Clinical Strategies for Cancer Treatment and Prevention (Part 2 of 2)

Question 1

When determining an effective screening test, what 5 pillars should you consider?

Answer 1

1. east to administer 2. economic 3. actionable 4. sensitive 5. Widely available

Question 2

What USPSTF grade is especially important to have the patient-centered conversation and informed decision making?

Answer 2

grade C

Question 3

What is a huge problem with ovarian cancer?

Answer 3

~20% of ovarian cancer is diagnosed at an early stage (so it is caught late 80% of the time)

Question 4

What screening do we have for ovarian cancer? (4)

Answer 4

physical exam, CA-125, Transvaginal ultrasound, and multimodal (CA-125 and TVUS)

Question 5

discuss the physical exam as used for a screening technique for ovarian cancer?

Answer 5

there is no data to suggest pelvic exams are useful in screening for ovarian cancer in average risk women; large ovarian masses are easiest to detect with pelvic exam, which typically indicates advanced disease

Question 6

discuss the use of CA-125 as a screening technique for ovarian cancer?

Answer 6

it is not specific for malignant ovarian tumors; by the time CA-125 is positive, many tumors are beyond cure; there is no improvement in mortality when using this as a technique

Question 7

discuss the use of TVUS as a screening technique for ovarian cancer?

Answer 7

there was no improvement in mortality during screening and 6 years after; it is observer dependent

Question 8

discuss the use of multimodal (CA-125 and TVUS) as a screening technique for ovarian cancer?

Answer 8

no improvement in mortality; there was a 9.6% false positivity rate–> lead to unneeded surgical intervention and harm

Question 9

overall what is the grade for ovarian cancer screening?

Answer 9

grade D; however, there is a gray area for high risk women

Question 10

who is considered a high risk woman for ovarian cancer?

Answer 10

if there is a family history of ovarian cancer or hereditary cancer syndromes (BRCA or Lynch syndrome)

Question 11

what is the leading cause of cancer among men in the united states?

Answer 11

prostate cancer

Question 12

what screening tools do we have for prostate cancer?

Answer 12

prostate specific antigen (PSA) and digital rectal exam (DRE) FORGET ABOUT DRE

Question 13

discuss using PSA as a screening tool for prostate cancer?

Answer 13

there is a high false positivity rate; serum testing increases in many benign and inflammatory conditions; 2/3 men who underwent biopsy for elevated PSA did not have prostate cancer

Question 14

what is the grade for PSA for men 55-69 years of age?

Answer 14

grade c

Question 15

what is the grade for PSA for men 70 years or older?

Answer 15

grade D: service has no benefit and/or harms may outweigh any potential benefits

Question 16

what screening tools do we have for cervical cancer?

Answer 16

Pap smear, HPV testing, and co-testing (PAP and HPV)

Question 17

when should you start pap smears?

Answer 17

start at age 21 and repeat every 3 years

Question 18

when should you stop pap smears?

Answer 18

at age 65

Question 19

for the age group 30-64, when should you get a pap smear?

Answer 19

pap alone: every 3 years; pap and HPV testing: every 5 years

Question 20

cervical cancer screening is especially effective because why?

Answer 20

since pap smears are excellent at identifying pre-cancerous lesions, which can be locally excised or cryoablated–> BEFORE INVASIVE CANCER EVEN ARISES

Question 21

what is the grade for pap smears for 21-29 year olds?

Answer 21

grade A

Question 22

what is the grade for pap smears for those younger than 21?

Answer 22

grade D

Question 23

how do you screen for endometrial cancer?

Answer 23

counseling of women at menopause to report any vaginal bleeding

Question 24

what is the most common type of non-skin cancer?

Answer 24

breast cancer

Question 25

what is the 2nd leading cause of cancer death for women, behind lung cancer?

Answer 25

breast cancer

Question 26

what screening tools do we have for breast cancer?

Answer 26

clinical breast exams, self-breast exams, mammography

Question 27

How should you educate your patient on how to perform a self breast exam?

Answer 27

check the axilla, look for skin changes, avoid checking prior to or during menstrual cycles

Question 28

what makes for complex testing guidelines for the BRCA-1 and BRCA-2 genetic testing?

Answer 28

if there is a family history of breast/ovarian cancer (multiple relatives, relatives diagnosed at young age, and male relatives) or if there is a personal diagnosis before age 45

Question 29

if you test positive for the BRCA gene, what can you do?

Answer 29

prophylactic surgery, chemoprevention medication (hormone therapy), increased screening and self exam

Question 30

mammography is the gold standard for breast cancer screening however guidelines are changing. Discuss this.

Answer 30

informed decision making on when to start mammography: 40-49 (grade c) 50-75 (grade b)

Question 31

what is the third leading cause of death for men and women in the US?

Answer 31

colon cancer

Question 32

when is colon cancer most commonly diagnosed?

Answer 32

between the age of 65-74

Question 33

what screening tools do we have for colon cancer?

Answer 33

high-sensitivity guaiac-based fecal occult blood test, fecal immunochemical test, fecal DNA test, CT colonography, and colonoscopy

Question 34

how often do you have to get a high-sensitivity guaiac-based fecal occult blood test?

Answer 34

annually

Question 35

what are the screening recommendations for colon cancer (regarding ages)?

Answer 35

45-49 (grade b) 50-75 (grade a)

Question 36

what is key to choosing the correct modality and timing for colon cancer screening?

Answer 36

informed decision making is key to choosing the correct time and screening modality for the patient

Question 37

what is the leading cause of non-skin cancer in the united states?

Answer 37

lung cancer

Question 38

what is the best prevention for lung cancer?

Answer 38

smoking cessation

Question 39

how do you screen for lung cancer?

Answer 39

low-dose CT annually for ages 50-80 with a 20-pack-year history of smoking or those actively smoking or those who only quit smoking in the past 15 years

Question 40

what is the screening for lung cancer graded?

Answer 40

grade B