ABCs of Recs
USPSTF recommendation designation for adults aged 76 to 85 years for colorectal cancer.
What is Grade C.
Adults in this age group who have never been screened for colorectal cancer are more likely to benefit.
Screening would be most appropriate among adults who 1) are healthy enough to undergo treatment if colorectal cancer is detected and 2) do not have comorbid conditions that would significantly limit their life expectancy.
USPSTF recommends this for adults aged 50 to 75. (Grade A)
What is COLORECTAL CANCER SCREENING
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Direct visualization tests:
Colonoscopy - every 10 yrs
CT colonography - every 5 yrs
Flexible sigmoidoscopy - every 5 yrs; low benefit
Flexible sigmoidoscopy with FIT - every 10 yr plus FIT every year
Women who are at increased risk for breast cancer and at low risk for adverse medication effects, clinicians should offer this.
What is tamoxifen or raloxifene (Grade B)
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Women not at increased risk (Grade D)
Tamoxifen has been approved for reducing the incidence of invasive breast cancer in women aged 35 years or older, and raloxifene has been approved for this use in postmenopausal women.
USPSTF recommends against screening for this in asymptomatic women and their eggs.
What is OVARIAN CANCER
For women aged 30 to 65 years, the USPSTF recommends screening with this test every 5 years alone for cervical cancer.
What is high-risk human papillomavirus (hrHPV) testing.
(Grade A)
every 3 years with cervical cytology alone, or every 5 years with hrHPV testing in combination with cytology (cotesting).
USPSTF recommendation designation for men aged 55 to 69 years for prostate cancer screening.
What is Grade C.
Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction.
USPSTF recommends screening for cervical cancer with cervical cytology alone in women aged 21 to 29 years this often. (Grade A)
What is 3 years.
Screening with cytology alone is slightly less sensitive for detecting CIN 2 and CIN 3 than screening with hrHPV testing alone.
Although screening with hrHPV testing alone or in combination with cytology detects more cases of CIN 2 and CIN 3, this method results in more diagnostic colposcopies for each case detected.
True or False: USPSTF recommends use of beta-carotene or vitamin E supplements for prevention of CVD or cancer.
What is False. (Grade D)
Clinical trials show do not decrease risk of CVD or cancer.
USPSTF recommends against screening for this in asymptomatic adults who love “sweetbread”.
What is PANCREATIC CANCER
Three groups of women in which USPSTF recommends against screening for cervical cancer. (Grade D)
Who are
1) women older than 65 - regardless of new sexual partner
2) younger than 21 - high likelihood of regression; Treatment of CIN 2 or CIN 3 may increase risk for adverse pregnancy outcomes
3) have had a hysterectomy with removal of cervix
USPSTF recommendation designation that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents.
What is Grade B
Face-to-face or phone interaction with a health care provider, print materials, and computer applications, can reduce the risk of smoking initiation in school-aged children and adolescents
USPSTF recommends that clinicians ask all pregnant women about tobacco use, advise them to stop using tobacco, and provide this kind of intervention for cessation to pregnant women who use tobacco. (Grade A)
What is behavioral interventions.
(Effective behavioral interventions include in-person behavioral support and counseling, telephone counseling, and self-help materials)
The USPSTF recommends initiating this medication for the primary prevention CVD and CRC in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take this medication daily for at least 10 years.
What is low dose aspirin. (Grade B)
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Adults aged 60 to 69 years with a ≥10% 10-year CVD risk (Grade C)
online ASCVD Risk Tool
USPSTF recommends against screening for this that stands before the testes in men 70 years and older.
What is PROSTATE CANCER.
Evidence in men 70 years and older does not support routine screening because of the lack of trial evidence of benefit, the low likelihood of benefit given the time to realize benefit, and the increased risk of harms from false-positive results, biopsies, overdiagnosis, and treatment.
This is how often women aged 50 to 74 years should get mammography screening for breast cancer. (Grade B)
What is biennial (every other year); provides best balance of benefits and harms.
Studies on annual mammography show small incremental increase in the number of breast cancer deaths averted, but also a large increase in the number of harms.
USPSTF recommends this for adults aged 55-80, with a history of smoking obtain to screen for lung cancer.
What is low dose CT.
(Grade B)
30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.
BONUS: How do you calculate pack years?
True or False: USPSTF recommends use of vitamin D supplementation to prevent falls in community-dwelling adults 65 years or older.
What is False. (Grade D)
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USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. (Grade B)
Recommend multifactorial interventions to prevent falls to community-dwelling adults 65 years or older who are at increased risk for falls. (Grade C)
All adults who are not pregnant should be asked about tobacco use, advised to stop, and provided behavioral interventions and these kinds of FDA approved pharmacotherapy for cessation. (Grade A)
What are bupropion SR (sustained release), varenicline, and NRT (including nicotine transdermal patches, lozenges, gum, inhalers, or nasal spray).
USPSTF recommends against screening for these balls in adolescent and adult men.
What is TESTICULAR CANCER
The three types of stool based tests in colorectal cancer screening.
What are
1) gFOBT - every year
2) FIT - every year; improved accuracy vs gFOBT
3) FIT-DNA - every 1 or 3 years; specificity lower than FIT
USPSTF recommendation designation for decision to start screening mammography in women prior to age 50 years.
What is Grade C.
While screening mammography in women aged 40 to 49 years may reduce the risk for breast cancer death, the number of deaths averted is smaller than that in older women and the number of false-positive results and unnecessary biopsies is larger.
All women undergoing regular screening mammography are at risk for the diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to their health, or even apparent, during their lifetime (known as “overdiagnosis”). Beginning mammography screening at a younger age and screening more frequently may increase the risk for overdiagnosis and subsequent overtreatment.
Women with a parent, sibling, or child with breast cancer are at higher risk for breast cancer and thus may benefit more than average-risk women from beginning screening in their 40s.
True or False: These screening tools accurately detect intimate partner violence (IPV) in women of reproductive age: HARK, HITS, E-HITS, WAST.
What is True. (Grade B)
Humiliation, Afraid, Rape, Kick (HARK);
Hurt, Insult, Threaten, Scream (HITS);
Extended–Hurt, Insult, Threaten, Scream (E-HITS); Partner Violence Screen (PVS);
and Woman Abuse Screening Tool (WAST).
HARK includes 4 questions that assess emotional and physical IPV in the past year. HITS includes 4 items that assess the frequency of IPV, and E-HITS includes an additional question to assess the frequency of sexual violence. PVS includes 3 items that assess physical abuse and safety. WAST includes 8 items that assess physical and emotional IPV.
This can be done in minimizing exposure to ultraviolet (UV) radiation for persons aged 6 months to 24 years with fair skin types to reduce their risk of skin cancer.
What is using sunscreen, avoiding midday sun, wearing sun-protective clothing. (Grade B)
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USPSTF now also recommends that clinicians consider selectively offering counseling to adults older than 24 years with fair skin types. (Grade C)
As in 2012, the evidence on persons without a fair skin type remains insufficient for this population to be included in the recommendation statement.
USPSTF recommends against screening for this H-shaped organ in asymptomatic adults.
What is THYROID CANCER
Women with family members that have any of these four types of BRCA-related cancer should be screened, receive genetic counseling, and undergo genetic testing. (Grade B)
What are Breast, Ovarian, Tubal, or Peritoneal Cancer
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USPSTF recommends against routine genetic counseling or BRCA testing for women whose family history is not associated with an increased risk for potentially harmful mutations in the BRCA1 or BRCA2 genes. (Grade D)