Posted by Alex
Most Pap smears in Canada are performed by family physicians. Despite the tremendous success of the Pap test in reducing the incidence of cancer of the cervix in Canada, 1350 new cases and 390 deaths were predicted to occur in 1996. Incidence rates have dropped from 21.6 per 1000 in 1969 to 10.4 per 1000 in 1990. To further reduce the incidence of invasive carcinoma of the cervix, we need to examine the role of family physicians as the primary providers of screening services.
The success of screening is directly related to the percentage of the target population who are screened and the reliability of the screening test performance. Family physicians have the opportunity and responsibility to influence both of these factors.
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Posted by Alex
Cancer of the colon is a long-term complication of UC. Its development depends on two factors: the extent of mucosal involvement (pancolitis greater than left-sided colitis) and the duration of disease. Severity of the initial attack, subsequent course, and specific medical therapies are not related to the cancer risk. Colonic adenocarcinomas may occur in patients who have had quiescent UC for decades. Indeed, these may be the patients at highest risk. In Europe, where colectomy is performed earlier, the risk of cancer is reduced.
TABLE 104-2 – CANCER IN ULCERATIVE COLITISRisk factors
Extent of colon involved
Duration of disease after 10 years
Surveillance
Begin after 10 years
Increase frequency of surveillance with increased duration of disease
Warning
Indefinite dysplasia: requires follow-up 3-6 months and/or confirmation by experienced pathologist
Surgical indication
Confirmed dysplasia, or dysplasia-associated lesion or mass (DALM)
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