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Clinical Med > lecture 1: epidemiology and oncology > Flashcards

lecture 1: epidemiology and oncology Flashcards

1
Q

benefit of cohort study over randomized control trial

A

large group of people over a long period of time

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2
Q

what is a cohort study? cohort vs case control?

A

cohort: Cohort of people selected and followed over time
case control: Select cases (individuals with the diagnosis being studied) then compare aspects of patient history (exposure to a possible risk factor) to controls (individuals matched to cases who do not have the diagnosis)

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3
Q

what is a benefit of a case control study?

A

Lower cost: can abstract data from records

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4
Q

95% Confidence Interval (CI)

A

Range of results for which the findings have a 95% chance of holding true

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5
Q

CI that crosses 1 is:

A

not significant

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6
Q

Conclusion from the “Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women” (what risks increased and what risks decreased?)

A

Increase in: Coronary Heart Disease, Stroke, venous thromboembolism, Breast cancer (after 5 years)

Decrease in: hip fracture

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7
Q

what is a meta-analysis

A

Statistical analysis allowing smaller studies to be merged to yield data in a larger population (= more robust)

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8
Q

what was the outcome of the study: “Passive Smoking and the Risk of Coronary Heart Disease — A Meta-Analysis of Epidemiologic Studies”?

A

Statistically significant “dose-response” relationship: trend for 1-9 years, then stat significant beyond that

**however!
MAYBE:
-Smoking more prevalent in socioeconomic groups in whom CVD is more prevalent
-Perhaps families of smokers ate less heart-healthy diets

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9
Q

Outcome of “A Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism: retrospective cohort study?

A

This study provides strong evidence against the hypothesis that MMR vaccination causes autism.

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10
Q

Outcome of “Once-Daily Valacyclovir to Reduce the Risk of Transmission of Genital Herpes” RCT?

A
  • oral valacyclovir taken by immunocompetent persons with recurrent genital HSV-2 infection significantly reduces the rates of HSV reactivation, subclinical shedding, and transmission of genital herpes to a susceptible partner.
  • According to the overall rate of HSV-2 acquisition and 48% reduction in risk with valacyclovir, one would expect to treat 38 persons with recurrent genital herpes for a year to prevent one case of HSV-2 infection in a susceptible partner. (NNT)
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11
Q

T/F: There was a large increase in the rate of advanced diagnostic imaging and associated radiation exposure between 1996 and 2010

A

TRUE

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12
Q

sensitivity:

A

Likelihood of an abnormal result in persons known to have the disease
(True positive / All with disease)

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13
Q

specificity:

A

Likelihood of a normal result in persons known not to have the disease
(True negative / All disease-free)

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14
Q

False positive rate:

A

Likelihood of an abnormal result in persons known not to have the disease
( = 1 -specificity)

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15
Q

False negative rate:

A

Likelihood of a normal result in patients known to have the disease ( = 1 - sensitivity)

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16
Q

Absolute vs. relative risk

A

relative risk can be misleading whereas absolute risk is more truthful

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17
Q

first and 2nd leading cause of death

A

1) heart disease

2) cancer

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18
Q

T/F: From 1950 to 2005, there has been a decreasing trend in death rates of heart disease and cancer

A

false, cancer has remained the same

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19
Q

T/F: More men die of cancer every year than women.

A

True

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20
Q

Incidence vs. Prevalence

A

Incidence: New cases
Prevalence: Current cases (new plus existing)

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21
Q

Incidence and mortality rates are close
in what type of cancer?

Give an example of cancer where Incidence&raquo_space; mortality

A

Incidence and mortality rates are close: Aggressive cancer with limited treatment options (eg lung)

Incidence&raquo_space; mortality:
Potentially aggressive cancer with early detection and effective treatment (eg breast)
Less aggressive cancer with effective detection (? prostate)

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22
Q

cancer with most new cases in women? men?

cancer with most deaths in women? men?

A

most new cases: breast and prostate

most deaths: lung (both gender)

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23
Q

what race has highest death rate/shortest survival rate from cancer?

A

African american

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24
Q

Lead time bias:

A

Earlier detection of disease without ultimate impact on mortality; however, the earlier diagnosis makes it appear as though early detection lead to improved survival
(ex: lung cancer)

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25
Q

Length time bias:

A

Detecting slow-growing cancer that would not result in patient’s death; detection results in diagnostic procedures and treatment that risk adverse effects without any benefit in terms of longevity
(ex: prostate cancer)

26
Q

T/F: NEVER treat cancer without a tissue diagnosis

A

true

27
Q

when you screen, you screen for what 3 things?

A
  • established malignancy
  • premalignancy
  • genetic risk of malignancy
28
Q

2 types of lung cancer? which is more associated with smoking?

A

1) Non-small cell lung cancer (>85%)- squamous cell.
- Detected early may be curable by surgery- spreads slowly

2) Small cell (10-15%)-associated with smoking
- Usually metastatic at diagnosis
- Rapidly fatal- not curable

29
Q

name 2 other risk factors for lung cancer besides smoking

A

Age and COPD are independent risk factors

30
Q

at under 30 cigs a day, which races are at higher risk for lung cancer?

