BPK 140 Chapter Notes - Chapter 5: Coronary Artery Disease, Prostate Cancer, Egg Cell

49 views8 pages

copperferret29

24 Jun 2016

School

Simon Fraser University

Department

Biomedical Physio & Kines

Course

BPK 140

Professor

Michael Hart

For unlimited access to Textbook Notes, a Class+ subscription is required.

Document Summary

Cancer is the leading cause of death in canada. Coronary artery disease (cad) and stroke accounted for 21% and 6% respectively. Four major cancers (lung, breast, colorectal, and prostate) account for the majority 53% of newly diagnosed cancers in canadians. Mortality rates declined in canada from 1998 to 2008 for all four of these cancers. We can attribute this trend to both improvements in screening and early detection, and the discovery and use of more effective and less toxic cancer treatments. Non-melanoma skin cancer is the most common cancer diagnosed in. Canadians, but it accounts for a very few deaths. Cancer is primarily a disease of older people. In canada, more males die of cancer than females. Cancer mortality rates are decreasing more rapidly for men than for woman because of increasing lung cancer mortality among women. Cancer was the leading cause of potential year of life lost (pyll) in 2009.

Related Questions

This includes showing all calculations and explaining why you selected a specific answer for each multiple choice question (i.e. donât just circle the correct answer). I am looking to see how you got the answer, not just that you have the correct answer.

Below is data from the United States Cancer Statistics about the number of news cases of lung cancer in males in the U.S. for 2011 for ages 30 and older.

Table 1: U.S. Population Size and Incidence Cases of Lung Cancer in Males for 2011

Age (Years)	U.S. Male Population	White Population	White Incidence Cases	Black Population	Black Incidence Cases
30-34	10,181,564	7,950,924	88	1,383,650	22
35-39	9,666,162	7,557,263	212	1,271,897	23
40-44	10,363,126	8,259,215	643	1,324,847	132
45-49	10,856,131	8,766,225	2,032	1,373,346	444
50-54	10,976,172	9,004,383	5,128	1,329,551	1,148
55-59	9,733,849	8,101,629	8,607	1,091,030	1,687
60-64	8,466,308	7,183,960	12,340	845,362	2,067
65-69	6,014,777	5,178,255	15,792	539,796	2,077
70-74	4,360,942	3,769,569	16,011	376,129	1,864
75-79	3,204,196	2,807,216	14,319	255,221	1,426
80-84	2,319,839	2,078,071	11,284	154,155	883
85+	1,873,942	1,688,433	7,616	117,267	545
Total	88,017,008	72,345,143	94,072	10,062,251	12,318

3. What is the age-specific incidence rate for lung cancer in white men age 75-79 for 2011?(1 pt)

0.005 per 1000

1.3 per 1000

1.2 per 1000

5.1 per 1000

5.6 per 1000

F. Cannot be calculated from the given information

4. What is the age-specific incidence rate for lung cancer in black men age 75-79 for 2011? (1 pt)

0.005 per 1000

1.3 per 1000

1.2 per 1000

5.1 per 1000

5.6 per 1000

F. Cannot be calculated from the given information

Questions 5 through 7 are based on the information below:

Using the information in Table 1, researchers calculated the crude incidence rates and age-adjusted incidence rates (via the direct method) for both groups.

Table 2: Crude incidence rates and age-adjusted incidence rates for white and black males

White Males		Black Males
Crude Incidence Rate	Age-adjusted Incidence Rate	Crude Incidence Rate	Age-adjusted Incidence Rate
1.3 per 1000	1.2 per 1000	1.2 per 1000	1.5 per 1000

5. True or False, there is likely a difference in the age composition between the white and black males. Explain your answer

6. Based on the information in Table 2, it was reported that there was an increased risk of lung cancer in black males in 2011. (1 pt)

The conclusion is:

Correct, the age-adjusted rate is higher in black males compared to white males

Correct, because both the crude and age-adjusted rates are higher in black males compared to white males

