cancer - screening, prevention, and nutrition

what are the leading causes of death for men?

lung

prostate

colorectal

what are the leading causes of death for women?

lung

breast

colorectal

which demographics are more likely to die from cancer?

men > women

black > white

what is the second most common cause of death after heart disease?

cancer

what are most cancer deaths attributed to?

lifestyle behaviors:

tobacco use

poor diet

physical inactivity

alcohol use

overweight/obesity

how should you apply a USPSTF grade A recommendation?

offer or provide the service

how should you apply a USPSTF grade B recommendation?

offer or provide the service

how should you apply a USPSTF grade C recommendation?

offer or provide this service for selected pts depending on individual circumstances

how should you apply a USPSTF grade D recommendation?

discourage the use of the service

how should you apply a USPSTF grade I recommendation?

counsel patients on uncertainty about the balance of benefits and harms if service is offered

what are the breast cancer screening recommendations for women?

40-74 yo

every 2 years via mammography

what is controversial about the age recommendations for breast cancer screening?

age 40-49

disease is less common

large number of false positives and unnecessary biopsies

what is the benefit of screening for breast cancer ever 2 years during ages 40-74 according to the USPSTF?

moderate net benefit

who is eligible to receive medication to reduce the risk of breast cancer? what grade recommendation is this?

> 35 yo

at increased risk for breast cancer

grade B

what are 2 classes of meds used for breast cancer risk reduction?

selective estrogen receptor modulators

aromatase inhibitors

what is the recommendation for prostate cancer screening according to the USPSTF? what grade recommendation is this?

55-69 yo

on individual basis according to family hx, race, and comorbid medical conditions

grade C

what is a disadvantage of PSA screening?

high false positive rate

what are complications of treatment for prostate cancer?

ED

urinary incontinence

bowel sx

CV events

DVT or PE

in the US prostate screening trial of 2009, what was the difference between screened vs not screened pts?

no statistical difference in likelihood of dying of prostate cancer

what is the complete age range for colorectal cancer?

45-85

what grade recommendation is age 45-49 for colorectal cancer?

B

what grade recommendation is age 50-75 for colorectal cancer?

A

what grade recommendation is age 76-85 for colorectal cancer?

C

what are the screening options for colorectal cancer?

colonoscopy - 10 yrs

CT colonography - 5 yrs

flexible sigmoidoscopy - 5 yrs or 10 yrs w/FIT

gFOBT or FIT yearly

what is the best screening method for colorectal cancer in detecting premalignant polyps?

colonoscopy

which new screening test for colorectal cancer works by detecting DNA released by cancerous tumors?

Shield

if Shield test is positive, what is the next step?

colonoscopy as f/u

is Shield (a blood test to find colorectal CA) FDA approved for adults 45+ at avg risk?

yes

is Shield included by the USPSTF?

no

what is now ineffective for lung cancer screening?

plain chest XR

what is the screening recommendation for lung cancer? what grade recommendation is this?

annual low dose helical CT in 50-80 yo that have a 20 pack year hx, currently smoke, or have quit smoking within the past 15 years

grade B

when should you discontinue lung cancer screening in high risk pts?

once the pt has not smoked for 15 yrs or has a limited life expectancy

what should all pts who smoke be counseled on?

that smoking cessation is the most effective intervention to reduce risk of lung cancer

what is the ability to rule out a disease if the test is negative?

sensitivity

what is the ability to rule in disease if the test is positive?

specificity

what is the screening recommendation for cervical cancer? what grade recommendation is that?

21-29 yo every 3 yrs w cytology alone

30-65 yo every 3 yrs w cytology alone

OR every 5 yrs w high risk HPV testing alone

OR every 5 yrs with hrHPV testing + cytology (cotesting)

grade A

if a women has had a hysterectomy, do they need to be screened for cervical cancer?

no

what is the screening recommendation for skin cancer? what grade recommendation is that?

visual skin examination evidence is insufficient

grade I

what are the recommendations from the USPSTF for skin cancer? what grade recommendation is this?

minimize UV exposure ages 6 months - 24 yrs w fair skin

grade B

which genetic mutation is associated with breast, ovarian, tubal, and peritoneal cancer?

