Prevention and Screening

Question 1

Primary Prevention

Answer 1

Most cost effective form of healthcare
Health screening for risk factors
Immunizations 
Health risk assessment
Education

Question 2

Secondary Prevention

Answer 2

Identify and treat individuals that are asymptomatic who have risk factors for a disease
Cancer: Mammogram, PAP, PSA, COLONOSCOPY
HTN: BP checks

Question 3

Tertiary Prevention

Answer 3

Part of management of a given established disease aimed at decreasing complications
Lifestyle modification
Education about the disease
Medications

Question 4

leading cause of death in the US

Answer 4

Coronary Artery Disease

Question 5

1 Cancer in the US

Answer 5

Basal cell CA

Question 6

1 cancer death for men and women in the US

Answer 6

Lung CA

Question 7

Most prevalent cancer for women in the US

Answer 7

Breast CA

Question 8

Sensitivity

Answer 8

“true positive”
% of patients that test positive
who have the disease

Question 9

Specificity

Answer 9

“true negative”
% of patients that test negative
who do not have the disease

Question 10

Mammography Recommendations USPSTF

Answer 10

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

Question 11

Mammography Recommendations ACS

Answer 11

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

Question 12

Mammography Recommendations American College of Obstetrics

Answer 12

Mammography every 1-2 years beginning age 40

Clinical breast exam annually beginning age 20 years

Question 13

second most common cancer in women

Answer 13

cervical cancer 
Most common cause of mortality from GYN cancer
Risk Factors
early onset intercourse < age 17
Smoking
DES exposure in-utero
HPV

Question 14

USPSTF Cervical CA screening recommendations

Answer 14

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.

Question 15

Recommendations by The American Cancer Society (ACS), The American Society for Colposcopy and Cervical Pathology (ASCCP), and The American Society for Clinical Pathology (ASCP)

Answer 15

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.

Question 16

Discontinuation of PAP

Answer 16

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

Question 17

USPSTF recommendation prostate screening

Answer 17

Recommend against PSA screening for prostate cancer

Grade D recommendation

Question 18

Colon Cancer Burden of disease

Answer 18

Third most common cancer in the US

Second leading cause of caner death

Question 19

Risk factors for Colon Cancer

Answer 19

personal or family h/o colorectal cancer/adenomatous polyps in 1st degree relative
UC
Familial polyposis or hereditary nonpolyposis colorectal cancer

Question 20

Guaiac Based FOBT

Answer 20

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%

Question 21

June 2017 the US Multi-Society Task Force on Colorectal Cancer issued updated screening recommendations that divide screening tests into three tiers

Answer 21

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.

Question 22

USPSTF Colon cancer screening recommendations

Answer 22

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

Question 23

Intervals for USPSTF colon cancer screenings

Answer 23

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

Question 24

Suggested timing of initial screening and intervals for subsequent testing for different risk populations are as follows (Colon cancer)

Answer 24

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

Question 25

Lung Cancer Screening USPSTF

Answer 25

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

Question 26

USPSTF cholesterol screening guidelines

Answer 26

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