Screening Programmes Flashcards
Prevention can be divided into what 3 categories?
Primary classification - prevents a disease from developing that hasnt occurred yet
Secondary prevention - to detect a disease while it is localised or ‘early’, to reduce impact as much as possible
Tertiary prevention - to mitigate the morbidity from established disease and to improve quality of life, after disease
How many criteria must a screening programme meet for it to be put in place?
20
What are the 3 types of population screening programmes for cancer?
- mass screening - screens an entire population
- selective screening - screens the high risk people for that cancer
- opportunistic screening - screens people who are being examined for other reasons, part of a routine check-up (dental appointments)
What is sensitivity a metric for in disease?
the probability of a test identifying someone with a disease as positive
calculated as true positive/TP+False negative
What is specificity a metric for?
shows the proportion of the population correctly classified as disease-free
calculated as True negative/TN+FP
Conventional oral examination (COE) Vital rinsing, light-based detection, biomarkers and mouth self examinations are all methods of detecting potentially malignant lesions, what is currently the only properly testes health technology for detection of oral potentially malignant lesions?
Conventional oral examination
What has been the only ever properly conducted review that has evaluated the clinical or cost efficacy of mouth cancer screening?
- A large cluster randomised control trial was carried out over 15 years with 4 rounds of screening in 13 municipalities in Kerala south india.
- 19,288 persons completed 4 rounds of screening by trained university graduates (Non-medical)
- 24% reduction in mortality for high risk individuals who used tobacco and/or alcohol
- 269 life years saved per 100,00
- 1,438 lives saved among the high-risk group
- cost 6$ per person
What are the features associated with malignant progression in oral potentially malignant disorders (OPMD)
size of lesion - >200 mm
texture - non-homogeneous
colour - red (or speckled)
site - tongue and floor of mouth
sex - female (medium strength)
age - >50 (medium strength)
Examples of OPMD (oral potentially malignant disorders)
- Leukoplakia
- Erythroplakia
- Oral Submucous Fibrosis
- Oral lichen planus
What does oral cancer look like?
- red patch (of unknown cause) = erythroplakia
- white patch (of unknown cause) = leukoplakia
- speckled patch (red and white)
- ulcer
- indurated margins (thick, heaped rubbery margins)
- endophytic (growing inwards) lesions
- exophytic (growing outwards)
What are worrying features of cancer?
- painless (cancer only becomes painful when it becomes secondarily infected or invades nerves)
- high risk sites - floor of mouth, lateral tongue
- bigger the lesion = more worrying
- bone involvement elevates the T stage
- spread to draining lymph nodes (can be early in oral cancer)
What is perineural spread of cancer?
spread of cancer cells into nerve tissue
common in head and neck cancer
In primary care if you are concerned of a lesion, what should you do?
Take a full detailed history, including risk factors
Take photographs of lesion
Eliminate trauma if suspected
Review the patient a week or 2 later
If no improvement once trauma has been eliminated refer using urgent pathway
Once a patient has been referred, what happens next?
They will be referred to the maxillofacial department
- they will carry out an incisional biopsy
- imaging of head and neck to check for spread to regional nodes and outlie the exact size of the lesion
- they will come up with a diagnosis and treatment accordingly