BRCA1/2

what are the screening recommendations for BRCA related cancer? what grade recommendation is this?

PCPs should access women w personal or family hx;

if positive - continue w genetic counseling and testing

grade B

what is metabolically active tissue that produces estrogen, proteins, insulin like growth factor, and leptin?

body fat

what does increased body fat lead to?

overall inflammation

what has a positive associated with obesity?

many types of cancer

what preservatives are added to processed meats and smoked/salted foods?

nitrates

what is consumption of red and processed meat linked to?

colorectal, pancreatic, and prostate cancer

what is the recommendation for a patient who eats lots of red and processed meat?

limit intake and eat more plant based proteins such as legumes, nuts, and seeds

what chemicals are formed by charring or cooking meat at high temperatures over an open flame?

polycyclic aromatic hydrocarbons (PAHs)

heterocyclic amines (HCAs)

which flame source is the worst for PAH formation?

charcoal

true or false - naturally occurring pesticides may be carcinogenic.

true

what are dietary inhibitors of carcinogenesis?

antioxidants

phytochemicals

what are examples of antioxidants?

vit C

carotenoids (A)

vit E

selenium

zinc

what is the function of antioxidants?

scavenge and neutralize free radicals to prevent damage

what are biologically active components of plants?

phytochemicals

what is excessive consumption of alcohol related to?

increased risk of many types of cancers

what is a possible carcinogen linked to hormone dysfunction?

bisphenol A (BPA)

how can we avoid BPA exposure?

BPA free products

avoid heat

use alternatives

what is the use of drugs, vitamins, or other agents to reduce the risk of, or delay the development or recurrence of cancer?

chemoprevention

what are the exercise recommendations for reducing risk of cancer?

150-300 mins of moderate intensity/wk

OR 75-150 mins of vigorous/wk

OR combo of both

what is limited in a "healthy eating pattern"?

red and processed meats

sugary beverages

highly processed foods

refined grains

alcohol consumption

in addition to cancer, what other health problems are at reduced risk when you live a physically active lifestyle?

heart disease

high blood pressure

diabetes

osteoporosis

what are the side effects and impact on nutrition for cancer pts?

malnutrition

weight loss

fatigue

neutropenia

altered taste/smell

GI sx

for a cancer patient, what intervention improves treatment tolerance, reduces breaks in treatment, decreases unintentional weight loss, and improves quality of life?

medical nutrition therapy

how can we manage diarrhea in cancer patients?

replace electrolytes

BRAT diet

low fat, low fiber diet

avoid caffeine and alcohol

how can we manage N/V in cancer patients?

ginger tea

smaller more frequent meals throughout the day

consuming liquids b/w meals

what are the effects of tumor growth on metabolism?

increased protein breakdown

increased lipolysis

increased need for protein and calories

what is a variant of protein energy malnutrition that results in progressive weight loss, anorexia, immunosuppression, fluid abnormalities, and altered BMR?

cancer cachexia

what medications can be used to manage cancer cachexia?

antihistamines

corticosteroids

progestin agents

antidepressants

marijuana

why is it important to prevent and treat malnutrition in pediatric populations?

it leads to stunted growth and development

A 47-year-old patient presents for a routine physical examination. The patient does not have a history of colorectal cancer, inflammatory bowel disease, or adenomatous polyps or a family history of colorectal cancer. The patient's body mass index is 29 kg per m2, and the A1C level at their last visit was 5.9%. The patient has not been screened for colorectal cancer in prior visits.

According to the U.S. Preventive Services Task Force (USPSTF) recommendation statement, how should this patient be counseled regarding the need for colorectal screening?

Regardless of risk factors, all patients should be screened for colorectal cancer starting at 45 years of age.

3 multiple choice options

According to the USPSTF recommendation statement, how does the patient's age affect the counseling approach to screening for colorectal cancer? Which is not correct?

The incidence of colorectal cancer is similar in all adults from 45 to 75 years of age; therefore, the patient's age is not an important risk factor.

3 multiple choice options

According to the USPSTF recommendation statement, which one of the following is an appropriate test and interval for colorectal cancer screening?

Colonoscopy every 10 years.

3 multiple choice options