PPM - Quiz 1

why are there multiple organizations for cancer screening guidelines?

different perspectives and priorities

varying evidence

target audience differences

primary function of US Preventive Services Task Force (USPSTF)

volunteer expert panal

evidence-based preventive care

primary care focus

responsibilities of US Preventive Services Task Force (USPSTF)

systemic evidence reviews

consider benefits, harms, and net benefit

influence insurance coverage

US Preventive Services Task Force (USPSTF) cancer screening focus

population-based screening recommendations

average-risk individuals

consider cost

primary function of American Cancer Society (ACS)

cancer prevention, detection, treatment, and survival

responsibilities of American Cancer Society (ACS)

screening guidelines, public and professional education, research funding

screening approach of American Cancer Society (ACS)

more aggressive than USPSTF

consider individuals

emphasize shared decision-making

cancer mortality reduction

primary function of National Comprehensive Cancer Network

alliance of cancer centers

clinical practice guidelines

responsibilities of National Comprehensive Cancer Network

treatment guidelines, screening recommendations, quality improvement

screening approach of National Comprehensive Cancer Network

specialist perspective, risk assessment, high-risk population focus, resource-intensive

primary function of CDC National Comprehensive Cancer Control Program

federal level

population-based cancer control

responsibilities of CDC National Comprehensive Cancer Control Program

surveillance and monitoring, program implementation, reduce health disparities, evidence-based programs

screening approach of CDC National Comprehensive Cancer Control Program

population health perspective, implementation and delivery, health equity, program evaluation

six priorities of CDC National Comprehensive Cancer Control Program

1. primary prevention

2. early detection and screening

3. treatment and quality of life

4. survivorship

5. end-of-life care

6. infrastructure and surveillance

primary prevention

risk factor reduction

environmental exposure prevention

lifestyle modification program

early detection and screening

evidence-based screening

increased screening

quality assurance

treatment and quality of life

access to quality treatment

survivorship care planning

symptom management

survivorship

long-term follow-up care

late effects management

psychosocial support

end-of-life care

palliative and hospice care

advanced care planning

family support

infrastructure and surveillance

cancer registry

data collection and analysis

program evaluation

USPSTF grading system

A = absolutely

B = better off

C = consider

D = don't

I = IDK

breast cancer screening recommendations

USPSTF - 50-74 years old, every two years (conservative)

ACS - 45- no upper limit, every year (earlier start (annual)

NCCN - 40 - no upper limit, annual (most aggressive)

clinical breast exam recommendations

USPSTF - insufficient evidence

ACS - optional for women 25-39

NCCN - annual starting age 25

self breast exam recommendations

USPSTF - not recommended

ACS - optional, with instruction

NCCN - monthly self-awareness

colorectal cancer screening recommendations

beginning at age 45-50 till 75

-guaiac fecal occult blood test (yearly) OR stool DNA tests (every 3 years)

OR

-colonoscopy every 10 years

age recommendations for colorectal cancer screening

USPSTF - 45-75 years

ACS - 45+ years

NCCN - 45+ years, individualized stopping

cervical cancer screening recommendations

Ages 21-29 - pap smear every 3 years, no HPV testing alone

Ages 30-65 - HPV testing every 5 years or pap + HPV co-testing every 5 years or pap alone every 3 years

Discontinuation - age 65 with adequate prior screening or post-hysterectomy (for benign conditions)

breast cancer screening tools

mammogram, clinical breast exam, self-beast exam

colorectal cancer screening protocols

colonoscopy, fecal immunochemical test (FIT), stool DNA tests (FIT-DNA)

cervical cancer screening protocols

pap smear (cytology), HPV testing, or co-testing for both

prostate cancer screening protocols

prostate-specific antigen (PSA), digital rectal exam

skin cancer screening protocols

clinical skin exam, dermoscopy, self-skin exam

young adults - age-specific screening

cervical cancer - begin at 21 years

breast cancer - clinical and genetic counseling

colorectal cancer - family history

middle-aged adults - age-specific screening

breast cancer - mammogram initiation

colorectal cancer - initiate screening 45-50

prostate cancer - shared decision-making discussion

older adults - age-specific screening

screening cessation to avoid unnecessary testing

cervical cancer - stop at 65

breast cancer - individual

high-risk populations

based on family history, genetics, environmental, and occupational

would need earlier screening for high-risk individuals

sensitivity

the ability to correctly identify disease when present

sensitivity formula

true positives / (true positives + false negatives)

specificity

ability to correctly identify absence of disease

specificity formula

true negatives / (true negatives + false positives)

sensitivity vs specificity

sensitivity - how well a test identifies truly ill people (SNOUT - rules OUT)

specificity - how well a test identifies truly well people (SPIN - rules IN)

usually inverse relationship

high sensitivities

few false negatives

good for screening

high specificity

few false positives

reduce unnecessary procedures

predictive values in screening

positive predictive value (PPV)

negative predictive value (NPV)

positive predictive value (PPV)

probability of disease when test is positive

negative predictive value (NPV)

probability of no disease when test is negative

positive predictive value (PPV) formula

true positives / (true positives + false positives)

negative predictive value (NPV) formulas

true negatives / (true negatives + false negatives)

