Review the clinician provider guidelines and recommendations from the United States Preventive Services Task Force A and B Recommendations. For the master’s-prepared nurse, knowledge of epidemiology and its application to preventive screening guidelines is important in many clinical areas: administrative, education, and nurse practitioner fields. Individual patient preventive screenings are ordered as a secondary measure before symptoms occur. Preventive screenings are recommended based on outcome data from epidemiological studies, that the test is beneficial; based on risk and characteristics of the identified population in the screening guideline. Select one screening below from the United States Preventive Services Task Force guidelines. • Abdominal aortic aneurysm • Breast cancer • Cervical cancer • Colon cancer • Diabetes mellitus II • Lung cancer CONDITION AND SCREENING • Define the condition and type of screening. EPIDEMIOLOGY OF CONDITION • Discuss the epidemiology of the condition in the United States, via three statistical terms. Include the mortality and related morbidity statistics in numerical format and address trends. Include 3 comparisons: related disparities, such as race, sex, age, etc. Clearly state an analysis of the data, identifying gaps and inequities in care. Provide trends and outcomes related to screening benefits in numerical statistics. METHODOLOGY • Incorporate the described USPSTF guideline development methodology process, (How the guideline was developed). • Discuss the preventive guideline criteria, the population, and provide details on the screening tool. • Include detailed risk factors. If there is a risk prediction tool, include this.
EPIDEMIOLOGY OF CONDITION
Colorectal cancer is the third most common cancer diagnosed and the second leading cause of cancer-related death in the United States when combining men and women.
Statistical Terms and Numerical Data
Statistical Term
Numerical Data (Approximate)
Trends
Incidence Rate (Age-Adjusted)
About 32.5 new cases per 100,000 population (2016–2020).
Declining by about 1-2% per year for ages 65 and older; however, rates are increasing by about 2% annually for people younger than 50 years of age, rapidly shifting the patient population younger.
Mortality Rate (Age-Adjusted)
About 11.2 deaths per 100,000 population (2016–2020).
Declining by about 2% per year overall since 2011; however, death rates have increased by about 1% annually in people younger than 50 since about 2005.
5-Year Relative Survival (Morbidity)
Overall survival is about 65%.
Survival is strongly linked to stage at diagnosis: Localized disease is ~91%; Distant metastasis is ~15%. Morbidity includes long-term side effects from treatment (e.g., neuropathy, ostomy-related issues).
Related Disparities, Gaps, and Inequities
Race/Ethnicity Disparity:
Black/African American individuals have the highest incidence and mortality rates of CRC in the US.
Incidence: 41.7 per 100,000 for Black individuals vs. 35.7 per 100,000 for White individuals (2015-2019).
Mortality: 17.6 per 100,000 for Black individuals vs. 13.1 per 100,000 for White individuals (2016-2020).
Analysis: This represents a significant inequity. Black individuals are about 20% more likely to be diagnosed and about 34% more likely to die from CRC compared to White individuals. Gaps in care likely include lower screening uptake, later stage at diagnosis, and differences in the quality of treatment or access to follow-up care.
Sample Answer
CONDITION AND SCREENING
Colorectal cancer (CRC) is a malignant tumor arising from the inner lining of the large intestine (colon) or rectum. It typically develops slowly over many years from precancerous growths called adenomatous polyps.
The type of screening is secondary prevention through testing asymptomatic, average-risk adults to detect precancerous polyps (which can be removed to prevent cancer) or early-stage cancer (which is highly curable).
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