Low Dose CT - Lung Cancer Screening
How are pack years calculated?
The number of years that the patient smoked x the number of packs per day. Example: the patient has smoked for 30 years and was 1 pack per day = 30 pack years
There are laminated forms in each health center to give to the patient so you can calculate outside the room. Use smokingpackyears.com to help.
A colonoscopy result comes into the chart. Where should you send it?
To the pap nurse!
Pap nurses manage pap results but also colonoscopy QM tabs
At what age do we start pap smears?
21 years old
What percent of patients with breast cancer have a family history?
A. 15%
B. 20%
C. 25%
D. 30%
Answer is A. 15%
Who queues the orders for the cancer screenings on the QM tab?
Who documents the decline if the patient chooses to not have a screening?
The Medical Assistant documents the orders and the Provider documents the decline and deletes the order.
You can also use the decline button in the order itself.
.decline macros exist for all cancer screenings
How many pack years does a patient need to smoke in order to qualify for a LDCT?
20 pack years
How often does a Cologuard screening get repeated?
Every three years when negative
In the initial stages of cervical cancer, what is a common symptom?
A. Pelvic pain
B. Vaginal bleeding
C. No symptoms
D. Pain with urination
Answer is C. No symptoms in early stages of cervical cancer
Which health center has the soonest openings for mammograms?
AMC
Please consider encouraging patients who are overdue to schedule in AMC rather than book out a few months.
Baystate and HMC have openings soon. CDH is booking out further than VMG.
Which cancer is the number one cause of cancer DEATHS in the United States?
Lung cancer
The 5 year survival rate improves by 51% when the cancer is detected in stage 1. Early detection saves lives!
Lung cancer causes more cancer deaths each year than breast, colorectal and prostate cancer combined!
Colorectal Cancer is second.
What age qualifies for a LDCT?
Ages 50-80 years old
Some Medicare plans stop covering at 77 years old. We should still place the order and referrals will let us know if the insurance does not cover.
Make sure the LDCT is labeled as LDCT. Otherwise it does not satisfy the QM tab.
What percent of patients with colorectal cancer have a family history of CRC?
Bonus: name of few other risk factors!
Only 30% of patients have a family history. This means we are all at risk!
Other risk factors: age, gender (male), history of pre-cancerous polyps, hereditary syndromes (Lynch etc), inflammatory bowel disease, American diet, 2 or more sugary drinks per day, smoking, frequent red meat consumption, lack of exercise, diabetes, low Vitamin D levels, obesity, alcohol use
What virus causes 99% of cervical cancers?
Bonus: What is the vaccine that children receive to prevent this viral infection?
HPV
The Gardasil vaccine.
Can be given to adults who have never been vaccinated up until age 45 (at the pharmacy for adults).
Name five risk factors for breast cancer.
Female gender
Age
smoking, alcohol consumption
early onset of menstruation or late menopause
obesity
lack of exercise
family history or genetic conditions
history of radiation
Name the two cancer screenings we perform that can PREVENT cancer (versus being an early detection test).
Cervical cancer screening with pap smear
CRC screening with a colonoscopy
Note: stool kits and Cologuard can detect some polyps which can then have a follow up colonoscopy
What triggers the QM tab to include the LDCT for lung cancer screening?
Pack years calculated in the social history, current or former smoker status
We need to calculate pack years for former smokers at least once if they remain former smokers, and more often if they start smoking again. They may qualify it has been within 15 years of quitting.
Bonus: How often should we calculate pack years for current smokers?
What percent of cases of CRC are diagnosed under the age of 50?
A. 5%
B. 10%
C. 15%
D. 20%
The answer is B. 10%
This is the main reason for the age of screening to lower to 45 years of age.
Which age range has the highest rates of cervical cancer?
A. 25 - 34 years
B. 35 - 44 years
C. 45 - 54 years
D. 55 - 64 years
This is a cancer of younger patients. Nearly 50% of patients with cervical cancer have been overdue for their cervical cancer screening.
What is the percent of breast cancer that is diagnosed in patients under 50 years old?
A. 5%
B. 10%
C. 15%
D. 20%
The answer is C. 15%
Mammograms start at age 40 years old. Breast cancer peaks in the age group 60-70 years old.
What are some of the benefits of offering screenings at all visit types?
All Eyes on The Patient/Quality At Every Visit
1. Engaging the patient when they choose to access healthcare leads to better follow through
2. Only 50-70% of our patients have a wellness visit each year (varies by insurance types) so we cannot just do quality at wellness visits.
3. Leads to health equity - all patients are offered the same tests regardless of their insurance or visit type.
How much radiation does a LDCT have compared to a standard CT scan?
1/5th the radiation of a standard CT scan
Name a few health conditions that would prevent a patient from having a direct colonoscopy order?
Cirrhosis
CKD 4 or 5
Uncontrolled diabetes
Recent heart attack or stroke within 1 year
CHF with EF <35%
Coumadin, DOACs, anti-platelets (not aspirin)
Weight >300lbs or BMI >40 (must be done at the hospital)
Recent positive stool kit or Cologuard
Note: Use the high risk colonoscopy referral order set, or the blood in stool order set instead
If a patient declines a pap smear for whatever reason, often due to history of trauma or prior negative experience, what test can be offered as screening?
HPV vaginal self swab. It must be collected in the office and cannot be sent home with the patient.
This is done in the office in patients 30 years or older.
QM-HPV BD Vaginal Self-Collect Swab-CDH
Reminder that all health centers have pap clinics quarterly for patients who want a pap smear but on a different day.
Why is it recommended to avoid applying deodorant, antiperspirant, or lotion on the day of your mammogram?
What is the leading cause of CANCER in the United States by incidence?
Breast Cancer - 32% of all new cancer diagnoses in women
Prostate Cancer - 30% of all new cancer diagnoses in men