Prevention and Screening Flashcards
Primary Prevention
Most cost effective form of healthcare Health screening for risk factors Immunizations Health risk assessment Education
Secondary Prevention
Identify and treat individuals that are asymptomatic who have risk factors for a disease
Cancer: Mammogram, PAP, PSA, COLONOSCOPY
HTN: BP checks
Tertiary Prevention
Part of management of a given established disease aimed at decreasing complications
Lifestyle modification
Education about the disease
Medications
leading cause of death in the US
Coronary Artery Disease
1 Cancer in the US
Basal cell CA
1 cancer death for men and women in the US
Lung CA
Most prevalent cancer for women in the US
Breast CA
Sensitivity
“true positive”
% of patients that test positive
who have the disease
Specificity
“true negative”
% of patients that test negative
who do not have the disease
Mammography Recommendations USPSTF
Recommends against routine screening 40-49 years: Grade C (individual decision)
Screen women age 50-74 every 2 years: Grade B biennially, stop at 75
Recommends against teaching SBE
Insufficient evidence grade D with grade I statement
Mammography Recommendations ACS
Annual mammography age 40 years
Age 40-44 individual decision
Age 45 all women yearly
Age 55 biennially
continue as long as good health and life expectancy is 10 years
Clinical breast exam every 3 years age 20-39
Annually after age 40years
Mammography Recommendations American College of Obstetrics
Mammography every 1-2 years beginning age 40
Clinical breast exam annually beginning age 20 years
second most common cancer in women
cervical cancer Most common cause of mortality from GYN cancer Risk Factors early onset intercourse < age 17 Smoking DES exposure in-utero HPV
USPSTF Cervical CA screening recommendations
Age <21 years: Recommend against screening.
Age 21-29 years: Screen with cervical cytology every 3 years.
Age 30-65 years: Screen with cervical cytology every 3 yearsorin women who want to lengthen screening interval, screen with cervical cytology and HPV testing every 5 years.
Age >65 years: Recommend against screening if adequate prior screening and not at high risk for cervical cancer.
Recommend against screening for cervical cancer with HPV testing, alone or in combination with cytology, in women younger than 30.
Recommendations by The American Cancer Society (ACS), The American Society for Colposcopy and Cervical Pathology (ASCCP), and The American Society for Clinical Pathology (ASCP)
Begin Pap smears at age 21, regardless of when sexual activity began.
Age 21-29: Screen with cervical cytology alone every 3 years.
Age 30-65: Screen with cervical cytology and HPV testing (co-testing) every 5 years (preferred)orscreen with cervical cytology alone every 3 years (acceptable).
Women >65 years of age with a history of CIN 2, 3, or adenocarcinoma in situ: Continue routine screening for at least 20 years after treatment or regression. In some women, this may mean screening past age 65.
HPV testing alone should not be used as cervical cancer screening.
Discontinuation of PAP
ACS/ASCCP/ASCP: Discontinue after age 65 with adequate negative prior screeningand no history of CIN 2 or higher within the last 20 years.
USPTF: Discontinue after age 65 with adequate prior screeningand not at high risk of cervical cancer (ie, history of high-grade precancerous lesion or cervical cancer, in utero DES exposure, or immunocompromised).
ACOG: Discontinue after age 65 with adequate negative prior screening* and no history of CIN 2 or higher.
*Adequate negative prior screening defined as three consecutive negative cytology results or two consecutive negative co-tests within the last 10 years before stopping with the most recent test within the last 5 years.
Women with HIV should continue to have screening
USPSTF recommendation prostate screening
Recommend against PSA screening for prostate cancer
Grade D recommendation
Colon Cancer Burden of disease
Third most common cancer in the US
Second leading cause of caner death
Risk factors for Colon Cancer
personal or family h/o colorectal cancer/adenomatous polyps in 1st degree relative
UC
Familial polyposis or hereditary nonpolyposis colorectal cancer
Guaiac Based FOBT
2 samples of 3 different stools to six test card panels
Positive Hgb: turns blue
False negative with Vitamin C
False positive with ASA, NSAIDS, red meat
DRE single panel test sensitivity 9% should not be used
Hemoccult II
Sensitivity 25-38% & specificity 98%
Hemocult SENSA
Sensitivity 64-80% & specificity 87-90%
June 2017 the US Multi-Society Task Force on Colorectal Cancer issued updated screening recommendations that divide screening tests into three tiers
Tier 1 tests consist of the following:
Colonoscopy every 10 years
Annual FIT
Tier 2 tests consist of the following:
CT colonography every 5 years
FIT–fecal DNA every 3 years
Flexible sigmoidoscopy every 5–10 years
Tier 3 testing is capsule colonoscopy every 5 years
Septin 9 testing is not recommended.
USPSTF Colon cancer screening recommendations
start average risk patients at age 50 years and continue until age 75 years
FOBT, sigmoidoscopy or colonoscopy
aged 76 to 85 years
Recommend against routine screening Grade C recommendation
USPSTF does not recommend colorectal cancer screening for adults older than 85 years
Intervals for USPSTF colon cancer screenings
Stool-based screening tests and intervals are as follows:
Guaiac-based fecal occult blood test (FOBT), every year
Fecal immunochemical test (FIT), every year
FIT-DNA, every 1 or 3 years
Direct visualization screening tests and intervals are as follows:
Colonoscopy, every 10 years
Computed tomographic (CT) colonography, every 5 years
Flexible sigmoidoscopy, every 5 years
Flexible sigmoidoscopy with FIT; sigmoidoscopy every 10 years, with FIT every year
to increase screening rates- the USPSTF provide a range of screening options rather than a ranking of tests
Suggested timing of initial screening and intervals for subsequent testing for different risk populations are as follows (Colon cancer)
average risk, testing with a tier 1 test should begin at age 45 years for African Americans and at age 50 for patients of all other races.
family history of colorectal cancer or advanced adenoma diagnosed
Lung Cancer Screening USPSTF
USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years (2013 update)
CT scan: sensitivity 94% specificity 73%
have a 30 pack-year smoking history and currently smoke
or have quit within the past 15 years
Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery
USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years (2013 update)
CT scan: sensitivity 94% specificity 73%
have a 30 pack-year smoking history and currently smoke
or have quit within the past 15 years
Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery
USPSTF cholesterol screening guidelines
Grade A Screen all men age 35 Screen all women age 45 Grad B Screen men age 20-35 and women age 20-45 Family history of CAD prior to age 50 Diabetes HTN Smoking
