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Medicine Year 1 - Semester 2 - Part 2 > Screening > Flashcards

Screening Flashcards

1
Q

What is screening ?

A

The process of identifying healthy people who may have an increased chance of a disease or condition.

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2
Q

What happens following screening ?

A

The screening provider then offers information, further tests and treatment.

This is to reduce associated problems or complications.

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3
Q

Key Fact about screening

A

Screening is a PROGRAMME, not a test.

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4
Q

What is the purpose of screening tests ?

A

Screening can:

  • Save lives or improve quality of life through early identification of a condition
  • Reduce the chances of developing a serious condition or its complications
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5
Q

State the Wilson and Jungner criteria for screening

A

The Condition
The Test
The Treatment
The Screening programme

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6
Q

The Condition

A
  • Should be an important public health problem
  • Natural history of the disease should be understood
  • Recognisable latent or early symptomatic phase
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7
Q

The Test

A

Should be:

  • Simple, safe, precise and validated
  • Acceptable to the population
  • Distribution of test results known and cut-off defined
  • Agreed policy of further diagnostic investigations
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8
Q

The Treatment

A

Should be effective and available

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9
Q

The Screening Programme

A
  • Evidence from randomised control trials that screening is effective/accurate
  • Clinically, socially and ethically acceptable
  • Cost effective
  • Quality assured
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10
Q

State some of the WHO screening criteria

A

Response to a recognised need

Defined target population

Scientific evidence of effectiveness

Programme should promote equity and access to screening

Overall benefits of screening should outweigh the harm

Quality assured, with systemic mitigation of risks

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11
Q

What screening tests are available for cancer ?

A

Bowel
Breast
Cervical

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12
Q

State some screening tests available

A

Bowel cancer
Breast cancer
Cervical cancer

Abdominal aortic aneurysm
Diabetic retinopathy

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13
Q

Describe facts surrounding screening for bowel cancer

A

Male and Female
Age: 50-74

Every 2 years

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14
Q

Describe facts surrounding screening for breast cancer

A

Female
Age: 50-70

Every 3 years

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15
Q

Describe facts surrounding screening for cervical cancer

A

Female
Age: 25-49

Every 5 years if HPV -ve

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16
Q

Describe facts surrounding screening for AAA

A

Male
Age: 65

One-off scan

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17
Q

Describe facts surrounding screening for diabetic retinopathy

A

Male and Female with diabetes
>= 12

Annually

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18
Q

What screening tests occur in pregnancy ?

A

Fetal anomaly
Infectious diseases
Sickle cell and thalassemia

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19
Q

What screening tests occur for a newborn & infant ?

A

Physical examination
Blood spot
Hearing test

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20
Q

Questions to think about when considering how good a screening test is

A

How does it perform ?
What is its sensitivity ?
What is its specificity ?

When applied to your population, how accurate are the results achieved ?

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21
Q

Sensitivity

A

How well the test picks up having the disease

22
Q

Sensitivity equation

A

Number of results where disease is detected in people with the disease

/

Number of people with the disease

23
Q

Specificity

A

How well the test detects NOT having the disease

24
Q

Specificity equation

A

Number of ‘normal’ results where the disease is NOT detected in people without the disease

/

Number of people without the disease

25
Q

Describe a highly sensitive test

A

Picks up most of the disease
Very few false negatives

26
Q

Describe a highly specific test

A

Correctly detects no disease
Very few false positives

27
Q

Positive predictive value

A

How reliable is the test result which shows disease is present

28
Q

Positive predictive value equation

A

Number of people with the disease and a positive test result

/

Number of people with a positive test result (i.e. showing disease)

29
Q

Negative predictive value

A

How reliable is the test result showing disease is NOT present

30
Q

Negative predictive value equation

A

Number of people who do not have the disease and have a negative test result

/

Number of people with a negative test result (i.e. showing no disease)

31
Q

Benefits of screening

A

Reduced disease incidence
Reduced disease mortality

Earlier, less radical treatment
Cost-effective

Overall population benefit

32
Q

Potential harms of screening

A

False reassurance
Anxiety

Over-investigation and treatment

Longer period of morbidity with unaltered prognosis

Harm from screening test
Opportunity costs
Increased health inequalities

33
Q

What was the Marmot Review ?

A

Benefit VS Harm of breast screening

34
Q

Give a brief description of the Marmot Review

A

Estimated for 10,000 women invited to screening:

681 cancers will be diagnosed, of which 129 will represent OVER-DIAGNOSIS.

43 deaths from breast cancer will be prevented.

35
Q

Feature of UK breast cancer screening programmes

A

Confer a significant benefit (reduction in mortality from breast cancer due to early detection and treatment)

Clear communication of the harms and benefits is of utmost importance.

36
Q

What does screening do ?

A

Increased incidence rates
Decreased mortality rates

37
Q

Describe informed consent relating to screening

A

Screening is NOT mandatory

Individuals should be provided with sufficient information about screening.

This includes:

  • purpose
  • potential risks and burdens
  • Pathway following tests results
38
Q

What information should be provided about screening ?

A
  • Purpose of screening
  • Potential risks and burdens
  • Pathway following tests results
39
Q

State some ethical issues about equitable outcomes

A
  • Increased cost of treatment, social care etc.
  • Viability of programme
  • Reduced effectiveness of the screening
40
Q

Describe the equality act 2010

A

Unlawful discrimination ?
Equal opportunities available ?

41
Q

Describe inequality related to bowel cancer

A

Incidence of most deprived is relatively - 12% higher than in least deprived.

But mortality rate is 22% higher.

42
Q

Describe inequality related to cervical cancer

A

Incidence is roughly 2x as high as most deprived.

But mortality is nearly 3x as high for those who are most deprived.

43
Q

Describe inequality related to breast cancer

A

Incidence of breast cancer is 14% higher in the least deprived.

Mortality is the same in both least and most deprived.

44
Q

What are some causes of inequalities ?

A

Identifying and inviting screening cohort.

Acceptability of the test

Failure to make reasonable adjustments

Poor communication about the test results or the next steps in the programme.

Prejudice leading to poor care

45
Q

State some challenges with optimising coverage

A

Change of address
Migrants
Travellers
Prisoners
Students
Trafficked people

46
Q

State some challenges with optimising uptake

A

Communication
Health literacy
Deprivation
Accessibility
Vulnerable groups
Minority ethnic groups

47
Q

Why does inequality in engagement matter ?

A

Equality of access is a legal duty

Less lives saved, poorer outcomes, more treatment

Less faith in programme - downwards spiral of engagement

48
Q

Known effective interventions

A

Letter from the GP
- patient navigation
- community mentors
- languages
- text reminders

48
Q

Stats involving inequality in engagement

A

Positivity rates affected by low coverage in high risk groups

Reduced effectiveness threatens programme viability as the balance of harm VS benefit changes

49
Q

How can we improve engagement in vulnerable groups ?

A

Social marketing
Everyone’s responsibility
Qualitative research

50
Q

How do you known if a screening programme is effective ?

A

Are the right people invited, getting screened, receiving quality treatment and follow up ?

Are the inequalities inherent in screening programmes being systematically addressed ?

Is the programme regularly reviewed ?

51
Q

Known barriers

A

Uncertainty of benefits
Fear of the screened for condition
Lack of time

Disgust
Discomfort
Embarrassment

Medicine Year 1 - Semester 2 - Part 2 (53 decks)

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