Download FCP- I - 1997 Lecture - Iowa Cancer Consortium

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Definition of Cancer Screening
The presumptive identification of
unrecognized cancer by the
application of tests, examinations, or
other procedures which can be
applied rapidly to an asymptomatic
population to sort out those who
probably have cancer from those
who probably do not.
Analytic Framework for Screening
(Adapted from USPSTF, Am J Prev Med 20(3S):25, 2001)
1
5
Screening
Test
Persons
At Risk
Treatment
Early Detection
of Targeted
Condition
3
4
Association
Intermediate
Outcome
2
7
Adverse Effects
of Screening
8
Adverse Effects
of Treatment
6
Reduced Morbidity
and/or
Mortality
Zapka, J. et al. J Natl Cancer Inst Monogr
2010 2010:58-71.
Breast Cancer
Screening Tests for Asymptomatic Patients
(Females)
Test or Procedure
ACS++

Mammography preceded by CBE 40+ q yr


MRI
Clinical breast exam (CBE)

Breast self exam
NR
20-39 q3 yr*
40+ q yr*
Optional
USPSTF+
50-74 q 2 yr
with or without
CBE**
IE***
IE***
Against
+ USPSTF at www.ahrq.gov/clinic/uspstf/uspsbrca.htm
++ Smith RA et al. CA Cancer J Clin 60:99-119, 2010
NR = not recommended
* As part of a health examination
** Before age 50, make an informed decision with your doctor
*** Insufficient evidence
Average Annual In Situ Female Breast Cancer Rates, Iowa,
1973-2006
(rates expressed per 100,000 persons using 2000 U.S. population as standard)
6-fold increase
Female Breast Cancer Mortality Rates, Iowa, 1973-2006
(Rates are per 100,000 women and age-adjusted to the U.S. 2000 population.)
Rate
34
32
30
28
26
24
22
20
Study (NEJM Oct 27, 2005)
reported 46% of breast
cancer mortality reduction
attributed to screening;
remainder due primarily to
Improved treatment.
32% decline
between 1992
and 2006
737475767778798081828384858687888990919293949596979899 0 1 2 3 4 5 6
Year of Death
Prostate Cancer
(Smith RA et al. CA Cancer J Clin 60:99-119; 2010 &
www.ahrq.gov/clinic/uspstf/uspsprca.htm)
Screening Tests for
Asymptomatic Patients
(Males)
Test or Procedure
ACS
Prostate specific antigen (PSA) test
and digital rectal exam (DRE)
Age 50+ q yr
thereafter*
USPSTF
Insufficient
evidence for men
< 75; against for
men 75+ years
* Require informed decision with health care provider for men who have a
life expectancy of at least 10 years.
PSA
Acceptance:


Widely used as cancer
marker for initial
diagnosis and monitoring
response to therapy
Aids in prediction of
prostate cancer risk and
of treatment outcome
Controversy:




Leads to diagnosis and
treatment of prostate
cancers that pose no real
threat
Disagreement over the
threshold level of PSA that
should indicate biopsy
Levels differ by racial,
ethnic, age groups
Clinical trials not showing
benefit
Malignant Prostate Cancer Rates, Iowa, 1973-2006
(Rates are per 100,000 men and age-adjusted to the U.S. 2000 population.)
Rate
220
200
180
160
140
120
100
80
60
40
20
0
Mortality
Incidence
15% decrease in
incidence between
1994 and 2006
37% decrease in
mortality between
1994 and 2006
73 75 77 79 81 83 85 87 89 91 93 95 97 99
Year of Diagnosis
1
3
5
Avenues for Cancer Prevention and Control
Primary
Prevention
Secondary
Screening
Early
Detection
Tertiary
Palliative
Treatment Rehabilitation
Care
Quality of Life/Care
Genes
Environment
Birth
Incidence Rates
Cancer Diagnosis
Stage Distribution
Mortality Rates
Quantity of Life
Death
Survival Rates