Feb 23, 2024 NR 503 Week 2: Discussion – Screening and Reliability
NR 503 Week 2: Discussion – Screening and Reliability
NR 503 Week 2: Discussion – Screening and Reliability
The screening test I chose is the prostate-specific antigen (PSA) test that screens for prostate cancer.
In 2017, 161,360 prostate cancer cases were diagnosed in men living in the United States; within the same year, 26,730 men died from prostate cancer or complications resulting from prostate cancer (Eastham, 2017). Researchers, doctors, and cancer specialists are pleased about the reduction in the number of deaths from prostate cancer and aim to lessen the morbidity and mortality rates even more. The decrease has been attributed to the use of the prostate-specific antigen (PSA) test (Eastham, 2017). This early detection test is beneficial because it measures the level of PSA in a man’s blood; PSA is a protein produced by prostate gland cells (National Cancer Institute, 2017). If the prostate-specific antigen test indicates the blood level of a man’s PSA is elevated, he may be diagnosed with prostate cancer. The FDA suggests the use of the PSA test along with a digital rectal exam (DRE) to test asymptomatic men for prostate cancer. The PSA test not only detects the possibility of prostate cancer, it also indicates non-cancerous conditions that cause a man’s PSA level to rise, such as inflammation of the prostate (prostatitis) and enlargement of the prostate (benign prostatic hyperplasia -BPH) (National Cancer Institute, 2017). Men at risk to develop prostate cancer are adult men over 50 years of age who have had no previous diagnosis of prostate cancer or other prostate related conditions (National Cancer Institute, 2017). Adult men at a greater risk for developing prostate cancer include African-American men and men who report a family history of prostate cancer (National Cancer Institute, 2017). Many health and cancer organization recommend that adult men in the increased risk category begin screening earlier than age 50, typically around ages 40 to 45 (National Cancer Institute, 2017).
The United States Preventive Services Task Force (2018) has reviewed the information and statistics regarding adult men and the occurrence of prostate cancer, the use of the PSA test and digital rectal exam (DRE) to test men for prostate cancer, and which population of men have been indicated as the at-risk population. The Task Force (2018) has determined there are advantages to screening men between the ages of 55 and 69 and concludes there is little benefit to screening men before age 55 unless they are in the high-risk category. The primary benefit of administering the PSA test and digital rectal exam (DRE) is catching prostate cancer early, which reduces the risk of metastatic cancer and the amount of men dying from prostate cancer.
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The United States Preventive Services Task Force (2018) agrees with the National Cancer Institute and strongly recommends that doctors inform their African American patients and patients with a family history of prostate cancer about the potential benefits of screening and their increased risk of developing and dying from prostate cancer. The Task Force (2018) does not recommend screening for men older than 70, including men in the high-risk category because the benefits do not outweigh the harms.
Reference
Eastham, J. (2017). Prostate cancer screening. Investigative and Clinical Urology, 58(4), 217–219. Retrieved from http://doi.org/10.4111/icu.2017.58.4.217
National Cancer Institute. (2017, October 4). Prostate-Specific Antigen (PSA) Test. Retrieved from https://www.cancer.gov/types/prostate/psa-fact-sheet#q1
United States Preventive Services Task Force. (2018). Prostate cancer screening final recommendation back to top. Retrieved from https://screeningforprostatecancer.org/
Thank you for your post. As you discussed, colorectal cancer is highly precedent within our world today. Given this, it is essential that screenings take place so that early detection is present among the disease. Colorectal screenings remain imperative as a preventive measure for colorectal cancer as it is known as an avoidable and treatable disease (Niikura, 2017). Given our knowledge of colorectal cancer (CRC) screening, one is now able to screen for colorectal cancer in attempts to decrease mortality rates of the disease. Colonoscopy is one of the most used screening techniques for CRC as it is a reliable procedure for detecting the presence of the disease. As you discussed, this screening is known as a standard for CRC screening worldwide. Through using colonoscopy screenings, deaths from colorectal, colon, and rectal cancers can be used to decrease deaths as it is able to catch cancer at its earliest stages (Niikura et al., 2017). I agree with you that screening and education will help to continue to lower mortality rates from colorectal and other related cancers.
