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Flashcards in Cancer Screening Deck (61)
1

Number 1 Cancer in Males

Prostate

2

Number 1 Cancer in Females

Breast

3

Number 1 Cancer that Males & Females Die from Each Year

Lung & bronchus

4

General Cancer Prevention

Avoid tobacco
Be physically active
Maintain a healthy weight
Limit alcohol
Avoid excess sun
Eat a diet rich in fruits, veggies, & whole grains & low in sat/trans fats
Protect against STIs
Regular screening for breast, cervical, & colorectal cancer

5

Principles of Screening

Disease has high prevalence
Disease has serious consequences
Detectable pre-clinical phase
Treatment for pre-symptomatic disease more effective than after symptoms develop
Positive impact on clinical health outcomes

6

Other Considerations for General Screening

What are patient's co-morbid conditions?
Associated life expectancy, feasibility of treatment, effects of treatment on QOL?
What will you do with the results?

7

Which cancers are largely asymptomatic in the early stages?

Colorectal
Breast
Cervical

8

What is the leading cause of death from gynecologic malignancy in the U.S.?

Ovarian cancer

9

Pelvic Examination in Ovarian Cancer

No evidence they reduce mortality
Early stage tumors rarely found
Usually detected at an advanced stage & associated with a poor prognosis

10

Screening for Ovarian Cancer

CA 125 & TVUS
Family ovarian cancer syndrome or BRCA genes: CA 125 & TVUS
Initiation at 35 years or 5-10 years earlier than earliest age of first diagnosis

11

BRCA1 Carriers & Breast, Ovarian, & Contralateral Breast Cancer Risk

Breast risk: 60%
Ovarian risk: 59%
Contralateral breast risk: 83%

12

BRCA2 Carriers & Breast, Ovarian, & Contralateral Breast Cancer Risk

Breast risk: 55%
Ovarian risk: 16.5%
Contralateral breast risk: 62%

13

When to Test for BRCA for Non-Ashkenazi Jewish Women

2 1st-degree relatives with breast cancer, one

14

When to Test for BRCA for Women of Ashkenazi Jewish Descent

1st degree relative with breast or ovarian CA

15

Positive Impact on Clinical Health Outcomes for Ovarian Cancer

Annual pelvic, CA-125, and TVUS DO NOT decrease mortality from ovarian cancer

16

Prevention of Ovarian Cancer

Oral contraceptives
Gynecologic surgery: tubal, hysterectomy
Pregnancy
Breastfeeding

17

Cervical Cancer Prevention

Pap test
Death rate decreased 50% since pap administration

18

Cervical Cancer Screening Recommendations

Women should begin screening at age 21 unless HIV or immunocompromised
21-29 cytology every 3 years
30 years old: cytology every 3 years, co-testing cytology & HPV testing every 5
May stop after 65 if adequate screening in past 10 years with 2 negative screens

19

High Risk Groups for Cervical Cancer

Patients with HIV infection
Patients who are immunosuppressed
Those who had in utero DES exposure
Women who have been treated for CIN2, CIN3, or cervical cancer

20

Cervical Cancer: Hysterectomy Patients who Still Need Pap Smears

Surgery was done as treatment for cervical CA or pre-cancer
Hysterectomy without removal of the cervix

21

Cervical Cancer Prevention

Gardasil
Avoid exposure to HPV
Don't smoke
Pap smear

22

Epidemiology of Breast Cancer

Most common in U.S
Second leading cause of cancer death in women
Diagnosed as a result of abnormal screening study

23

Primary Risk Factors for Breast Cancer

Predominantly in females
Age: 85% age 50+

24

Screening Tools for Breast Cancer

Mammography
Ultrasound
MRI: high risk patients

25

Proper Clinical Breast Exam (CBE) Technique

Flatten breast tissue against chest
Examine in vertical strips
Make circular motions with pads of the middle 3 fingers
Examine each breast with 3 different pressure for at least 3 minutes

26

Epidemiology of Colorectal Cancer

3 most common cancer in U.S.
2nd leading cause of cancer-related deaths in U.S.

27

Assess Colorectal Cancer Risk

Start at age 20 & every 5 year thereafter
Have you ever had colorectal cancers or an adenomatous polyp?
Have you had inflammatory bowel disease?
Have any family members had CBC or adenomatous polyp? If so, how many were 1st degree relatives & at what age was cancer or polyp diagnosed?

