Download Health Promotion and Disease Prevention

Health Promotion and Disease
Prevention-focus on Cancer
Edward Anselm, MD
Assistant Professor of Medicine
Icahn School of Medicine at Mount Sinai
Medical Director
Health Republic Insurance of New Jersey
Outline: learning objectives
• Know the most common causes of preventable cancer
• Describe the epidemiology of cancer nationally, state wide and locally
• Understand the primary and secondary prevention measures for each
cancer
• Understand the evidence for the effectiveness of screening
procedures utilizing USPSTF guidelines
• Understand the risks of screening procedures
• Understand the role of genetics and environment in cancer
• Discuss some of the Public Health measures to address cancer
prevention
Common Cancers
http://apps.nccd.cdc.gov/uscs/toptencancers.aspx
Difference between incidence rates and death rates
Male v Female
Differences among the races
Common Cancers in Men
Common Cancers in Women
Cancer Causation
• Spontaneous mutations
• Exposure to chemicals, radiation, or toxins
• Inflammation, certain infections
• Populations with higher genetic risk
• Conditions with higher risk
• Effects of hormones
Cancer Prevention
• Don’t smoke/stop smoking
• Diet/weight
• Avoid solar radiation
• Immunize
• Hepatitis B
• Human Papilloma Virus
• Prevention in high risk groups
• Hormones
• Surgery
Early Detection and Treatment of Cancer
• Screening of populations at risk
• Age and gender
• Genetic markers
• Specific medical conditions
• Breast
• Colorectal cancer and polyps
• Lung Cancer
• Prostate
• http://www.uspreventiveservicestaskforce.org/adultrec.htm#cancer
Risks of screening and subsequent
investigations
• Anxiety
• Inconvenience
• Pain
• Complications of radiation and other procedures
• Cost
• Finding a cancer may not improve health or help a patient live longer.
• False-negative test results can occur.
• False-positive test results can occur.
Risk for Breast Cancer
• Gender and Age
• Genetics
• BRACA 1/2
• Family History
• Race
• Non-cancerous breast conditions/dense breasts
• Radiation treatment
• Hormonal effects
• Early menarche, late menopause
• Child-bearing, breast feeding
• Use of oral contraceptives, hormone replacement therapy
Mammography: Number needed to screen to
prevent one death
Age band
40 and 49
50 and 59
60 and 69
NNS
746
351
233
NNI
1904
1339
377
Annual screening of women between 40 and 84 years yields an NNS of 84
Biennial screening of women ages 50-74 yields an NNS of 144
•
AJR Am J Roentgenol. 2012 Mar;198(3):723-8. doi: 10.2214/AJR.11.7146. Mammography screening: a new estimate of number needed to screen to prevent one breast cancer
death. Hendrick RE1, Helvie MA.
Table 2. Estimated Benefits and Harms of Mammography Screening for 10,000 Women Who Undergo Annual Screening Mammography Over a 10
Estimated Benefits and Harms of Mammography Screening for
10,000 Women Who Undergo Annual Screening Mammography
Over a 10-Year Period
http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional/Table2
Age, y
No. of Breast Cancer No. (95% CI) With ≥1 No. (95% CI) With ≥1
No. of Breast
Deaths Averted With False-Positive Result
False Positive
Cancers or DCIS
c
Mammography
During the 10 y
Resulting in a Biopsy Diagnosed During
c
Screening Over Next
During the 10 y
the 10 y That Would
b
15 y
Never Become
Clinically Important
d
(Overdiagnosis)
e
40
1–16
6,130 (5,940–6,310)
700 (610–780)
?–104
50
3–32
6,130 (5,800–6,470)
940 (740–1,150)
30–137
60
5–49
4,970 (4,780–5,150)
980 (840–1,130)
64–194
Persuading doctors to screen
• Overcoming cultural bias
• Overcoming controversy
• Overcoming expediency/Electronic reminders
• Performance measurement
• Performance incentives
• Reimbursement rates
Persuading patients to screen
• De-stigmatization of cancer
• Explain advantages of early detection
• Lowering barriers to access
•
•
•
•
Insurance/Insurance copayment
Referral requirements
Appointment access
Workplace programs
• Increasing public awareness