Screening Flashcards

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1
Q

Screening

A

Testing (i.e. questions, physical exams, labs etc.) asymptomatic
people

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2
Q

Examples of Screening

A

“Annual physical”

Periodic:
* Colonoscopies
* Gynecological exams
* Mammograms
* PSA

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3
Q

Purpose of Screening

A

Detect diseases that are better treated before signs and
symptoms show up and prevent people from suffering with or
dying from them
* E.g. (in theory) PSA for prostate cancer

Use knowledge of risk factors for disease to prevent or
decrease the burden of the disease by modifying the risk factors
* E.g. lipid panels for cardiovascular disease

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4
Q

For the best results, the disease should be:

A

A significant public health problem (common and/or significant
morbidity and/or mortality)

Treatable with these stipulations:
- the potential for cure increases with early detection and treatment is easily available

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5
Q

For the best results, the test should be..

A
  • sensitive to pre-clinical disease
  • SAFE
  • inexpensive
  • easily accessbile
  • lead to demonstrated improved health outcomes
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6
Q

a condition detected by screening that does not require treatment because it will not adversely affect the patient’s life.

A

pseudo disease

If treated, patient may be considered “cured” despite the fact that even if untreated, the condition would not have killed them before they died of something else.

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7
Q

conditions that might not progress to symptomatic disease
and may even regress.

A

Type 1 pseudo disease

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8
Q

slowly progressive disease (conditions with a long detectable preclinical phase). Patient would “die with it, not from it”

A

Type II pseudo disease
- PROSTATE CANCER OFTEN

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9
Q

Unlike when a patient arrives with a concern, screening applies tests
to ostensibly healthy people. What is the pre-test probability?

A

VERY LOW

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10
Q

Harms of Screening

A
  • harms of test (radiation, colonoscopy, cost, time)

False positives:
- psychological burden
- further testing (over-testing)
- over-treatment (even “safe” treatments impose a burden, financial and otherwise)

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11
Q

Thyroid cancer incidence increased 6.4X during this period

95% of these cancers were small and detected mainly
through the screening program

Mortality from thyroid cancer remained unchanged

What criteria did this program fail to fulfill?

A
  • the potential for cure apparently did NOT increase with early detection
  • testing did NOT lead to demonstrated improved health outcomes
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12
Q

Screening means testing people for conditions when they are
___________

A

asymptomatic

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13
Q

The goal of screening is to prevent disease or treat it early to…

A

to minimize disease harms

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14
Q

Advantages of screening include

A

disease prevention and early treatment.

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15
Q

Disadvantages include

A

over-testing and over-treatment

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16
Q

Particularly low pretest probabilities are a significant factor when

A

interpreting the results of a screening test

17
Q

Screening represents a balance between cases in which it may be
possible to change the outcome and those in which we are causing a net harm (overdiagnosis

A