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43 Cards in this Set
- Front
- Back
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What are the 3 defining features of epidemiology?
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-Distribution of diseases
-Determinants of diseases -In populations |
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What 3 features of the breast cancer Distribution are we concerned with?
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-Incidence
-Mortality -2ndary prevention |
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What is 2ndary prevention?
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Early detection
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What is incidence?
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The # of new cases of a disease in a population over a period of time.
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What is the most common cancer in women and what is its incidence?
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Breast cancer - highest of all the cancers
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How has the incidence of breast cancer changed since 1975?
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Increase then plateaud
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How does the incidence of breast cancer change with increasing age?
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It increases dramatically especially starting at age 45 or so
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In what races does this correlation of increasing incidence of br cancer with age appear?
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Both Whites and AA's
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In recent years what race has shown a 20% increase incidence of breast cancer?
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Whites! Yikes.
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What ethnic group has actually shown a decline in breast cancer incidence since 1975?
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American indians/alaskans
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How does the incidence of Whites and AA's breast cancer compare to other ethnic groups?
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Significantly higher
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So what is the most common cancer in US women?
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Breast cancer
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What is the highest cancer-cause of death in US women however?
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Lung cancer
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Where does Breast cancer fall in terms of cancer-caused deaths?
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2nd
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What is the trend since 1975 in cancer-caused deaths?
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Breast Ca used to be the highest cause, then it decreased as Lung cancer deaths increased.
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So how does death due to breast cancer change with increasing age?
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It increases
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In what ethnic/age group have we seen a higher decline in death rates due to breast cancer?
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Whites <65 yrs old have a disproportionately lower death rate than other races - esp in lite of their lower INCIDENCE - they shouldnt be the ones dying
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Why have we seen a huge increase in breast cancer incidence, but a decrease in deaths due to it?
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Because MAMMOGRAM screenings pick up more, and earlier.
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How do we get the data on incidence and mortality?
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From observational studies
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And what are observational studies prone to?
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Biases
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What are 3 types of bias in observational studies?
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-Lead time bias
-Length bias -Overdiagnosis bias |
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Why do we see these biases in observational studies?
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Because they aren't RCT's
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What is Lead time bias?
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What appears to be an increase in survival due to cancer screening, but really just longer time of being AWARE of the cancer.
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So is survival/time after diagnosis until death a good measure of cancer screening effectiveness?
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No
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What is the best way to study the effectiveness of screening? Why?
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Look at Mortality with RCT's - they compare mortality in screened vs UNscreened groups
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What is LENGTH bias?
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The tendency of screening to pick up INDOLENT cases that are longlasting than shorter more fatal cases, so it LOOKs like it helps survival, but not really.
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What is overdiagnosis bias?
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Detection of a disease that never would have caused morbidity anyway if it had been undetected.
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What is Sensitivity?
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True pos on the test
---------------------- TP + FN (all truly positives) |
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What is Specificity?
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True neg on the test
------------------------- TN + FP (all truly negatives) |
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When is mammography the most sensitive for women? Why?
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In women over 50 - there are more true positives
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What is PPV of mammography affected by more than Specificity or sensitivity?
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Incidence
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What is PPV of mammograpy in younger vs older women?
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Lower in young
Higher in older |
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What are 2 reasons for the lower PPV of mammography in younger women?
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-Lower incidence
-More FP's |
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When does the ACA recommend beginning annual mammogram screenings in women?
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Age 40
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How much Br cancer is hereditary?
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5-10%
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How much is family clustered?
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15-20%
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What is relative risk?
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Ratio of risk in one group (exposed to a risk factor) compared to another group's risk (unexposed)
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What is a positive risk factor that actually helps prevent breast cancer?
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Lactation
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What type of drinking promotes breast cancer?
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>14 drinks per week
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What is the RR of developing breast cancer when exposed to Tamoxifen?
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50% (decreased)
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What is Population attributable risk (PAR)?
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The % of cancer cases in the population that are attributable to a certain risk factor
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What risk factor has the highest PAR for breast cancer?
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Obesity after menopause
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What should you tell women age 40-49 about mammogram screenings?
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They have more false positives and lower sensitivity for this age group.
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