The trends show that education is directly related to lowering the mortality rates for this disease. As you have found, fecal occult blood tests (FOBTs) have been proven to effectively lower mortality rates, but adhering to screening guidelines for this type of test will prove to be a challenge. This test needs to be done annually in order to be most effective. Making FOBTs more accessible and clear will help promote this screening as an effective method (Arnold et al., 2016). In addition to education on screenings and guidelines I believe it will be beneficial to provide education on possible means of prevention of CRC. Studies have found that there is strong evidence to support the use of daily, low-dose aspirin, for initial prevention of CRC in moderate-to-high risk adults. Further education must be done to those at-risk populations to teach that there are means to prevent CRC and answers to other objections regarding daily aspirin intake (Jensen et al., 2016). Education on screening will be beneficial for patient populations, as many individuals may be undereducated on the subject. It will be the duty of advanced practice nurses to promote research and education within this area, as colorectal screenings will be of note in current and future generations.
References:
Arnold, C., Rademaker, A., Wolf, M., Liu, D., Lucas, G., Hancock, J., & Davis, T. (2016). Final results of a 3-year literacy-informed intervention to promote annual fecal occult blood test screening. Journal of Community Health, 41(4), 724-731. doi:10.1007/s10900-015-0146-6
Jensen, J. D., Holton, A. E., Krakow, M., Weaver, J., Donovan, E., & Tavtigian, S. (2016). Colorectal cancer prevention and intentions to use low-dose aspirin: A survey of 1000 U.S. adults aged 40–65. Cancer Epidemiology, 41(1), 99-105. doi:10.1016/j.canep.2016.02.003
Niikura, R., Hirata, Y., Suzuki, N., Yamada, A., Hayakawa, Y., Suzuki, H., . . . Koike, K. (2017). Colonoscopy reduces colorectal cancer mortality: A multicenter, long-term, colonoscopy-based cohort study. Plos One, 12(9), e0185294. doi:10.1371/journal.pone.0185294
NR 503 Week 2: Discussion – Screening and Reliability
From the U.S. Preventive Task Force website https://www.uspreventiveservicestaskforce.org/BrowseRec/Index (Links to an external site.)Links to an external site., choose one screening test that might be considered in primary care.
Define the test, its positive predictive value, reliability and validity. Discuss patient medical or family history that may alter your recommendation for screening?
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A Papanicolaou test or better known as Pap smear testing is a method of cervical cancer screening. It is used to detect cervical epithelial changes that can be pre-cancerous and cancerous (Sachan, Singh, Patel, & Sachan, 2018). There are two forms of cervical screening testing, conventional and liquid-based cytology. There is no clinical or significant difference in the results. As with any testing and results, there can be a potential false-positive or a false-negative. In essence, one is not better than the other. Both methods share the same high accuracy rate. If further testing is needed a colposcopy is performed as the diagnostic test.
Cervical cancer screening consist of cytology (Pap smear) for women with a cervix at ages 21-29 every 3 years and for women 30 to 65 cytology every 3 years or cytology with human papilloma virus (HPV) every 5 years. There has been a large reduction rate of cervical cancers in the United States. Early screening and detection reduces cervical rates 60% to 90% within 3 years of interventions (U.S. Preventive Services Task Force [USPSTF], 2012). Unfortunately, for developing countries cervical cancer is higher due to the lack of knowledge, technology, and experience.
“The overall sensitivity of the Pap test in detecting a high-grade squamous intraepithelial lesion (HSIL) is 70.2%. A Pap screening done in association with a HPV DNA test increases the sensitivity for early detection of precancerous lesions” (Sachan, Singh, Patel, & Sachan, 2018). There can be 6 different pap results, I will list the severity in ascending order: negative, atypical squamous cells (ASC-US), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), atypical squamous cells-cannot exclude HSIL (ASC-H), and atypical glandular cells (ACG) (The American College of Obstetrician and Gynecologists [ACOG], 2016). Depending on the results and the patient’s age will depend on if a colposcopy, biopsy, or an endocervical sampling is needed.