benefits of screening

mortality reduction, morbidity reduction, reassurance, more treatment options

harms of screening

false positives, overdiagnosis, false negatives, procedural risks

organized screening programs

population-based

higher participation, quality control, cost-effective

opportunistic screening programs

individual-based

provider-initiated, provider flexibility

participation rates

percentage of eligible population

recall rates

percentage requiring additional testing

adherence to guidelines

protocol compliance

cancer detection rates

cases found per population screened

stage distribution

proportion of early-stage cancers detected

interval cancer risks

cancers developing between screenings

mortality reduction

population-level cancer death rates

training requirements

provider competency standards

equipment standards

regular calibration and maintenance

audit and feedback

performance monitoring and improvement

individual barriers to cancer screening participation

individual barriers - knowledge and awareness, fear and anxiety, cultural and religious factors, language barriers

access barriers to cancer screening participation

access barriers - geographic, financial, scheduling, transportation

provider barriers to cancer screening participation

provider barriers - knowledge gaps, time constraints, system issues

system barriers to cancer screening participation

capacity limitations, coordination problems, quality issues

patient-oriented interventions to increase screening rates

education and outreach, reminder systems, patient navigation, mobile screening

provider-directed interventions to increase screening rates

clinical decision support, performance feedback, education and training, financial incentives

system-level interventions to increase screening rates

standing orders, extended hours, one-stop screening, population health management

policy interventions to increase screening rates

insurance coverage, quality measures, public health programs

primary prevention in cancer control

target population - 9-26 and up to 45

getting appropriate vaccines, tobacco cessation, and other lifestyle modifications, and limiting environmental exposures

integration of prevention

primary prevention - risk factor reduction

secondary prevention - early detection through screening

tertiary prevention - treatment and survivorship care

clinical practice integration

risk assessment, counseling, care coordination

population and health approach to integration

community partnerships, policy advocacy, health promotion

quality measures for screening programs

Healthcare Effectiveness Data and Information Set (HEDIS) Cancer Screening Measures

Healthcare Effectiveness Data and Information Set (HEDIS) Cancer Screening Measures

Breast Cancer Screening - women 50-74 years with mammography

Colorectal Cancer Screening - adults 50-75 years with appropriate screening

Cervical Cancer Screening - women 21-64 years with appropriate screening

National Quality Strategy MeasuresComprehensive Quality Assessment

structure measures, process measures, outcome measures, equity measures

future directions in cancer screening emerging technologies and approaches

precision screening, implementation science, technology integration

preventive health screening

to prevent possible development of a future health issue

key organizations

U.S. Preventive Services Task Force (USPSTF)

American Heart Association (AHA)

American College of Cardiology (ACC)

U.S. Preventive Services Task Force (USPSTF)

gold standard for preventive care recommendations

evidence-based approach methodology

Grade A, B, C, D, and I recommendations

American Heart Association (AHA)

cardiovascular disease prevention focus

life's Essential 8 guidelines

blood pressure and cholesterol recommendations

American College of Cardiology (ACC)

joint guidelines with AHA

risk calculator development

clinical decision support tools

American Diabetes Association (ADA)

diabetes screening and prevention

prediabetes identification

standards of medical care

Centers for Disease Control and Prevention (CDC)

population-based screening programs

vaccine recommendations (ACIP)

infectious disease screening protocols

National Osteoporosis Foundation (NOF)

bone health screening guidelines

FRAX risk assessment tools

treatment thresholds

American College of Obstetricians and Gynecologists (ACOG)

women's preventive care

cervical and breast cancer screening

reproductive health guidelines

cardiovascular disease screening current guidelines

normal - <120/80 mmHg

elevated - 120-129/<80 mmHg

stage 1 HTN - 130-139/80-89 mmHg

stage 2 HTN - ≥140/90 mmHg

cardiovascular disease screening recommendations

adults ≥18 years: Annual screening (USPSTF Grade A)

lipid screening guidelines

ages 35-75 - screen every 5 years (Grade B)

ages 20-39 with risk factors - consider screening (Grade C)

primary prevention focus

lipid screening - risk factors for earlier screening

family history of premature CVD

diabetes mellitus

hypertension

smoking

obesity

diabetes screening recommendations

all adults ≥35 years, screen every 3 years

adults with BMI ≥25 kg/m² and risk factors, begin at any age

annual screening for prediabetes

diabetes screening methods

fasting plasma glucose (FPG)

2-hour oral glucose tolerance test (OGTT)

hemoglobin A1c

random plasma glucose (with symptoms)

diabetes - high-risk individuals

family history of diabetes

high-risk ethnicity (African American, Hispanic, Native American, Asian)

previous gestational diabetes

PCOS

metabolic syndrome

cardiovascular risk assessment

risk calculators and risk factors integration

age and gender-based recommendations

young adults (18-39) - BP screening annually, lipid screening with risk factors, diabetes screening with BMI ≥25 + risk factors

middle-aged adults (40-65) - annual BP screening, lipid screening every 5 years, diabetes screening every 3 years

10-year ASCVD risk assessment

older adults (>65) - more frequent monitoring, consideration of life expectancy, medication benefit vs risk

HIV screening

all adults 15-65: Screen at least once (Grade A)

annual screening for high-risk populations

opt-out screening approach

HIV high-risk populations

men who have sex with men

injection drug users

commercial sex workers

partners of HIV-positive individuals

hepatitis B screening

high-risk populations

pregnant women

household contacts of HBV carriers

hepatitis C screening

all adults 18-79: Screen once (Grade B)

risk-based screening for others

baby boomers (1945-1965) priority