Incorrect, because the incidence rate for white males is actually higher than the incidence rate for black males

7. What type of age-adjusted rate was calculated in table 2? How does it differ from the age-adjusted rate in question 5 in the in-class exercise for age-adjustments? Hint: See slide title: Adjustments for Other Measures of Disease Frequency in the lecture title Adjusted Rates (1 pt)

Question 8 is based on the information given below:

Cause-specific mortality rates for men in 2010 in the U.S. from various types of cancers are shown in the table below:

Cause-Specific Mortality Rates

(per 100,000 Men)

Location of the Cancer

in the Body White Asian

Pancreas 13.2 5.7

Prostate 19.1 2.5

Lung 62.3 18.5

Skin 4.9 0.3

8. The inference that White men in the U.S. are at higher risk of death due to cancer of the pancreas, prostate, lung, and skin compared to Asian men in the U.S. is

A. correct

B. incorrect because of failure to determine cause-specific mortality rates

incorrect because proportionate mortality alone does not give an estimate of risk

D. incorrect because of failure to adjust for differences in the age composition of the two populations

E. incorrect because counts were used when cause-specific mortality rates were needed

9. In January 1996, a team of epidemiologists identified a sample of 4,500 men, 65-74 years of age, for a study of prostate cancer. Tests indicated that 315 of the men already had prostate cancer and, therefore, were not at risk. The rest of the men were followed prospectively for five years to determine the incidence rate of prostate cancer in the sample. By the end of the five years of follow-up 156 of the men had developed prostate cancer. What is the incidence rate of prostate cancer in this group?

10. An epidemiologic investigation that started on January 1, 2011, identified a population of 1,000 individuals. At the start of the study 4 were found to have the disease. During the year of study, 6 new cases were found; thus a total of 10 cases were identified. Among those 10 cases, 6 deaths occurred during the year. What was the prevalence of the disease during the 1-year study?

pinkhornet564

61) How areantiangiogenic drugs used in the treatment of

cancer?

A) These drugsstop the replication of DNA so cancer cells

cannot reproduce.

B) These drugsstop the growth of blood vessels into the

tumor, so the cells "starve" to death.

C) These drugsstop metastasis.

D) These drugsstimulate the immune system.

E) These drugsstimulate the production of free radicals,

which kill cancer cells.

62) Which of the

following is true regarding photodynamic therapy?

A) It involves the use

of light sensitive drugs to target a cancer.

B) It uses magnets to

attract beads coated with a chemotherapeutic drug to acancer.

C) It is presently used

for the treatment of cancers of the breast and ovary.

D) It inhibits

angiogenesis.

E) It involves the use

of antibodies to deliver treatments to a cancer.

63) Which ofthe following types of cancer kills the highest

percentage of people diagnosed with the condition?

A)lung

B)breast

C)prostate

D)skin

E)colon

64) A mutationin which of the following genes can lead to

breast cancer?

A) BT05

B) HeLa

C) BRCA1

D)BCG

E)BCG2

65) If angiogenesis

were not to occur, a tumor would reach the size of a ________and stop growing.

A) period on a

typewritten page (.)

B) baseball

C) grapefruit

D) pea

E) basketball

66) Not onlydoes smoking cause lung cancer, it also doubles

the risk of which of the following types of cancer?

A)stomach

B)prostate

C)bladder

67) For women with a

mutated BRCA gene, the risk of breast cancer is about 60%.However, detection

of the mutated gene can occur before cancer ever develops by

A) testing of a blood

sample.

B) screening

mammography.

C) taking a biopsy of

breast tissue.

D) a PET scan.

E) urinalysis.

68) In some cases, why

doesn%u2019t the immune system recognize and destroy acancer?

A) Cancer cells that

produce abnormal antigens sometimes shed them.

B) Cancer cells have

less surface receptors needed for proper activation of Tcells.

C) Cancer cells have

enough %u201Cself%u201D surface markers as to be identified asnormal cells.

