Prevention, screening and family risk

From Oncology for Medical Students
Ideal oncology curriculum > Prevention, screening and family risk

Objective 1.3

At graduation, the student should be able to:

a) describe methods for the primary and secondary prevention of cancer, including measures that employ a public health approach, as well as those depending on individuals and their doctors
b) describe the methods of screening for cancer and pre-malignant conditions
c) demonstrate an understanding of the scientific evidence for the utility of screening, the difference between population-based screening and surveillance of individuals, and cost-effectiveness issues
d) discuss environmental control and behavioural and chemical approaches to the prevention of cancer
e) demonstrate an understanding of the psychosocial impact of screening and staging investigations on the patient
f) demonstrate ability to take family history.

Prerequisite knowledge

  • Basic epidemiological concepts including: prevalence; incidence; specificity; sensitivity; predictive value; screening v diagnosis; cost-benefit analysis; and prevention strategies.

Representative questions that suggest the required depth of knowledge

1. Elizabeth Smith, a 54 year-old long-standing patient is seeing you in a follow-up visit for a settling U.T.I. You decide it is time she had a mammogram and suggest this to her. She replies: "Why should I do that and what good would it do me?" What is your answer?

Essential in answer:

  • Mammographic screening of women over 50 years of age has been shown to improve survival and produce better outcomes in populations that are screened

2. John Smith, the 54 year-old husband of Elizabeth is seeing you for a routine insurance check-up. During the course of the visit he asks you about cancer. He smokes 10 cigarettes a day, drinks "socially", is modestly overweight and has a younger brother with colorectal cancer. He then specifically asks for a PSA test, as he is worried about prostate cancer. What course of action and relevant explanations would you offer to him?

Essential in answer:

  • Knowledge of environmental and lifestyle risk factors
  • Knowledge of the genetics of colorectal cancer
  • Knowledge of the controversy regarding PSA screening
  • Recognition that smoking, overweight and familial risks are, on balance, more significant issues than PSA levels for this patient

3. With respect to screening for common cancers in Australia, select the best answer:

(a) Mammography has been advocated in Australia for asymptomatic women aged <40 years.
(b) Pap smears can be discontinued when the woman ceases regular sexual activity.
(c) A normal result for prostate specific antigen (PSA) excludes a diagnosis of prostate cancer.
(d) A family history of familial adenomatous polyposis increases the probability of malignancy in an anxious 27 year-old female who reports altered bowel habit.

Answer: (d)