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Oncology Therapeutics > Screening and Prevention > Flashcards

Screening and Prevention Flashcards

1
Q

What are risks that are causally associated with cancer? (5)

A
  1. Cig smoking/tobacco
  2. Infections
  3. radiation
  4. enviromental exposures/pollutants
  5. Immunosuppression
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2
Q

What are some modifiable risk factors?

A,C,D,E,S,M,O,S,U

A

Alcohol
Comorbidities
Diet
Exercise
STD related infections
medications
obesity
smoking
UV exposure

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3
Q

Non Pharm : Smoking Cessation
1. which cancers can this benefit ? (3)

  1. Interestingly, the act of smoking DECREASES ___

Non Pharm : Sunscreen and UV protection
1. Which cancers can this reduce incidence for?

A
  1. Lung cancer
  2. Head and neck cancer
  3. Stomach and bladder cancer risk reduced over time

2.endometrial cancer risk

  1. new Melanoma
  2. Squamous cell cancers
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4
Q

Pharm : HPV Vaccination
1. It’s FDA approved only for use in prevention of which types of cancer? (3)
2. When is it most effective?

A
  1. Genitourinary, anal, and head+neck cancer
  2. If given before initiation of sexual contact
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5
Q

SERMS in Breast Cancer:

  1. Tamoxifen
    - Reduced risk 30-50% over 5 yrs but only for what kind of breast cancer? (2)
    - Which women recc for ?
    - As compared to Raloxifene, Tamoxifen is better for ?
    -Risk of ___ or ___ is higher w/tamoxifen
  2. Raloxifene
    -Shown only to reduce incidence of breast cancer in ?
    -It’s duration of effect is not as __ as tamoxifen
    -However, as compared to tamoxifen it is better ___
A
  1. ER +, ductal carcinoma in-situ
  • Post menopausal and high risk premenopausal women
  • prevention

-VTE, endometrial cancer

  1. Postmenopausal women
  • long
  • tolerated
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5
Q

NCCN Breast Cancer Risk reduction Guidelines:

  1. For which group of women ?
  2. Options for risk reduction ? (2)
A
  1. Women >=35 yo at HIGHER RISK than the general population (genetic predisposition with first degree relative, prior thoracic radiation therapy at <30 yo, life expectancy >=10 yrs)
  2. Surgery (Bilateral total mastectomy +/- reconstruction or Bilateral salpingo-oophorectomy w/peritoneal washings)

Treatment : Premeno using clinical trial or tamoxifen

posmeno using clinical trial , tamoxifen, raloxifene, or aromatase inhib

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6
Q

Oral Contraceptives :

  1. Which cancers can they decr risk in and by how much ? (3)
  2. For Ovarian, state how long the protective effect could last
  3. It can also potentially incr risk of ____
  4. What drug can reduce risk of endometrial cancer in those w/complex atypical hyperplasia?
A
  1. Ovarian Cancer , up to 50% after 5+yrs
    -Longer use = greater protection

Endometrial Cancer , up to 50% or more
-Longer use = greater protection

Colorectal Caner

  1. Ovarian = up to 30yrs after stopping
  2. breast cancer
  3. Progesterone
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7
Q

Aspirin and NSAIDS :
1. Decr risk of developing or dying from which type of cancer ?
2. decr risk of developing ___
-This is dose dependent…. whats the regular usage ?

  1. What about those with FAP? what drug shows benefit ?
A
  1. Esophageal cancer
  2. colon cancer
    ->=2tabs/week reduces risk of colon cancer
  3. Celecoxib
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8
Q

5Alpha Reductase Inhibs for Prostate Cancer Prevention :

  1. Even though the risk is reduced, what happens to those who develop prostate cancer?
  2. Is there a survival benefit?
A
  1. They have more aggressive prostate cancer !–> OS not affected though bc grade of cancer once diagnosed is higher
  2. No
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9
Q

HepB Vaccination :
1. vax’s in younger pt’s reduced ____ incidence in young adults

HPylori Eradication
1. Tx of infection can reduce risk of ?
2. Will it reduce mortality ?