D) Cancer cells develop

from normal cells that cannot regulate cell division.

E) all of the above are

correct.

69) Theultimate goal of the male reproductive system is to

A) ensure thatsperm is produced at the correct time,

coinciding with ovulation.

B) releasesperm into the female's reproductive system.

C) join spermwith an egg, in an environment that favors

fertilization.

D) producelarge numbers of sperm.

E) maintain thehomeostatic condition of the male's body.

70) Synthesisof new sperm cells occurs in the

A) ductusdeferens.

B)urethra.

C) prostategland.

D) epididymis.

E) seminiferous tubules.

71) Externalgenitalia

of the male reproductive system include(s)

A) theejaculatory duct.

B) the urethraand scrotum.

C) the penisand scrotum.

D) thepenis.

E) the penis,urethra, and ejaculatory duct.

72) The releaseof LH in human males signals that

A) inhibin hasinhibited FHS secretion.

B) thehypothalamus has been stimulated to release inhibin.

C) spermproduction must be reduced.

D) the positivefeedback loop that regulates sperm production

is active.

E) blood levels of

testosterone are low

emeraldjellyfish291

While the concepts of screening and surveillance are intertwined there are subtle distinctions between the two ideas. The main goals are data collection to measure magnitude, changes, and trends in populations. The objective is to create interventions in defined populations. On the contrary, testing to identify individuals with infection or disease is the main goal of screening. The area of breast cancer screening and breast cancer surveillance has been a point of contention. Please read the following article and weigh in on which side seems most convincing:

There is a heated debate in this country about the risks and benefits associated with screening mammography. Proponents on both sides of the debate feel equally as strongly for or against annual breast cancer screening. Despite oneâs opinions regarding the utility of screening mammography, it is difficult to deny that the rates of false-positive exams, the rates of overdiagnosis, and the cost of annual screening are too high. We can do better. It is time to stop devoting energy to arguing about data from studies performed decades ago and start working toward gathering new evidence. In late 2015, we will initiate the WISDOM study to investigate the safety and effectiveness of a personalized breast cancer screening model. This model will use a comprehensive risk assessment process to determine individualized screening regimens for women in the interventional arm. The data collected in this study will better inform the screening debate and will allow us to shed more light and less heat on the issue.

There is a great debate in this country about the risks and benefits of screening mammography. On one side of the debate are those in favor of the one-size-fits-all model of performing annual mammograms starting at the age of 40 for women who are not known to be at greatly elevated risk of developing breast cancer. The radiology community argues that this model reduces the rates of interval cancers, aids early detection, and should not be changed. On the other side of the debate are those who support the United States Preventive Services Task Force (USPSTF) recommendations to screen women biennially starting at age 50, and to screen women in their 40s based on personal preferences regarding the potential benefits and harms of screening.¹ Specialists on this side of the debate believe that annual screening results in unacceptably high rates of false-positive recalls, overdiagnosis, and overtreatment.

Recently, the USPSTF published a draft update to the 2009 breast cancer screening recommendations, and the debate has once again intensified. The solution to this problem is not to continue the debate with repetitious reviews of studies that were performed more than 30 years ago, but to focus ahead on how to make breast cancer screening safer and more effective. The time has come to put the debate to rest by conducting a modern-era screening trial.

Before focusing on the future, let us first take a moment to review the current state of breast cancer screening in the United States. The majority of providers in this country continue to recommend annual screening starting at age 40.² Proponents of annual screening mammography cite a resulting relative reduction in breast cancer mortality of 21%, which is based on data from randomized screening trials performed in the 1970s and 1980s.³ However, this estimated benefit comes with significant drawbacks. After 10 years of annual screening, over one-half of women screened will receive a false-positive recall, and 7% to 9% will undergo a benign biopsy.^4,5 False-positive recalls and benign biopsies can cause long-lasting psychological distress that can negatively impact a womanâs willingness to undergo screening for breast cancer in the future. Additionally, false-positive recalls and overdiagnosis cost the United States an estimated $4 billion per year,⁶ and screening in aggregate is estimated to cost between $8 and 10 billion per year.⁷ This estimate is based on a screening mammogram costing between $135 and $195. If the cost of mammography increases, the overall cost of breast cancer screening increases proportionally. As a country and as healthcare professionals, we can and should do better.

