Flashcards in RACGP Red Book Screening Guidelines Deck (43)
What age range should opportunistic STI screening be performed?
15 - 29 year olds
Who are high risk STI populations and how often should they be screened?
High risk: aboriginal or TSI, IVDU, sex workers, MSM
How often should absolute CVD risk be assessed?
- every 2 years from age 45
- unless aboriginal or TSI, need to screen every 2 years from age 35
What components are required to calculate absolute CVD risk? (8)
Age, sex, smoking status, total and HDL cholesterol, SBP, diabetes and LVH
Cholesterol aims for primary prevention of CVD
Total cholesterol < 4
HDL > 1
LDL < 2
Non-HDL < 2.5
TG < 2
How often should cholesterol be assessed/screened?
Screening every 5 years from 45 or 35 if aboriginal ort TSI
Cholesterol screening in low, moderate and high risk CVD groups
Low risk: screen every 5 years
Moderate risk: Consider pharmacotherapy if not reaching targets in 6 months or if family history of premature CVD
High risk: commence rx + antihypertensive
What is AUSDRISK?
Screening tool for risk of developing diabetes, should be done every 3 years in patients over 40 or aboriginal or TSI patients > 18.
How often should HbA1c screening be performed in patients with impaired glucose tolerance?
Annually with a fasting glucose
Which patients fall into the high risk for diabetes category and how often should HbA1c be performed?
High risk: age > 40 and BMI > 25, AUSDRISK score >12
Screening: either fasting glucose/HbA1c every 3 years
Fasting glucose interpretation
< 5.5mmol/L = diabetes unlikely
5.5 – 6.9mmol/L = perform OGTT
> 7mmol/L (or >11.1 non-fasting) = diabetes likely, repeat on separate date to confirm
Risk factors for kidney disease (9)
BMI > 30,
Aboriginal or TSI over 30 years old,
Hx of AKI
Describe the screening for patients at risk of kidney diease
Patients should be screened every 1-2 years with blood pressure check and urine ACR.
Interpreting urinary ACR results
Normal: < 3.5mg/mmol in women, < 2.5mg/mmol in men
Microalbuminuria: 3.5-35mg/mmol in women, 2.5-25mg/mmol in men
Macroalbuminuria: > 35mg/mmol in women, > 25mg/mmol in men
Describe the rationale behind screening for prostate cancer in men (as per Redbook).
No obligation to screen asymptomatic men for PSA
Benefit vs risks
- Risk of over diagnosis & rx, impotence + incontinence
DRE is no longer recommended as it is insufficiently sensitive to detect prostate cancers early enough
High risk: Men with one or more first-degree relatives diagnosed
Describe the categories of risk with colorectal cancer. (Cat 1/2/3)
Cat 1: average risk
- Asymptomatic people with no family history
- Fhx of a 1st or 2nd degree relative with CRC > age 55
Cat 2: moderate risk
- Asymptomatic patients with FHx of CRC < age 55
- 2 x first degree or 1 x first degree + 1 x second degree relative on same side of family with CRC diagnosed at any age
Cat 3: high risk
- Suspicion or confirmed familial polyposis syndrome
(3x 1st or 2nd degree relatives on the same side)
(2x 1st or 2nd degree relatives on the same side with high risk features)
(1x 1st or 2nd degree relative with FAP or microdeletion tumours)
Describe the screening for CRC in category 1, 2 and 3 patients.
Cat 1 (average risk)
- FOBT screening every 2 years from > 50 until age 75
- Actively consider aspirin 100-300mg/day prophylaxis
Cat 2 (moderate risk)
- iFOBT every 2 years from 40-49
- Colonoscopy every 5 years from 50 to 74yo
- Actively consider aspirin 100-300mg/day prophylaxis
Cat 3 (high risk)
- iFOBT every 2 years from 35-44yo
- colonoscopy from 45-74yo
- Refer for genetic screening
- Refer to bowel cancer specialist
- Suggest aspirin 100-300mg/day prophylaxis
Follow up after polypectomy: small hyperplastic polyps
Follow up after polypectomy: 1-2 small tubular adenomas (<10mm)
Colonoscopy in 5 years
Follow up after polypectomy: High risk adenomas
High risk: three or more, > 10mm, tubulovillous or villous histology or high grade dysplasia
Colonoscopy every 3 years
Follow up after polypectomy: Sessile adenomas removed in piecemeal
Repeat colonoscopy in 3-6 months and again at 12 months
Follow up after polypectomy: > 5 adenomas or > 10 adenomas
>5: Repeat colonoscopy in 12 months
>10: Within 12 months to ensure nil missed
Follow up of polyps in patients > 75
Nil surveillance, lead time from progression from adenoma to cancer is around 10-20 years
Describe breast screening in low risk asymptomatic patients.
- Screening mammogram every 2 years for women aged 50-74
Side note: for every 2000 women invited for screening over 10 years, one will avoid dying of breast cancer and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily
Define the risk factors for breast cancer (5).
Increasing age, personal history of breast ca/atypical hyperplasia/carcinoma in situ, strong family history, mutation of BRCA, previous radiotherapy
Define recommendations for breast screening in patients with a first degree relative, <50yo with breast cancer.
Cancer Australia recommends considering annual mammograms from age 40 if women have had a 1st degree relative <50 diagnosed with breast cancer.
Which patients are at "moderately" increased risk of breast cancer?
- one first degree relative <50 years of age in absence of high risk features
- two first degree relatives on same side of family
- two second degree relatives on same side with at least one <50
Define the recommended screening for patients at moderate risk of breast cancer.
At least every 2 years from 50-74. May consider annual mammograms from 40 if 1st degree relative <50 with breast cancer.
What makes a patient "high risk" for breast cancer? (3)
1.Two first degree or second degree relatives on same side diagnosed with breast or ovarian cancer with:
> additaion relatives with breast/ovarian cancer
> breast ca diagnosed before 40
> bilateral breast cancer
> Ashkenazi Jewish ancestry
> breast cancer in male relatives
2. 1 first degree or second degree relative diagnosed <45 with another first or second degree on same side with sarcoma <45
3. Known family history of high risk breast cancer gene mutation