Questions and Answers
What is lead time bias?
What is length time bias?
What is positive predictive value?
The proportion of patients who test positive that have the disease
What is negative predictive value?
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What is sensitivity?
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What is specificity?
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What is the single most important risk factor for developing breast cancer?
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When does the American Cancer Society recommend starting breast cancer screening?
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What is the false negative rate of mammography?
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When is MRI recommended for breast cancer screening?
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When should screening colonoscopy begin for those with a family history of colorectal cancer?
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How often should a person with a normal colonoscopy be screened if they have a family member diagnosed with colorectal cancer at age less than 60?
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How often to repeat colonoscopy if one has normal or hyperplastic polyps?
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When should prostate cancer screening stop?
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What is PSA velocity?
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When should lung cancer screening be performed?
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When should early colon cancer screening be done?
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Study Notes
Study Notes on Cancer Screening and Biases
- Lead Time Bias: Apparent increased survival attributed to earlier detection of a disease.
- Length Time Bias: Occurs when slower-growing cancers are more likely to be detected through screening, creating a false impression of longer survival in screened populations.
Diagnostic Values
- Positive Predictive Value: Percentage of patients who test positive and actually have the disease.
- Negative Predictive Value: Percentage of patients who test negative and do not have the disease.
- Sensitivity: Ability to accurately identify individuals who have the disease.
- Specificity: Ability to accurately identify individuals who do not have the disease.
Breast Cancer Screening
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Most Important Risk Factor: Age is the single most important risk factor for developing breast cancer.
- One first-degree relative with breast cancer doubles the risk; two or more quadruples it.
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Screening Recommendations:
- Begin breast cancer screening at age 40, per the American Cancer Society and National Cancer Institute.
- American College of Physicians and U.S. Preventive Services Task Force recommend individualized discussions for women aged 40-49, without routine mammography recommendations for this age.
- Mammography False Negative Rate: Approximately 10%. All palpable masses require further evaluation through ultrasound, even with an unremarkable mammogram.
MRI Recommendations for Breast Cancer
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Conditions for MRI:
- Women aged 25-30 or older with a known BRCA mutation.
- First-degree relatives of individuals with a known BRCA mutation.
- Patients who underwent chest irradiation between ages 10-30.
- Individuals with over 20% lifetime breast cancer risk according to clinical risk predictions.
Colorectal Cancer Screening
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Family History Guidelines:
- Initiate screening colonoscopy at age 40 if a first-degree relative was diagnosed with colorectal cancer before age 60, or 10 years earlier than the age of diagnosis in the family member.
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Screening Intervals:
- For individuals with a first-degree relative diagnosed with colorectal cancer before age 60, repeat colonoscopy is every 5 years if initial screening is normal.
- If normal or hyperplastic polyps are found, repeat colonoscopy is recommended every 7-10 years.
Prostate Cancer Screening
- Age to Stop Screening: Prostate cancer screening is typically discontinued for individuals over 75 years of age.
- PSA and Biopsy Decision: Assess PSA velocity, particularly if the PSA value exceeds 4.0 ng/ml and increases by more than 1 ng/ml per year, suggesting the need for a prostate biopsy.
Lung Cancer Screening
- Eligibility for Screening: Recommended for current or former smokers (quit within the last 15 years) aged 55-74 with a 30 pack-year smoking history (ACS guidelines) or aged 55-80 (USPSTF guidelines).
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Description
Explore key concepts in cancer screening, including lead time bias and length time bias. Learn about diagnostic values such as positive predictive value, sensitivity, and specificity. Understand the importance of age and familial risk factors in breast cancer screening.