LWBK1006-13 LWW-Govindan-Review November 24, 2011 11:22
Chapter 13•Cancer Screening 147population. The currently available screening tests do not have adequate
sensitivity and specificity, especially considering the relatively low preva-
lence in the population.Answer 13.13. The answer is D.
LCIS is associated with an annual risk of developing breast cancer of up
to 1% per year. Screening with mammography and physical examination
can reduce breast cancer mortality in women with LCIS to the same level
as that of the general population. ADH or ductal atypia increases cancer
risk four- to fivefold, or even higher in women with a family history of
breast cancer or those with ADH at ages less than 30 years. A personal
history of mantle radiation (especially between the ages of 10 and 30
years) has also been shown to elevate breast cancer risk. Cases of breast
cancer have been reported as early as 8 years after treatment, so screening
of these women as early as 8 years posttreatment has been recommended.Answer 13.14. The answer is D.
Women without a cervix are not at risk for cervical cancer unless there
was a history of cervical cancer (then PAP smears are for follow-up of
the cancer, not for screening). Vaginal cuff smears are unnecessary; they
have an extremely low likelihood of detecting vaginal dysplasia, and the
false-positive rate is high.Answer 13.15. The answer is C.
Large trials of careful BSE instruction have failed to show any mortality
benefit, so BSE is no longer a standard component of breast cancer screen-
ing programs (the American Cancer Society lists BSE as an option). Latina
and African-American women are at higher risk for developing triple neg-
ative disease. Older women have higher risk for developing breast cancer
but they are less likely than younger women to develop triple negative
disease.Answer 13.16. The answer is B.
Aging and noncancerous diseases of the prostate are associated with rising
PSA levels. African-American men and men with family history of prostate
cancer in a nonelderly relative are at higher risk for prostate cancer than
the general population.Answer 13.17. The answer is C.
The studies to evaluate the effectiveness of screening test are susceptible to
several issues that includes lead-time bias, length-time bias and overdiag-
nosis bias. Therefore, an improvement in survival is not an appropriate
end point of cancer screening trials. Mortality rates are a more appro-
priate end point for these trials. Risk modeling techniques can identify
patients at high risk for developing cancer and are therefore candidates
for screening trials.