A
  • African American and Native Hawaiian populations=highest risk
  • White populations=medium risk
  • Japanese Americans and Latino populations =lowest risk
31
Q

should we screen for lung cancer?

A

maybe some benefit using low dose CT over chest X ray but in studies there were still quite a few deaths from complications and quite a bit of complications
-in another study, despite more surgical intervention, no decrease in mortality (where another study found annual CT scans helped in stage 1 lung cancer)

32
Q

Name 5 things smoking is associated with(diseases or health conditions):

A

1) Cardiovascular (heart attack, stroke, peripheral vascular disease which can cause erectile dysfunction)
2) Cancer (lung, larynx, oral cavity, esophagus, pancreas, bladder)
3) Pulmonary diseases (COPD, pneumonia)
4) AMD
5) Osteoporosis

33
Q

T/F: Smokers who quit by age 35 have preserved longevity

A

TRUE

34
Q

Give some examples in terms of lung cancer and cardio health of why smoking cessation is important

A
  • At 1 year, CAD risk falls 50%
  • At 15 years, CAD risk is similar to non-smokers
  • At 10 years, lung cancer risk falls to almost half vs continuing to smoke
35
Q

T/F: Counseling and/or medications approximately double quit rates at 6 months

A

true

36
Q

T/F: in terms of smoking cessation counseling, 1-3 minutes is nearly effective as 4-30 minutes?

A

true

37
Q

T/F: Death rate of of colon cancer is declining

A

true

38
Q

colorectal cancer risk factors:

A

age, IBD, family history, race (african americans, azkenash jews), lifestyle (diet smoking etc.)

39
Q

for those with FAP (Inherited mutation in the APC gene), the risk for colon cancer approaches 100% by what decade?

A

usually 3rd, so get colectomy by 5th decade

40
Q

Sigmoidoscopy vs colonoscopy

A

Sigmoidoscopy=only descending colon
colonoscopy is more likely to detect lesions
*small risk of perforation in both

41
Q

why might women benefit from colonoscopy over sigmoidoscopy?

A

women tend to have more proximal lesions and may benefit from colonoscopy (over sigmoidoscopy)

42
Q

weakness of CT Colonography?

A

hard to detect small polyps

43
Q

efficacy of colorectal cancer screening?

A

Probability of developing/dying from cancer decreased at least 50%

44
Q

T/F: there has been a decline in mortality in cervical cancer?

A

True

45
Q

list some risk factors for cervical cancer:

A 
Human Papillomavirus Infection (HPV)
Smoking
HIV Infection
Multiple Sex Partners
DES Exposure in-utero
46
Q

HPV low risk vs high risk virus:

A

High risk viruses can cause cervical cancer
(Most women clear HPV and do not progress to cancer)

Low risk viruses can cause genital warts = “condyloma”

47
Q

T/F: HPV is a risk factor for anal cancer (squamous cell)

A

true

48
Q

T/F: breast cancer incidence is decreasing?

A

TRUE

49
Q

risk factors for breast cancer:

A 
Age 
Family history 
Late pregnancy (Pregnancy is protective (especially before 30)
Prolonged estrogen / progestin exposure
Early menarche
Later menopause
Chest irradiation
DES exposure 
Alcohol intake > 1 drink/day
Overweight / obesity
Physical inactivity
50
Q

what race is more likely to develop breast cancer? what race is more likely to die from it?

A

whites=develop

blacks=more likely to die

51
Q

recommendations for cervical cancer screening?

A

pap evry 3 years after 21 years

52
Q

why isn’t breast self exam very helpful?

A

by the time it is this large to be detected, usually has metastatsized
-also, didn’t help reduce mortality in one stdy, just increased amount of benign biopsies

53
Q

one con of mammography?

A

high false positive rate

54
Q

T/F: Prostate cancer mortality declining

A

true

55
Q

what population should get yearly mammograms?

A
  • Inadequate evidence for or against mammography screening in avg risk women under 50
  • Women 50-69 should have annual or biennial mammography
56
Q

what are some risk factors for prostate cancer?

A

Age, family Hx, African Americans (40%higher 2xmortality), high fat diet

57
Q

are digital rectal exams helpful?

A

no impact on mortality, only examines posterior portion of prostate

58
Q

T/F: PSA screening has resulted in earlier detection of cancer (by 5 to 10 years)

A

true

59
Q

risk factors for testicular cancer?

A

whites more than blacks, undescended testicle

60
Q

current recommendation for testicular cancer screening?

A

Recommends against routine screening for testicular cancer in asymptomatic adolescent and adult males

61
Q

peak age of incidence of testicular cancer:

A

Peak incidence 15-34

62
Q

what were the findings for men with early prostate cancer in surgery vs watchful waiting?

A

surgery only really helpful in men under 65, otherwise not much difference in mortality

Clinical Med (10 decks)

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