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Pop health > Screening lecture > Flashcards

Screening lecture Flashcards

1
Q

What is screening?

A

The application of a test, examination or other procedure to the ASYMPTOMATIC population to distinguish between those with disease and those who don’t have it

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2
Q

What is screening NOT intended to be…

A

A diagnostic tool - someone with a breast lump.. NO SCREENING go on to a diagnostic test

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3
Q

What does a screening test do?

A

Identifies screened people as positive (High risk) or negative (low risk) populations

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4
Q

For high risk populations the screening test is…

A

Diagnostic/confirmatory (disease present - true positive, no disease, false positive)

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5
Q

For low risk populations the screening test is…

A

(Disease present - false negative), no disease (true negative)

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6
Q

What is sensitivity?

A

True positive/ (true positive + false neg) * 100

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7
Q

What is specificity?

A

True negative/ (true negative + false positive) * 100

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8
Q

What is a PPV? (performance of test rather than accuracy)

A

True positive / (True positive + False positive)

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9
Q

What is a NPV?

A

True negative / (True negative + False negative)

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10
Q

What is Lead time?

A

Lead time is the interval between the time of detection by screening and the time at which the disease would have been diagnosed in the absence of screening

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11
Q

What happens because of lead time?

A

All individuals with disease identified as a result of scenting will have a longer survival time than those diagnosed the “normal way” (falsely elongated survival time)

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12
Q

What is length time bias? (e.g. prostate cancer)

A

Less rapidly progressing cancers will not progress to symptomatic stages quickly. more likely to be found by screening vs more aggressive cancers. (Better outcomes in screen-detected vs non-screen detected tumours)
Always more likely to detect slowly progressing disease

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13
Q

What are the 4 biases in screening?

A
  1. Lead time bias
  2. Length time bias
  3. selection bias
  4. overdiagnosis
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14
Q

What is selection bias?

A
  1. People who are screened may appear to live longer
  2. more likely to have higher SES and education
  3. self-selected studies - people have better outcomes
  4. better educated wealthier … etc
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15
Q

What are 3 pros of screening?

A
  1. Detect cancer early
  2. Tests done easily without discomfort
  3. Can make you feel more at ease and in control of your health
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16
Q

What are 3 cons of screening

A
  1. Can produce false negatives
  2. can be uncomfortable and complicate your health
  3. can produce false positives - follow-up, stress,
  4. complications from the test itself
  5. Labeling - damage when we tell someone who feels well they are sick
17
Q

What is population-based screening?

A

Test is offered systematically to all individuals in the defined target group within a framework of agreed policy, protocols, quality management, monitoring and evaluation

18
Q

What is case-finding?

A

Opportunistic, occurs when a test is offered to an individual without symptoms of the disease when they present to HCP for reasons unrelated to that disease

19
Q

What is the effectiveness of screening for BrCA?

A

25% reduction in MORTALITY (50-69 yrs) - evidence from RCTs

20
Q

What is the effectiveness of screening for cervical Ca?

A

80% reduction in INCIDENCE with regular screening (world cancer report 2008)

21
Q

What is the effectiveness of screening for Colerectal Ca?

A

16% reduction in MORTALITY
20% reduction in INCIDENCE
(RCT evidence)

22
Q

What are the breast screening recommendations for mammography?

A

40-49 - NOT routinely screened
50-69 routine screening (2-3 years)
70-74 routine screening (2-3 years)

23
Q

What are the breast screening recommendations for MRI?

A

40-74 NOT at high risk - NOT routinely screened

30-69 HIGH risk - ANNUAL screening + Mammography

24
Q

What are the breast screening recommendations for breast self examination?

A

NOT advising women to BSE

25
Q

What are the breast screening recommendations for clinical breast examination?

A

NOT RECOMMENDED to CBE alone or in conjunction with mammography

26
Q

What are the ontario cervical screening guidelines?

A

No annual pap test - only every 3 years -

27
Q

When do you start screening for Cervical cancer?

A

Age 21 - have been or are sexually active

28
Q

when do you stop screening?

A

if you’ve had 3 regular pap tests in previous 10 years and are over the age of 70.

29
Q

Who should be screened annually for cervical cancer?

A
  1. HIV positive or immunocompromised women

2. Previous treated for dysplasia

30
Q

Who should be screened as per guidelines?

A
  1. as before
    +
  2. Women with subtotal hysterectomies with intact cervix
  3. pregnant women screened same as non pregnant women
  4. women who have sex with women same as with men
31
Q

who can discontinue cervical screening?

A

women with total hysterectomies removed for benign causes

32
Q

If you have no signs or symptoms and no affected 1st degree relatives - do a FOBT q2 years and it’s positive

A

refer to colonoscopy

33
Q

If you have no signs or symptoms and no affected 1st degree relatives - do a FOBT q2 years and it’s incomplete

A

CCC will recall

34
Q

If you have no signs or symptoms and no affected 1st degree relatives - do a FOBT q2 years and it’s negative

A

repeat in 2 years

35
Q

Who is at an increased risk –> colonoscopy?

A
  1. individuals with Family Hx ( primary relative with cc)

2. Start at age 50, or 10 years earlier than relatives age at diagnosis whichever is earliest!!!

36
Q

If prevalence decreases (i.e. proportionately less people with disease) THEN what happens?

A

the Positive predictive value will decrease because you will have more FALSE POSITIVE

37
Q

To rule out a disease explain…

A

Sensitivity - to rule OUT… a NEGATIVE result RULES OUT

high sensitivity

38
Q

To rule in a disease…

A

Specificity - Positive score rules IN SPIN

39
Q

If you want to be sure of someone who HAS disease - a test should be…. highly

A

Sensitive

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