancer?
no improvement in mortality; there was a 9.6% false positivity rate–> lead to unneeded surgical intervention and harm
overall what is the grade for ovarian cancer screening?
grade D; however, there is a gray area for high risk women
who is considered a high risk woman for ovarian cancer?
if there is a family history of ovarian cancer or hereditary cancer syndromes (BRCA or Lynch syndrome)
what is the leading cause of cancer among men in the united states?
prostate cancer
what screening tools do we have for prostate cancer?
prostate specific antigen (PSA) and digital rectal exam (DRE) FORGET ABOUT DRE
discuss using PSA as a screening tool for prostate cancer?
there is a high false positivity rate; serum testing increases in many benign and inflammatory conditions; 2/3 men who underwent biopsy for elevated PSA did not have prostate cancer
what is the grade for PSA for men 55-69 years of age?
grade c
what is the grade for PSA for men 70 years or older?
grade D: service has no benefit and/or harms may outweigh any potential benefits
what screening tools do we have for cervical cancer?
Pap smear, HPV testing, and co-testing (PAP and HPV)
when should you start pap smears?
start at age 21 and repeat every 3 years
when should you stop pap smears?
at age 65
for the age group 30-64, when should you get a pap smear?
pap alone: every 3 years; pap and HPV testing: every 5 years
cervical cancer screening is especially effective because why?
since pap smears are excellent at identifying pre-cancerous lesions, which can be locally excised or cryoablated–> BEFORE INVASIVE CANCER EVEN ARISES
what is the grade for pap smears for 21-29 year olds?
grade A
what is the grade for pap smears for those younger than 21?
grade D
how do you screen for endometrial cancer?
counseling of women at menopause to report any vaginal bleeding
what is the most common type of non-skin cancer?
breast cancer
what is the 2nd leading cause of cancer death for women, behind lung cancer?
breast cancer
what screening tools do we have for breast cancer?
clinical breast exams, self-breast exams, mammography
How should you educate your patient on how to perform a self breast exam?
check the axilla, look for skin changes, avoid checking prior to or during menstrual cycles
what makes for complex testing guidelines for the BRCA-1 and BRCA-2 genetic testing?
if there is a family history of breast/ovarian cancer (multiple relatives, relatives diagnosed at young age, and male relatives) or if there is a personal diagnosis before age 45
if you test positive for the BRCA gene, what can you do?
prophylactic surgery, chemoprevention medication (hormone therapy), increased screening and self exam
mammography is the gold standard for breast cancer screening however guidelines are changing. Discuss this.
informed decision making on when to start mammography: 40-49 (grade c) 50-75 (grade b)
what is the third leading cause of death for men and women in the US?
colon cancer
when is colon cancer most commonly diagnosed?
between the age of 65-74
what screening tools do we have for colon cancer?
high-sensitivity guaiac-based fecal occult blood test, fecal immunochemical test, fecal DNA test, CT colonography, and colonoscopy
how often do you have to get a high-sensitivity guaiac-based fecal occult blood test?
annually
what are the screening recommendations for colon cancer (regarding ages)?
45-49 (grade b) 50-75 (grade a)
what is key to choosing the correct modality and timing for colon cancer screening?
informed decision making is key to choosing the correct time and screening modality for the patient
what is the leading cause of non-skin cancer in the united states?
lung cancer
what is the best prevention for lung cancer?
smoking cessation
how do you screen for lung cancer?
low-dose CT annually for ages 50-80 with a 20-pack-year history of smoking or those actively smoking or those who only quit smoking in the past 15 years
what is the screening for lung cancer graded?
grade B
