Screening and Prevention

Question 1

What are the levels of prevention?

Answer 1

1st - wellness activities focused on patients with risk factors but without disease (e.g., use of condoms by MSM)
2nd - screening of patients with pre-clinical stages of disease (e.g., screening IDUs for HIV infection)
3rd - prevention of complications for patients with active disease (e.g., use of antiretroviral medications to prevent OIs in PLHIV)

Question 2

When is screening recommended in older adults?

Answer 2

when balance of life expectancy, functional status, comorbid conditions, overall health goals, preferences, and benefits of screening test outweigh risks

Question 3

What are the USPSTF recommendations regarding breast cancer screening in women?

Answer 3

women ages:

• 40-49 should have a discussion with provider and decision should be individualized (shared decision making)
• 50-74 every 2 years

Question 4

What are the American Cancer Society recommendations on breast cancer screening in women?

Answer 4

start screening at age 45
- 40-44 should have the opportunity to begin annual screening (shared decision making)
- 45 to 54 annual screening
- 55 and older may be screened bi-annually
=> screening for women older than 50 is not controversial - the benefit of screening increases with age

Question 5

What is the recommended screening test for breast cancer?

Answer 5

mammography - CT, MRI, and ultrasound do not have a clear place

Question 6

What are the recommendations on self breast exam (SBE)?

Answer 6

• USPSTF: recommends against

- American Cancer Society: recommends breast awareness (aware of normal appearance and changes) => SBE optional

Question 7

What are the recommendations on clinical breast exam (CBE)?

Answer 7

• USPSTF - no recommendation

- American Cancer Society - does not recommend CBE as a screening method

Question 8

What is the USPSTF recommendation on prostate screening?

Answer 8

USPSTF recommends AGAINST routine PSA-based screening for men of average risk, regardless of age

Question 9

What is the American Cancer Society recommendation on prostate screening?

Answer 9

shared decision making for men 50 to 70 - start at age 45 for African American men

Question 10

What is the recommended screening test for prostate cancer?

Answer 10

prostate specific antigen (PSA) for patents who prefer to be screened - digital rectal exam (DRE) can improve cancer detection but only for cancers at advanced stages (has no effect on cancer mortality)

Question 11

What are the recommendations for colon cancer screening?

Answer 11

both USPSTF and ACS recommend screening between ages 50 and 75 for patients at average risk

Question 12

What is the recommended screening test for colon cancer?

Answer 12

any of the following can be used - none of the methods has proven superior:

• colonoscopy (direct visualization) q 10 years
• flexible sigmoidoscopy (direct visualization - limited to the rectum and sigmoid) q 5 years
• CT colonography (virtual colonoscopy) - q 5 years
• fecal occult blood (detection of “heme” portion of hemoglobin) q 1 year
• fecal immunochemical testing (detection of “globin” portion of hemoglobin) q 1 year
• stool DNA (detects DNA of cancer cells shed in stool) q 1 year