SM_280b: Cancer Screening Flashcards

1
Q

Cancer screening is ___

A

Cancer screening is performance of a procedure to detect cancer or precancerous condition before onset of symptoms

  • Not the same as diagnosis
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2
Q

Describe factors that favor screening as a population strategy

A

Factors that favor screening as a population strategy

  • High burden of disease (cancer is common)
  • Precancerous lesion or early stage disease detectable by screening (long latency)
  • Clinical intervention at this stage prevents subsequent development of cancer or improves prognosis of cancer
  • Screening test with favorable test characteristics: accurate, safe, affordable and available
  • Clinical outcomes are improved: requires effective treatment intervention, risks and harms of intervention are acceptably low, early treatment after screening is more effective than later treatment without screening
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3
Q

Describe the adenoma carcinoma sequence in colorectal cancer

A

Adenoma carcinoma sequence in colorectal cancer

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4
Q

Biases in screening are ___, ___, and ___

A

Biases in screening are lead-time bias, length-time bias, and compliance bias

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5
Q

Lead-time bias is ___

A

Lead-time bias is when lead time in diagnosis makes it seem that survival is prolonged but death is not delayed

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6
Q

Length bias is ___

A

Length bias is when screening detects more indolent cancers

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7
Q

____ is best way to avoid lead time and length time bias in cancer screening trials

A

Using cancer specific mortality rates is best way to avoid lead time and length time bias in cancer screening trials

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8
Q

Describe factors that make screening unfavorable

A

Factors that make screening unfavorable

  • Overdiagnosis and overtreatment
  • Harms of initial screening test
  • Harms of false positive results
  • Screening test has poor sensitivity
  • Cancer is very rare
  • Outcomes not improved with earlier detection
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9
Q

Overdiagnosis bias is when ___

A

Overdiagnosis bias is when screenign detects cancer (pseudodisease) that would remain subclinical before death from other causes

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10
Q

____ and ____ are ways to decrease the rate of false positives in screening

A

Screening higher risk populations and limiting the frequency of screening are ways to decrease the rate of false positives in screening

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11
Q

Sensitivity of screening can be improved by ___

A

Sensitivity of screening can be improved by increasing the frequency of screening

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12
Q

Screening fails to improve outcomes when ___ and ___

A

Screening fails to improve outcomes when there is excellent prognosis at clinical presentation or no accurate screening tests are available

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13
Q

Describe the USPSTF classification system

A

USPSTF classification system

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14
Q

Progression for LGSIL / CIN I to cervical cancer takes ___

A

Progression for LGSIL / CIN I to cervical cancer takes 15 years

  • Sufficient time interval exists when precancerous condition or early stage cancer is detectable by screening
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15
Q

HPV ___ and ___ are associated with cervical neoplasia

A

HPV 16 and 18 are associated with cervical neoplasia

  • Key factor is persistence of HPV infection
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16
Q

Describe potential harms of cervical cancer screening

A

Potential harms of cervical cancer screening

  • Overdiagnosis and subsequent overtreatment of cervical abnormalities which will eventually regress
  • Treatment has been associated with adverse pregnancy outcomes
  • Guidelines decrease harm by limiting frequency of screening and using age criteria to determine screening
17
Q

Describe cervical cancer screening

A

Cervical cancer screening (21-65 yo)

  • 21-29: Pap q3 years
  • 30-65: Pap q3 years or co-testing every 5 years or high risk HPV alone every 5 years
18
Q

Most colorectal cancer arises from adenomas with ___

A

Most colorectal cancer arises from adenomas with long asymptomatic interval stage

19
Q

Colorectal cancer screening tests include ___ or ___

A

Colorectal cancer screening tests include stool based tests or direct visualization tests

20
Q

USPSTF recommends ____ as first line for colorectal cancer screening

A

USPSTF does NOT recommend any one test over another as first line for colorectal cancer screening

21
Q

Colorectal cancer screening should be ___ and ___

A

Colorectal cancer screening should be started at age 45 and recommends no specific test strategy

22
Q

Controversies in colon cancer screening are ___ and ___

A

Controversies in colon cancer screening are age to begin and which test to use

23
Q

Screening women aged ___ has greatest effect in averting deaths from breast cancer

A

Screening women aged 60-69 has greatest effect in averting deaths from breast cancer

24
Q

Describe mammogram guidelines for average risk women

A

Mammogram guidelines for average risk women

  • Start at age 50
  • Stop age age 74
  • Screen every two years
  • Insufficient evidence for clinical breast exam
  • Recommends against teaching women how to perform breast self-exam
25
Q

USPSTF ___ for prostate cancer

A

USPSTF recommends against routine screening for prostate cancer

26
Q

___ and ___ are harms of screening for prostate cancer

A

Biopsy and harms of treatment are harms of screening for prostate cancer

27
Q

Decision to undergo prostate cancer screening should be ___

A

Decision to undergo prostate cancer screening should be individual one

  • Routine screening not recommended
28
Q

Lung cancer screening involves ___

A

Lung cancer screening involves low-dose CT

29
Q

Describe USPSTF guidelines for lung cancer screening

A

USPSTF guidelines for lung cancer screening

  • Annualscreening with low-dose CT in adults ages 55-80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years
  • Discontinue once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or ability to have curative lung surgery
30
Q

Describe shared decision making in screening

A

Shared decision making in screening

  • Invite patient to participate
  • Present options
  • Provide info on risks and benefits
  • Assist patients in evaluting options based on their goals and concerns
  • Facilitate deliberation and decision making
  • Assist patients to follow through on their screening decisions