SLP - Cancer Screening - Kirana Lockyer

SLP – Cancer Screening Kirana Lockyer (Med Student) Acknowledgement to Country I would like to acknowledge the traditional owners, the Whadjak people of the Noongar nation and acknowledge the connection to the land on which we learn and share our kaartdijin (knowledge). I’d also like to pay...

SLP – Cancer Screening Kirana Lockyer (Med Student) Acknowledgement to Country I would like to acknowledge the traditional owners, the Whadjak people of the Noongar nation and acknowledge the connection to the land on which we learn and share our kaartdijin (knowledge). I’d also like to pay my respects to elder's past, present and emerging.  A 52 year old woman comes to see the GP. She tells the GP that she has decided that she needs to start taking positive steps about her health and wants the GP to test her for ‘everything’. Case On closer questioning the GP discovers that the reason for the visit is that a close friend has been diagnosed with end stage ovarian cancer and she wants to know what she can do to make sure that she doesn’t have any type of cancer.. Her friend had no warning until it was too late. The patient has heard about the Ca125 blood test for ovarian cancer.  Outline WHO criteria for What Is Screening? – Why Do We Screen? What Types of Benefits And Harms cancer screening: Screening Vs Cancer Screening Is of Cancer Screening What Makes A Diagnostic Tests There? Screening Test And What Is NOT Valid? Recommended. Definitions Screening tests (SKREE-ning …) Tests that checks for the presence of disease, in patients that are asymptomatic Diagnostic tests (DY-ug-NAH-stik …) Tests that confirms the presence of disease, based of their signs and symptoms.  Why do we screen?  Early detection – Detecting before any symptoms have developed is important to improve prognosis and outcome.  Reduce the risk of disease or further progression – By screening you can reduce burden of disease on the individual and families.  Reduce mortality and morbidity – Treating the patient during the latent stage of disease can help to reduce the risk of the disease progression and further harm. What Screening tests are there? - 3 major government funded screening tests What age is What are you What screening recommended How often? screening for? test? for average risk? Bowel Cancer FOBT From age 45-74yo* Repeat every 2 years Breast Cancer Mammogram From age 50-74yo Repeat every 2 years Cervical Cancer HPV Test From age 25-74 Repeat every 5 years  Bowel Cancer – FOBT Fecal Occult Blood Test = Self collected sample to detect the presence of occult (hidden) blood in the stool. It involves using a test kit to take sample from two or three different bowel motions. You will receive the kit in the mail, the sample is collected at home and sent to the lab for analysis. The results are then sent to your GP.  Breast Cancer – Mammogram Mammogram is an x-ray image of the breast The process is usually not painful but can be uncomfortable. It can be used to identify masses, calcifications and changes to breast density Increased breast density may be cancerous  Cervical Cancer – HPV Testing Since the introduction of the screening program in 1991, cervical cancer incidence and rates have halved. HPV testing has replaced the pap smear The test screens for presence of HPV infection The main risk factor and cause of cervical cancer High-risk HPV subtypes – 16, 18 You may choose to either screen through: Self-collection of vaginal sample using a simple swab. Clinician-collection of the cervix using a speculum.  Other tests that are not recommended Ovarian Cancer – Cancer antigen 125 (CA 125) screening in asymptomatic, low-risk women is not recommended Transabdominal/ Transvaginal ultrasound is also not recommended. Prostate Cancer – PSA is not recommended for screening asymptomatic (low risk) patients. Benefits have not shown to outweigh the harm Skin cancer – Screening of asymptomatic patients is not recommended. Education is recommended, to raise awareness of early signs of skin cancer (Particularly >40yo). Testicular cancer – Clinical screening/ self examination is not recommended  Benefits and Harms of Cancer Screening Benefits Harms Reducing Over diagnosis Incidence Reducing False positives deaths Less False negatives aggressive treatment Increasing Exposure to harm Autonomy Decrease costs Anxiety and stress  Sensitivity vs Specificity Sensitivity = the probability that those WITH the disease with test positive Tests that are highly sensitive will rarely miss people who have the disease Specificity = the probability that those WITHOUT the disease will test negative Tests that are highly specific will rarely classify ‘disease- free’ people as having the disease WHO Criteria for Screening Programs  What makes it a valid screening test? WHO Criteria: 1. The condition should be an important health problem with a recognisable latent or early symptomatic stage 2. The test should be simple, safe, precise, validated and acceptable to the population The test should be suitable 3. There should be an acceptable treatment available This includes having facilities for diagnosis and treatment. 4. The screening program should be highly evidence based With RCTs showing effective reduction in mortality or morbidity.  A 52 year old woman comes to see the GP. She tells the GP that she has decided that she needs to start taking positive steps about her health and wants the GP to test her for ‘everything’. On closer questioning the GP discovers that the reason for Case the visit is that a close friend has been diagnosed with end stage ovarian cancer and she wants to know what she can do to make sure that she doesn’t have any type of cancer.. Her friend had no warning until it was too late. The patient has heard about the Ca125 blood test for Continued ovarian cancer. … Additional History: She has no family history of cancer. She doesn’t smoke and she drinks only social amounts of alcohol. She has no current symptoms to suggest anything is wrong.  Miss McGillivray is a 52 year old woman who comes to see you in your GP practice. She tells you that she has decided that she needs to start taking positive steps about her health and wants you to test her for ‘everything’. After building rapport and closer questioning, you discovers that the reason for the visit is that a close friend Case has been diagnosed with end stage ovarian cancer and she wants to know what she can do to make sure that she doesn’t have any type of cancer.. Her friend had no warning until it was too late. How would The patient has heard about the Ca125 blood test for we approach ovarian cancer. this? Additional History: She has no family history of cancer. She doesn’t smoke and she drinks only social amounts of alcohol. She has no current symptoms to suggest anything is wrong.  Case study – Activity (2 mins) 1. Is this a normal or high-risk patient? Why? 2. Is there any current screening programmes for ovarian cancer? 3. “Wants you to test for everything”, thinking about her age and current history what are some tests that can be done for her? (try thinking out of the box) 4. How do we communicate this to the patient whilst still maintaining a patient centred approach, addressing her concerns?  Case study 1. She is asymptomatic and therefore she is at low risk 2. CA 125 testing is not recommended as a screening test 3. Yes, there is bowel, cervical and breast screening. But there is also BP, cholesterol and diabetes. Doing a general health check may give her some peace of mind. 4. Addressing the patients underlying anxiety about her health, reassuring her that her risk is ‘normal/low’ and her concerns are understood. Suggesting screening programs that do have evidence, and she is eligible for (breast, bowel and cervical) New Screening Program – Lung Screening The first new national cancer screening program in 20 years Commence screening by July 2025 The program will target high-risk individuals to detect lung cancer in its early stages which will help to increase the likelihood of successful treatment and improve lung cancer outcomes Where to find info Lung cancer screening program – https://www.canceraustralia.gov.au/about-us/lung-cancer -screening#:~:text=The%20first%20new%20national%20cancer,and%20improve%20lung% 20cancer%20outcomes. WHO guidelines for cancer screening – https://iris.who.int/bitstream/handle/10665/351396/9789289057561-eng.pdf Cancer Council – https://cancerwa.asn.au/cancer-prevention/screening-and-early-diagnosis/ RACGP guidelines for preventative activities – https://www.racgp.org.au/FSDEDEV/media/documents/Clinical%20Resources/Guidelines/Red %20Book/Guidelines-for-preventive-activities-in-general-practice.pdf