Breast cancer screening should harness the advances that have been made in breast cancer risk assessment and our understanding of breast cancer tumor biology. Screening should be more effective at finding relevant and consequential cancers, and should result in fewer benign biopsies. Screening should also be better integrated with prevention. Lastly, screening should be more cost-effective. A personalized screening model could potentially achieve all of these goals.

The aim of a personalized screening model would be to focus resources on those women who are most likely to benefit. The foundation of the model would be a comprehensive risk assessment that would take into consideration a womanâs classical risk factors for breast cancer, such as her personal and family history of breast disease. This comprehensive risk assessment would also include an evaluation of breast density and germline genetic testing. These risk factors would then be placed into a breast cancer risk model that would estimate the womanâs 5-year risk of developing breast cancer, and personalized screening recommendations would be made according to this risk. Women at high risk of developing breast cancer would be screened more frequently, and women at low risk would be screened less frequently. This risk estimation could also be used to make recommendations regarding chemoprevention, thereby integrating screening and prevention, which is the real key to reducing mortality from breast cancer.

This model has the potential to optimize the benefits of mammography in the context of modern systemic therapy while minimizing harms. Using a similar risk model in 3 independent study populations, it has been shown that 50% of cancers occur in women with the top 20% predicted risk.⁸ This model is also practical because these risk factors are easy to assess, and it is estimated to be more cost-effective than annual screening, despite the use of genetic testing, which has decreased in cost significantly since the Supreme Court ruling in June 2013 that stated that the human genome could not be patented.

Personalized screening may be the way forward, but this can only be determined in the setting of a randomized controlled trial. In the fall of 2015, a randomized controlled trial comparing personalized breast cancer screening with annual screening will be initiated within the Athena Breast Health Network that spans the University of California and the Sanford Health system in the Midwest. This study will be called the WISDOM study (Women Informed to Screen Depending on Measures of Risk). We have received a large grant from the Patient-Centered Outcomes Research Institute to perform this trial, and are also working with payers and self-insured employers, such as Blue Shield of California and UC Health, to create a Coverage with Evidence Development policy that will cover the medical costs of the trial. Using surrogate endpoints and long-term follow-up, we aim to determine whether personalized screening is as effective, less morbid, more preferred by women, and enables prevention more as compared with annual screening. Our hope is that this trial will provide us with the information we need in order to determine the safest and most effective way to screen women for breast cancer. Then, and only then, will we be able to put âThe Great Mammography Debateâ to rest.

As we move toward a more biology-based approach to the treatment of diseases, our approach to screening for and preventing those diseases should follow suit. The opportunity before us is to learn who is at risk for which type of breast cancer, and to optimize our screening and prevention strategies for each individual according to her personal risk. Over the last 20 years, many advances have been made in our understanding of the risk factors that contribute to a womanâs risk of developing breast cancer. The time has come for us to harness this knowledge and apply it in an evidence-generating fashion to shed more light and less heat on the screening controversy.

Do you believe that US Preventive Services Task Force (USPSTF) recommendations should be followed or do you believe screening should start at age 40? Why or why not?

BPK 140 Chapter Notes - Chapter 5: Coronary Artery Disease, Prostate Cancer, Egg Cell

Document Summary

Get access

Related Documents

BPK 140 Chapter Notes - Chapter 5: Colorectal Cancer, Prostate Cancer, Lung Cancer

BPK 140 Chapter Notes - Chapter 5: Breast Cancer Screening, United States Preventive Services Task Force, Lung Cancer

BPK 140 Lecture Notes - Lecture 4: Prostate Cancer, Skin Cancer, Melanoma

Related Questions