OC 4 - screening programmes

Question 1

What are the 3 classifications of prevention?

Answer 1

• primary prevention
• secondary prevention
• tertiary prevention

Question 2

What is primary prevention?

Answer 2

prevents a disease from developing e.g. risk factor education

Question 3

What is secondary prevention?

Answer 3

to detect disease while it is localised or ‘early’ e.g. detection of early/localised cancer

Question 4

What is tertiary prevention?

Answer 4

to mitigate the morbidity from established disease and to improve quality of life e.g. maintaining oral health of remaining dentition, continuing risk factor education etc.

Question 5

What are the 3 types of population screening programmes?

Answer 5

• mass screening
• selective e.g. cervical cancers women 25yo-74yo
• opportunistic e.g. patient presenting voluntarily to dentist

Question 6

For a test to be used by the population, what does the sensitivity and specificity need to be?

Answer 6

80% +

Question 7

What is sensitivity?

Answer 7

the proportion of the population who are correctly classified as having the disease

Question 8

What is specificity?

Answer 8

the proportion of the population correctly classified as disease-free

Question 9

How do you calculate sensitivity?

Answer 9

True positive / True positive + false negative

Question 10

How do you calculate specificity?

Answer 10

True negative / True negative + false positive

Question 11

What is lichen planus?

Answer 11

an autoimmune condition that can manifest in the oral mucosa etc, can be white patches, ulcerated patches etc

Question 12

What is the association between the size of a lesion and malignant progression?

Answer 12

larger the lesion, the higher chance of becoming malignant

Question 13

Order white, red and, speckled patches in decreasing order of association with malignancy

Answer 13

red -> speckled -> white
(highest risk —> lowest risk)

Question 14

Are males or females are higher risk of malignant progression in OPMD (oral potentially malignant disorders)?

Answer 14

females

Question 15

What can oral cancer look like?

Answer 15

• red patch
• white patch
• red/white speckled patch
• ulcer
• indurated margins
• endophytic and exophytic lesions

Question 16

What is leukoplakia?

Answer 16

white patch, not able to wipe off

Question 17

What is erythroplakia?

Answer 17

red patch

Question 18

Are malignant ulcers painful?

Answer 18

no, malignant ulcers are generally painless

Question 19

What do indurated margins indicate?

Answer 19

heaped indurated margins - cancer invading the underlying mucosal margin

Question 20

What does endophytic mean?

Answer 20

inwards growing, can lead to ulcerative lesions

Question 21

What does exophytic mean?

Answer 21

outward growing, finger-like projections, cauliflower-life growths

Question 22

What are worrying features of cancer to look out for?

Answer 22

• painless
• high risk sites - FOM, lat. tongue
• duration - short duration but rapid progression
• size - the bigger the lesion, the more invasive, the worse the prognosis
• bone involvement - worse prognosis, radiotherapy
• spread to draining lymph nodes - quite an early event, always do EO exam

Question 23

What should you do if you detect a suspicious lesion in a patient?

Answer 23

• full detailed history - risk factors, eliminate trauma
• IO and EO exams
• photograph/document in notes
• review
• refer using urgent pathways - e.g. if ulcer hasn’t healed within 2-3 weeks

Question 24

Once referred to urgent pathway, what will happen to the patient next?

Answer 24

• biopsy
• imaging (of head, neck and chest, checking for spread to regional lymph nodes, size, staging and grading etc.)
• diagnosis
• treatment