28

Recommendations

Fecal occult blood test: begin at 50
Flexible sigmoidoscopy: begin at 50, every 5 years; + sensitive FOBT every 3 years
Colonoscopy: begin at 50, every 10 years
Virtual colonoscopy: every 5 years

29

FOBT

Finds blood in the stool (3 samples)
Stool guaiac
Immunochemical stool tests
Check for some intestinal conditions or colorectal cancer
+ test = colonoscopy

30

Sigmoidoscopy

View rectum, sigmoid, and last 2 feet of large intestine
Biopsies can be taken

31

Risks of Sigmoidoscopy

Bleeding from site where biopsy was taken
Tear in colon or rectum wall

32

Drawbacks of Sigmoidoscopy

Cannot see entire colon
Proximal lesions may not be seen

33

Define Colonoscopy

Endoscopic exam of the colon AND the distal part of the small bowel with a fiber optic camera on a flexible tube passed through the rectum

34

Positives of a Colonoscopy

Visual diagnosis
Opportunity for biopsy or removal of lesions

35

Complications of Colonoscopy

Bleeding from biopsy site
Tear in the colon or rectum wall

36

CDC Colorectal Cancer Control Program

Colorectal CA screening services to low-income men & women aged 50-64
Program sites also provide diagnostic follow-up

37

Screening for High Risk Populations

Family history
Family adenomatous polyposis (FAP)
Hereditary non-polyposis colon cancer (HNPCC)

38

Screening for High Risk Populations: History of Adenomatous Polyps

Colonoscopy age 40 or 10 years prior to earliest diagnosis; repeat every 5 years
Based on pathology & # of adenomas
Adenoma with high grade dysplasia- repeat in 3 years
1-2 small tubular adenomas with low grade dysplasia- repeat in 5 years

39

Screening for High Risk Populations: Family Adenomatous Polyposis

Sigmoidoscopy starting at age 10-12

40

Screening for High Risk Populations: Hereditary Non-Polyposis Colon Cancer

Colonoscopy q1-2 years beginning at age 20-25 or 10 years prior to earliest CA diagnosis in family

41

Virtual Colonoscopy

Uses a CT scanner to take images of the entire bowel
2D & 3D

42

PROs of Virtual Colonoscopy

Doesn't require sedation
Non-invasive
Entire bowel can be examined

43

CONs of Virtual Colonoscopy

Abnormality will need colonoscopy

44

Epidemiology of Prostate Cancer

Most common cancer in men
Mainly in older men
2nd leading cause of cancer death in U.S. men

45

Screening Tests for Prostate Cancer

DRE
PSA

46

DRE Testing in Prostate Cancer

Can detect 85% of tumors
Doesn't show reduction in morbidity or mortality

47

PSA Screening Prostate CA

Give men the pros & cons and let them make their own screening diagnosis

48

Potential Benefits of Prostate Cancer Screening

Detect cancers early
Treatment more effective when it is found early
5-year survival with localized cancer 100%

49

Potential Risks of Prostate Cancer Screening

False positive test results lead to further tests
Potential SE: infection from biopsies
Treatment may have never affected a man's health if left untreated

50

Complications of Prostate Cancer Treatment

Sexual dysfunction
Urinary incontinence
Bowel dysfunction

51

Screening in Regular Risk Men

Age 50 unless life expectancy

52

Screening in High Risk Men

Age 40
African American men
Family history of prostate CA esp.

53

Screening Guidelines for Lung Cancer for People at High Risk

55-74 years old
Fairly good health
At least 30 pack year history, still smoking, having quit last 15 years

54

Recommend Screening for Lung Cancer

Method: LDCT scan
Location: center that can accurately do scans; expertise to interpret & advise the patient
Risk: unnecessary biopsies, partial removal of lung

55

Principles of Lung Cancer Screening

Disease has high prevalence
Disease has serious consequences
Detectable preclinical phase
Treatment for pre-symptomatic disease more effective than after symptoms develop
Screening reduces cancer mortality

56

High Prevalence of Lung Cancer

2nd most common cancer in the US

57

Serious Consequences of Lung Cancer

#1 cause of cancer mortality

58

Prevention of Lung Cancer

Smoking cessation

59

Prevention of Skin Cancer

Wear sunscreen
Don't use tanning beds

60

Factors that Effectiveness Depends on for Skin Cancer

Whether clinician can identify early stage disease
Whether pathologist can accurately diagnose & histologically stage disease
Whether tumor is identified at a stage where treatment would be effective
Whether tumor identified by screening would become clinically meaningful

61

Epidemiology of Oral Cancers

Men > Women
Oropharyngeal CA linked with HPV