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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
Describe a highly sensitive test
Picks up most of the disease Very few false negatives
26
Describe a highly specific test
Correctly detects no disease Very few false positives
27
Positive predictive value
How reliable is the test result which shows disease is present
28
Positive predictive value equation
Number of people with the disease and a positive test result / Number of people with a positive test result (i.e. showing disease)
29
Negative predictive value
How reliable is the test result showing disease is NOT present
30
Negative predictive value equation
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
Benefits of screening
Reduced disease incidence Reduced disease mortality Earlier, less radical treatment Cost-effective Overall population benefit
32
Potential harms of screening
False reassurance Anxiety Over-investigation and treatment Longer period of morbidity with unaltered prognosis Harm from screening test Opportunity costs Increased health inequalities
33
What was the Marmot Review ?
Benefit VS Harm of breast screening
34
Give a brief description of the Marmot Review
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
Feature of UK breast cancer screening programmes
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
What does screening do ?
Increased incidence rates Decreased mortality rates
37
Describe informed consent relating to screening
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
What information should be provided about screening ?
- Purpose of screening - Potential risks and burdens - Pathway following tests results
39
State some ethical issues about equitable outcomes
- Increased cost of treatment, social care etc. - Viability of programme - Reduced effectiveness of the screening
40
Describe the equality act 2010
Unlawful discrimination ? Equal opportunities available ?
41
Describe inequality related to bowel cancer
Incidence of most deprived is relatively - 12% higher than in least deprived. But mortality rate is 22% higher.
42
Describe inequality related to cervical cancer
Incidence is roughly 2x as high as most deprived. But mortality is nearly 3x as high for those who are most deprived.
43
Describe inequality related to breast cancer
Incidence of breast cancer is 14% higher in the least deprived. Mortality is the same in both least and most deprived.
44
What are some causes of inequalities ?
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
State some challenges with optimising coverage
Change of address Migrants Travellers Prisoners Students Trafficked people
46
State some challenges with optimising uptake
Communication Health literacy Deprivation Accessibility Vulnerable groups Minority ethnic groups
47
Why does inequality in engagement matter ?
Equality of access is a legal duty Less lives saved, poorer outcomes, more treatment Less faith in programme - downwards spiral of engagement
48
Known effective interventions
Letter from the GP - patient navigation - community mentors - languages - text reminders
48
Stats involving inequality in engagement
Positivity rates affected by low coverage in high risk groups Reduced effectiveness threatens programme viability as the balance of harm VS benefit changes
49
How can we improve engagement in vulnerable groups ?
Social marketing Everyone's responsibility Qualitative research
50
How do you known if a screening programme is effective ?
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
Known barriers
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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