Situations that can alter the screening for this patient is having a total hysterectomy (medical history). It is not recommended a pap smear be performed on someone without a cervix due to a lack of cervical precancerous lesions. Another alteration could be if their immediate family member has been diagnosed with cancer early in life (family history). If a patient is HIV positive they may require more frequent screening. Also, the patient’s age. Studies have found screening prior to age 21 and after age 65 with previous normal Pap smear results is not beneficial. The risk outweighs the benefits and can potentially cause physical and/or psychological damage.
NR 503 Week 2: Discussion – Screening and Reliability Reference
The American College of Obstetrician and Gynecologists. (2016). Abnormal cervical cancer screening test results. Retrieved from https://www.acog.org
Sachan, P.L., Singh, M., Patel, M.L., & Sachan, R. (2018). A study on cervical cancer screening using pap smear test and clinical correlation. Asia-Pacific Journal of Oncology Nursing, 5(3), 337-341.
U.S. Preventive Services Task Force. (2012). Cervical Cancer: Screening. Retrieved from https://www.uspreventiveservicestaskforce.org.
Good Evening,I enjoy reading your post, it was quite informative. Cancer is the second leading cause of death globally, and was responsible for 8.8 million deaths in 2015. Globally, nearly 1 in 6 deaths is due to cancer (WHO, 2018). Approximately 15% of cancers diagnosed in 2012 were attributed to carcinogenic infections, including Helicobacter pylori, Human papillomavirus (HPV), Hepatitis B virus, Hepatitis C virus, and Epstein-Barr virus (Plummer, Martel, Vignat, Ferlay, Bray, & Franceschi, 2016). More specifically, cervical cancer was a known cause of death for American women. However, this rate of death was decreased due to the use of the Pap test (WHO, 2018). It has been my experience that many young women visit the ED with vaginal complaints and have never obtained a Pap smear, let alone visit the gynecologist for these complaints. The challenge as a nurse is educating these young women on the importance of this screening. The views or beliefs held by the young ladies are that they are not in need of this test, embarrassed, or just lack of knowledge. To enable a positive moment where the information presented is grasped by the female patient, the nurse should strive to provide education that stresses the importance of the Pap smear and strategies allowing greater understanding of one’s own body (Plummer et.al, 2016). Additionally, continue to build trust and allow for opportunities to plant the seeds of knowledge. Screening aims to identify individuals with abnormalities suggestive of a specific cancer or pre-cancer who have not developed any symptoms and refer them promptly for diagnosis and treatment. Screening programms can be effective for select cancer types when appropriate tests are used, implemented effectively, linked to other steps in the screening process and when quality is assured. In general, a screening program is a far more complex public health intervention compared to early diagnosis.
Examples of screening methods are:visual inspection with acetic acid (VIA) for cervical cancer in low-income settings;HPV testing for cervical cancer;PAP cytology test for cervical cancer in middle- and high-income settings; andmammography screening for breast cancer in settings with strong or relatively strong health systems.
Plummer, M., Martel, C., Vignat, J., Ferlay, J., Bray, F., & Franceschi, S. (2016). Global burden of cancers attributable to infections in 2012: a synthetic analysis. Lancet Glob Health. 4(9):e609-16. doi: 10.1016/S2214-109X(16)30143-7.
World Health Organization (2018). Cancer. Retrieved from http://www.who.int/news-room/fact-sheets/detail/cancer on 07/18/2018
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Thank you for your follow-up! This information is exactly what I was looking for this week. As you are learning this week, sensitivity and specificity are both characteristics of a test. There is always a trade-off between the two. In other words, a test may be more sensitive, but less specific and vice versa. For example, a test that’s very sensitive will pick up even the slightest abnormal finding. This means it will miss few cases of the disease, but it will also mistake some people as having the disease when they don’t. Unlike PPV and NPV, the sensitivity and specificity of diagnostic tests are not affected by the prevalence of the disease/condition. Instead, they can be influenced by differences in disease characteristics (such as clinical severity or anatomic extent of a disease) and characteristics of patients such as age. As you discuss, the accuracy of a Pap screen greatly depends on the technique and collection method, affecting the quality of the test. Also, the threshold utilized creates varied results regarding sensitivity, and specificity
Colorectal Cancer: Screening
Colorectal cancer (CRC) is a major health problem given its high incidence and associated morbidity and mortality (US Preventive Services Task Force, 2016). Colorectal cancer is the fourth most common cancer diagnosed each year in the United States. This year, it is estimated that 135,430 adults in the United States will be diagnosed with colorectal cancer. These figures include 95,520 new cases of colon cancer and 39,910 new cases of rectal cancer.
