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MD2002 Lucas > Screening > Flashcards

Screening Flashcards

1
Q

What is screening ?

A

A process of identifying apparently healthy people who may be at increased risk of a disease or condition.

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2
Q

If a person is found to be at increased risk of a disease/condition, what are some steps which can be taken ?

A

Offered information, further tests and appropriate treatment to reduce associated risks or complications.

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3
Q

What are some of the main differences between screening and healthcare ?

A

Screening:

  • mostly proactive
  • targets asymptomatic patients
  • implies benefit, but harms are always possible.

Healthcare:

  • Patient initiated
  • targets symptomatic patients
  • possible hope or expectation but no promise of benefit
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4
Q

Give 3 examples of screening programmes for each of adults, pregnant women, and infants.

A
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5
Q

Describe the age, M/F, and frequency of screening for bowel cancel and breast cancer.

A

Bowel Cancer:

  • M and F
  • 50-74
  • Every 2 years

Breast Cancer:

  • F
  • 50-70
  • Every 3 years
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6
Q

What are the requirements for the screening of a condition to be viable and effective ?

A
  • Response to a recognized need
  • Objectives defined and evaluation planned at outset
  • Defined target population
  • Scientific evidence of effectiveness
  • Programme should be comprehensive and integrated
  • Quality assured, with systematic mitigation of risks
  • Informed choice, confidentiality and respect for autonomy -Programme should promote equity and access to screening The overall benefits of screening should outweigh the harm
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7
Q

What does sensitivity calculate in screening programmes ? What is for the formula for it ?

A
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8
Q

What does specificity calculate in screening programmes ? What is for the formula for it ?

A
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9
Q

What is the characteristic of a highly sensitive screening programme ?

A

Detects most of the disease

Very few false negatives

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10
Q

What is the characteristic of a highly specific screening programme ?

A

Correctly detects no disease

Very few false positives

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11
Q

What is a positive predictive value ?

A

“Probability that subjects with a positive screening test truly have the disease.”

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12
Q

What is a negative predictive value ?

A

“Probability that subjects with a negative screening test truly don’t have the disease.”

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13
Q

What is the formula for positive predictive value ?

A
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14
Q

What is the formula for negative predictive value ?

A
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15
Q

How are Positive Predictible Value and Negative Predictible Value affected by prevalence ?

A

“If we test in a high prevalence setting, it is more likely that persons who test positive truly have disease than if the test is performed in a population with low prevalence.”

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16
Q

What are the potential benefits of screening ?

A
  • Reduced disease incidence (increased QOL)
  • Reduced disease mortality
  • Earlier, less radical treatment (increased QOL)
  • Cost-effective
  • Overall population benefit
  • Reducing risks of developing serious condition or its complication
17
Q

What are the potential harms of screening ?

A
18
Q

What is the purpose of the Marmot Review of the UK Breast Screening Programme ?

A

Weights the benefits (e.g. deaths prevented) and harms (e.g. overdiagnoses ) of breast screening

19
Q

What was the conclusion of the Marmot Review of the UK Breast Screening Programme ?

A

Significant benefits to the screening, so it should continue.
Communication about the benefits and harms with the women crucial.

20
Q

What pieces of information which must be given to the patient before he/she can give informed consent to a screening procedure ?

A
  • Purpose
  • Potential risks and burdens
  • Pathway following test results
21
Q

What are some examples of biases in screening programmes ?

A
  • Participant (volunteer) bias
    – “When the subjects who volunteer to participate in a research project are different in some ways from the general population”
  • Lead-time bias
    – “An apparent increase in survival due to detecting a health condition such as cancer at an early stage, when there is no actual effect on survival, just a longer period with the diagnosis”
  • Length-time bias
    – Detection of less aggressive forms of condition in screening (“increases apparent survival”)
22
Q

How can one measure the effectiveness of a screening ?

A

Randomised controlled trial
Time trend studies
Case control studies
Modelling studies

23
Q

Compare breast, cervical, and bowel cancer in terms of incidence and mortality for different deprivation levels.

A

Bowel Cancer: Higher incidence and mortality for more deprived levels

Cervical cancer: More incidence and mortality for more deprived levels

Breast cancer: Slightly more incidence for less deprived levels, same mortality

24
Q

Describe the potential impact of screening programmes on health inequalities ?

A
  • Increased cost of treatment, social care etc
25
Q

Why are the inequalities created by screening programmes illegal ?

A

Equitable outcomes are a legal requirement of Equality Act

26
Q

With a = eligible population b = invited population

c = screened population, what is the formula for coverage ?

A

c/a x 100%

27
Q

What are some challenges with optimising coverage ?

A
  • Minority ethnic groups
  • Immigrants
  • Travellers
  • Prisoners
  • Students
  • Reduced uptake
28
Q

With a = eligible population b = invited population

c = screened population, what is the formula for uptake ?

A

c/b x 100%

29
Q

What are some challenges with optimising uptake ?

A
  • Change of address
  • Communication
  • Health literacy
  • Deprivation
  • Accessibility
  • Vulnerable groups
30
Q

What are some measures to improve screening engagement and uptake ?

A
  • Promotion of screening programme
  • Material in variety of languages
  • “The wee C”
  • “The Smear Amnesty”
  • Toolkits for general practice
31
Q

What are some inequalities which exist in uptake of screening, in addition to inequalities in wealth ?

A

Learning disability, sex, minority ethnicity and age.

32
Q

What are some ways in which higher level of deprivation are affected by inequalities, regarding screening ?

A

Poorer outcomes, less lives saved, more treatment, reduced productivity (which threatens program viability)
As a result, less faith in the programme

33
Q

What are some measures to improve engagement in vulnerable groups ?

A

MD2002 Lucas (111 decks)

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