USPSTF Cancer Screening Guidelines

Question 1

The grade recommendation for colorectal cancer screening is grade A for what age group? Grade C for what age group?

Answer 1

A = 50-75

C = 75-85

Question 2

What are the three stool-based screening methods for colorectal cancer?

Answer 2

buiac based recal occult blood (FOBT)

Fecal immunochemical testing

Fecal immunochemical testing with DNA

Question 3

What are the three direct visualization screening methods for CRC?

Answer 3

colonoscopy
flex sig
CT colonography

Question 4

How often should you be tested if you use the FOBT method?

Answer 4

annually

Question 5

What is the pooled estimate of CRC mortality reduction in the FOBT trials? Any reduction in all cause mortality?

Answer 5

15% reduction in CRC mortality

but no reduction in all-cause mortality

Question 6

What is the reduction in CRC mortality for flex sig?

Answer 6

27%

Question 7

What is the risk reduction in CRC mortality for colonoscopy?

Answer 7

trick question - we don’t know because there haven’t been any RTCs

Question 8

How do the FIT and FIT-DNA studies compare in terms of sensitivity and specificity?

Answer 8

FIT-DNA has higher sensitivity (92% vs 88% for FIT), but lower specificity (84% vs. 93%) so will have more false positives

Question 9

What are the risks of colonoscpy?

Answer 9

4 colonic perforations and 8 major intestinal bleeding per 10,000 screening colonoscopies

(note: 85% of serious complications are associated with polypectomies)

Question 10

What is the main harm of screening with CT colonography?

Answer 10

extra-colonic findings are common (40-70% of screens), so there are potential risks to the diagnostic follow-up

Question 11

What is the recommendation grade for breast cancer screening in ages 50-75?

Ages 40-49?

Answer 11

Grade B for 50-75

Grade C for 40-49

Question 12

What is the recommended frequency of mammography?

Answer 12

every 2 years

Question 13

True or false: mammography has been found to significantly decrease breast cancer mortality and all-cause mortality.

Answer 13

False - significantly reduces the risk for breast cancer in women ages 50-69, but no changes in all-cause mortality

Question 14

What is the sensitivity of mammography?

Answer 14

77 to 95%

Question 15

What is the specificity of mammography?

Answer 15

94 to 97%

Question 16

In ages 50-75, how many many breast cancer deaths were prevented for 1000 screened?

Answer 16

only 7

122 life-years gained

Question 17

According to the USPSTF, who should be screened for lung cancer?

Answer 17

Current or past smokers within 15 years with a 30-pack/yr hx, starting at age 55 through age 80

Question 18

What is the recommendation grade for lung cancer screening in this population?

Answer 18

grade B

Question 19

What is the screening test for lung cancer?

Answer 19

annual low dose CT

Question 20

In a study comparing low dose CT to CXR, what was the reduction in lung cancer mortality? in all-cause mortality?

Answer 20

20% reduction in lung Ca mortality

6.7% reduction of all-cause mortality

Question 21

What is the sensitivity of low dose CT?

Answer 21

~90%

Question 22

What is the specificity of low dose CT?

Answer 22

broader range: 28-100% depending on study

Question 23

What is the PPV of low dose CT?

Answer 23

2-42%

Question 24

What is the radiation exposure with a low dose CT scan and how does it compare to the background radiation?

Answer 24

0.5-1.61 mSV for the low dose CT scan

background radiation exposure is about 2.4 mSV/yr in the US

Question 25

What is the recommendation grade for prostate cancer screening?

Answer 25

Grade D (don’t do it)

Question 26

What is the screening test for prostate cancer we shouldn’t do?

Answer 26

screening PSA (followed by biopsy if positive)

Question 27

What are the complications associated with prostate biopsy?

Answer 27

infection, bleeding, urinary difficulty (68 per 10,000)

Question 28

What are the complications associated with prostatectomy? In what percentage of men?

Answer 28

erectile dysfunction (68-87% HOLY SHIT)

incontinence (10-15%)