It is estimated that 50,260 deaths (27,150 men and 23,110 women) will be attributed to colon or rectal cancer this year (Lin, Piper, Perdue, Rutter, Webber, O’Connor, Smith, & Whitlock, 2016). Colorectal cancer is the second leading cause of cancer death in the United States for men and women combined. It is the second leading cause of cancer death in men and the third leading cause of cancer death in women. Colorectal cancer mainly affects older adults, but an increasing incidence is observed in younger people (Lin et al., 2016).
When colorectal cancer is detected early, it can often be cured. The mortality rate of this type of cancer has decreased since the mid-1980s (Lin et al., 2016), probably due to the fact that currently there are better treatments and, in general, it is detected in its initial stage.
The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years (A recommendation). The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient’s overall health and prior screening history (C recommendation) (2016).
Assessment of Risk
A colon cancer risk assessment survey at Cleveland Clinic in Cleveland, Ohio, found that participants who exercised more, followed a healthy diet and did not smoke were less likely to have a personal history of colorectal cancer or colon polyps (2015). For the vast majority of adults, the most important risk factor for colorectal cancer is older age. Most cases of colorectal cancer occur among adults older than 50 years; the median age at diagnosis is 68 years (Kalady & Heald, 2015). Male sex and black race are also associated with higher colorectal cancer incidence and mortality. Black adults have the highest incidence and mortality rates compared with other racial/ethnic subgroups. Also, A positive family history (excluding known inherited familial syndromes) is thought to be linked to about 20% of cases of colorectal cancer. About 3% to 10% of the population has a first-degree relative with colorectal cancer (Lin et al., 2016). The USPSTF did not specifically review the evidence on screening in populations at increased risk; however, other professional organizations recommend that patients with a family history of colorectal cancer (a first-degree relative with early-onset colorectal cancer or multiple first-degree relatives with the disease) be screened more frequently starting at a younger age and with colonoscopy (2016).
The main risk factors for colorectal cancer are family history and older age, but some other factors have been linked to a higher risk, including excessive alcohol consumption, obesity, physical inactivity, smoking cigarettes and possibly the diet (Lin et al., 2016). In addition, people with a history of inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease) have a higher risk of colorectal cancer than people who do not have those diseases (Lin et al., 2016). And people who have some inherited diseases (such as Lynch syndrome and familial adenomatous polyposis) are also at increased risk of colorectal cancer.
Several screening tests have been created to help doctors find colorectal cancer early, when it is most treatable. Some tests that detect adenomas and polyps can actually prevent the onset of cancer, since these tests allow the detection and removal of lumps that might otherwise become cancerous. That is, screening for colorectal cancer can be a way to prevent cancer, not just detect it when it starts.
Screening
Screening is an activity of medical practice. It is defined by WHO as “presumptive identification, with the help of tests, examinations or other techniques susceptible of rapid application, of the subjects affected by a disease or an anomaly that until then had gone unnoticed “( Doubeni, Weinmann, & Adams, 2013).Screening is a secondary prevention measure; its purpose basic is to reduce the incidence of complications derived from a pathology (for example, blindness in diabetic retinopathy), decrease mortality by a disease (for example, colorectal cancer) and / or increase the quality of life of people affected by a certain pathology (Doubeni, Weinmann, & Adams, 2013).
Screening Test:
Fecal occult blood test based on guaiac (FOBT)
Historically utilized guaiac-based tests that identify the presence of hemoglobin based on a nonspecific peroxidase reaction (Weiss, 2013). With regard to the reliability of a standard of annual high-sensitivity fecal occult blood testing (sensitivity for cancer ≥70%) .Guaiac-based FOBT is no longer recommended for cancer screening because it does not detect most polyps and cancers. Furthermore, the false-positive rate with guaiac tests is high if patients do not follow the recommended dietary (withholding notably meat, certain vegetables, iron supplements) or pharmaceutical (withholding nonsteroidal anti-inflammatory drugs, vitamin C) restrictions. Finally, multiple stool collections are needed for optimal interpretation of guaiac-based FOBT results.