A
  1. hepatocellular carcinoma (HCC)
  2. risk of gastric cancer
    -Amoxicillin + PPI reduced incidence but not mortality
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10
Q

Breast Cancer Screening : Average Risk

What is the USPSTF guideline for the following :

  1. Breast self exam
  2. Clinical breast exam
  3. Mammogram
  4. WHat did the meta analysis by USPSTF find out about annual mamography?
A
  1. not recc
  2. not recc
  3. Age 40-49 –> risk/benefit decision for biennial screening
    Age 50-74 Biennial screening
    Age 75+ insuff evidence
  4. Annual mammography reduces mortality from breast cancer in women age 50yrs and older
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11
Q

Breast Cancer Screening Controversy:

  1. Screening cant address?
  2. Early screening would NOT ADDRESS ___
  3. Recc is to Allow women to ?

See chart for BC screening for high risk

A
  1. Underlying differences in cancer biology (incidences of trip neg cancer –> can also be missed by screening )
  2. problems facing poor women (lower quality of medical services avail, delayed follow up on abnormal scans, delays to tx, and less use of adjuvant therapy best and most equitable tx possible)
  3. Make their own decisions based on their own assessment of the data and their values and to redirect resources to ensuring that ALL WOMEN with breast cancer receive the best and most equitable tx possible
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12
Q

CRC (Colorectal Cancer) Risk Stratification
1. Average risk
2. Incr risk
3. High risk

A
  1. age >=45
    -No hx of adenoma or SSP or CRC
    -No hx of IBD
    -Neg fam history for CRC
  2. Personal history of: ADenoma or SSP
    -CRC, IBD (UC or Crohn’s)

Pos Fam HX of
-one 1st degree relative with CRC at age <=60
-2 1st degree relatives w/CRC at any age
-1st degree relative w/confirmed advanced adenoma

  1. Lynch syndrome
    -Polyposis syndromes (FAP)
    -Li Fraumeni SYndrome
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13
Q

Screening for Avg Risk Pt’s for CRC >=45yo : See chart!!!

A

See chart

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14
Q

Lung Cancer
1. Screening guidelines for which subset of pt’s using wat ?
2. Age range
3. pack history ?
4. Former Smoker?

A
  1. asymptomatic high risk patients with low dose CT
  2. > =50yrs
  3. 20+pack-years
  4. QUit within 15yrs, discontinue after 15yrs of cessation or when health precludes curative therapy or limits life expectancy
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15
Q

Prostate Cancer Screening :
1. Why is it controversial ?
2. Screening modalities? (2)

A
  1. screening may reduce incidence or mortality, but risks of overdiagnosis and tx make long term survival outcomes questionable
  2. Prostate specific antigen (PSA)
    -Lots of false positives , can be altered by medications (5alphareductase inhibs, saw palmetto, androgen blockers)
    -Goal levels controversial
  3. Digital Rectal Exam (DRE)
    -High variable, most guidelines dont recc
16
Q

Cancer Screening for Transgender and Gender Diverse Pt’s : Breast Cancer Screening for Transmasculine Persons

  1. Pt has NO HX of mastectomy or have only undergone breast reduction
    -Recc?
    -Screening modality ?
  2. PreOP evaluation
    -Recc?
    -Screening modality ?
  3. Post SQ mastectomy with or w/o testosterone use
    -recc?
    -Screening Modality ?
A
  1. Follow BC guidelines for cisgender women
    -Mammography
  2. Screening mammography may be indicated if pt meets requirements for cisgender women
    -Mammography
  3. Clinician needs to obtain clear surgical hx and discuss with pt unknwon link between residual breast tissue + cancer risk to determine need for screening! Yearly chest wall and axillary exam

-Annual chest wall and axillary exam

17
Q

Breast Cancer Screening : Transfeminine Persons

  1. PT HX –> Age 50 and completed 5-10 yrs of feminizing hormones

-Recc?
-Screening Modality ?

Prostate Cancer Screening for Transfeminine:

  1. Androgen suppression associated with ___ may actually be ___ , overall incidence of prostate cancer among TF persons is ____
  2. Prostate screening for TF persons based on screening guidelines for ?
A
  1. Screen every 2 yrs!

Mammography

  1. Gender affirming hormonal therapy , protective
    -low (Due to PSA levels decr)
  2. Cisgender men , starting at age 50

Oncology Therapeutics (17 decks)

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