Fecal immunochemical testing (FIT)
Has evolved as the preferred occult blood test for colorectal cancer screening due to the lack of specificity and sensitivity of guaiac-based methods. FIT specifically detects the presence of human hemoglobin, eliminating the need for dietary and medication restrictions (Weiss, 2013). For colorectal cancer screening only, a single collection is required. The specificity of FIT is routinely >95% with reported sensitivities ranging from 40% to 70% based on the patient population (Weiss, 2013). The clinical specificity of FIT is 97% based on internal studies conducted at Mayo.
Sigmoidoscopy, flexible (SF) or rigid (SR),
It is necessary a previous preparation of the intestine by means of enemas but, in general, it is tolerated without need of sedation. It allows to visualize the distal colon and take biopsies, although biopsies are not usually performed because of the risk of explosion that exists in cauterization and also because the presence of polyps in the distal colon is usually associated with polyps in the proximal colon and is required, therefore, a complete colorectal exam. One of its main limitations is the inability to examine the proximal colon as well as the doubtful ability to detect polyps less than 1 cm in diameter (Weiss, 2013). The risk of complications is low.
The double contrast barium enema
DCBE is the type of enema most proposed as a CRC screening technique. It requires liquid diet, laxatives and enemas during the previous 24 hours. Between 5 and 10% of explorations are not conclusive and it is necessary to repeat them or perform a posterior colonoscopy (Weiss, 2013). It can miss sigma and rectum injuries.
Colonoscopy
Requires prior bowel preparation and sedation. The risk of complications is greater than in any of the above (perforation, severe bleeding, respiratory depression) (Weiss, 2013). False negatives are little frequent. So far, there have been no controlled and randomized trials that the evaluate as a screening technique for the reduction of mortality by CRC. On the other hand, research is being carried out on non-invasive possibilities, such as molecular biology, calprotectin detection or virtual colonoscopy. Colonoscopy is currently considered the reference test or gold standard for the diagnosis of CCR, allowing the capture of samples (biopsy) for anatomopathological examination, as well as the extirpation of cancers and premalignant lesions. It has not been widely used as a technique primary screening in moderate risk population, although it is the test of selection of screening recommended by the American College of Gastroenterology.
The conclusion that is finally drawn is that the fecal occult blood test is the test that has greater scientific evidence as a population screening technique for CRC. Very few diagnostic tests, perhaps none, identify with certainty whether the patient has the disease in question or not. The validity of a diagnostic test depends on its ability to correctly detect the presence or absence of the disease being studied, which is expressed mathematically in several indices: sensitivity, specificity, positive predictive value and negative predictive value, overall value of the test, reason of positive likelihood and reason of negative likelihood (Weiss, 2013).
Doubeni, C.A., Weinmann, S., Adams, K., (2013). Screening colonoscopy and risk of incident late-stage colorectal cancer diagnosis in average-risk adults: a nested case-control study. Ann Int Med.
Kalady, M. F. & Heald, B. (2015). Diagnostic Approach to Hereditary Colorectal Cancer Syndromes.Clin Colon Rectal Surg. 28(4): 205–214. doi: 10.1055/s-0035-1564432
Lin, J.S., Piper, M.A., Perdue, L.A., Rutter, C. M., Webber, E.M., O’Connor, E., Smith, N., & Whitlock, E.P (2016). Screening for Colorectal Cancer Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 315(23):2576-2594. doi:10.1001/jama.2016.3332
US Preventive Services Task Force (2016). Screening for Colorectal Cancer US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(23):2564-2575. doi:10.1001/jama.2016.5989 Weiss, N. (2013). Case-control studies of screening for colorectal cancer: Tailoring the design and analysis to the specific research question.Epidemiology. 24(6): 894–897 doi: 10.1097/EDE.0b013e3182a777b2
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