Screening & Prevention — MCQs
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A 67-year-old man with a 4.2 cm infrarenal abdominal aortic aneurysm (AAA) detected through NHS screening attends for review. He is asymptomatic. His BP is 158/92 mmHg. He continues to smoke 10 cigarettes daily despite previous advice. What is the single most important intervention to reduce his risk of AAA rupture?
A 47-year-old woman attends requesting advice about alcohol consumption. She drinks half a bottle of wine (13% ABV, 750ml bottle) most evenings, approximately 5 nights per week. She works as a lawyer and finds it helps her unwind. She has no medical problems and takes no medications. Using the AUDIT-C screening tool, her score is 7. What is the most appropriate initial management approach?
A 29-year-old woman who is 9 weeks pregnant attends for booking. She previously had a termination of pregnancy 4 years ago and declined antenatal screening at that time. She now wishes to have all recommended screening tests. Her booking bloods include screening for infectious diseases. Which combination of infections is routinely screened for in all pregnant women in the UK?
A 66-year-old man with a 50 pack-year smoking history quit smoking 3 months ago using varenicline. He remains abstinent and attends for follow-up. He asks about his ongoing cancer risk now that he has stopped smoking. Which statement most accurately describes his lung cancer risk following smoking cessation?
A 54-year-old woman with a BMI of 36 kg/m² attends for weight management support. She has tried multiple diets over the years with temporary success but regains weight. She has no other comorbidities. Her HbA1c is 40 mmol/mol. She is motivated to lose weight but feels she needs additional support beyond lifestyle advice. Which pharmaceutical intervention is most appropriate to offer alongside lifestyle modification?
A 27-year-old woman attends with her first cervical screening result. The hrHPV test is positive, and cytology shows low-grade dyskaryosis. She is anxious and asks what this means for her risk of cervical cancer. What is the most appropriate explanation regarding her current result?
A 58-year-old man attends for NHS Health Check. His BMI is 32 kg/m², BP 136/84 mmHg, total cholesterol 5.8 mmol/L, HDL 1.0 mmol/L, non-smoker. His QRISK3 score is 8.5%. He asks about lifestyle modification to reduce his cardiovascular risk. Which lifestyle intervention would have the most significant impact on reducing his 10-year cardiovascular risk?
A 68-year-old man with type 2 diabetes attends following his routine diabetic eye screening. The report states: 'Proliferative diabetic retinopathy with extensive neovascularization at the optic disc (NVD) in the right eye. Left eye shows pre-proliferative changes. Graded R3 right eye, R2 left eye. Urgent ophthalmology referral recommended.' He is asymptomatic with normal visual acuity. What timeframe is defined as 'urgent' for this ophthalmology referral?
A 55-year-old woman attends for cardiovascular risk assessment as part of her NHS Health Check. She is of South Asian ethnicity. Her blood pressure is 132/78 mmHg, BMI 27 kg/m², non-smoker. Fasting lipids show total cholesterol 5.8 mmol/L, HDL 1.1 mmol/L. HbA1c is 39 mmol/mol. When calculating her QRISK3 score, which adjustment should be applied based on her ethnicity?
A 61-year-old man completes his NHS bowel cancer screening FIT kit. The result is 110 micrograms Hb/g faeces (positive). He attends worried and asks about his likelihood of having bowel cancer. Based on NHS bowel screening data, approximately what proportion of people with a positive FIT result are found to have colorectal cancer at colonoscopy?
Screening & Prevention UK Medical PG Practice Questions and MCQs
Question 41: A 67-year-old man with a 4.2 cm infrarenal abdominal aortic aneurysm (AAA) detected through NHS screening attends for review. He is asymptomatic. His BP is 158/92 mmHg. He continues to smoke 10 cigarettes daily despite previous advice. What is the single most important intervention to reduce his risk of AAA rupture?
- A. Immediate surgical repair given the aneurysm size
- B. Optimising blood pressure control with target <140/90 mmHg
- C. Smoking cessation support and intervention (Correct Answer)
- D. Commencing statin therapy if not already prescribed
- E. Arranging urgent vascular surgery outpatient assessment
Explanation: ***Smoking cessation support and intervention*** - **Smoking** is the single most significant modifiable risk factor for **AAA expansion** and has the strongest association with **rupture risk**. - Evidence confirms that continued tobacco use increases the rate of **aneurysm growth** significantly compared to non-smokers. *Immediate surgical repair given the aneurysm size* - Elective surgical repair for men is generally only indicated when the aneurysm exceeds **5.5 cm** or grows by **>1 cm per year**. - At **4.2 cm**, this is classified as a small aneurysm, where the risks of surgery outweigh the risk of rupture. *Optimising blood pressure control with target <140/90 mmHg* - While **hypertension management** is vital for reducing general **cardiovascular mortality**, its impact on preventing AAA rupture is less potent than smoking cessation. - This patient does require better BP control, but it is not the single most important intervention for **aneurysm-specific stability**. *Commencing statin therapy if not already prescribed* - **Statins** are indicated for all patients with AAA to manage **atherosclerotic risk** and lower the incidence of cardiovascular events. - Although they improve long-term survival, they do not reduce the **rupture risk** as effectively as stopping smoking. *Arranging urgent vascular surgery outpatient assessment* - Under NHS screening protocols, an aneurysm of **4.2 cm** requires surveillance (typically every **3 months**) rather than urgent referral. - Urgent vascular assessment is usually reserved for symptomatic patients or those with a diameter reaching the **5.5 cm threshold**.
Question 42: A 47-year-old woman attends requesting advice about alcohol consumption. She drinks half a bottle of wine (13% ABV, 750ml bottle) most evenings, approximately 5 nights per week. She works as a lawyer and finds it helps her unwind. She has no medical problems and takes no medications. Using the AUDIT-C screening tool, her score is 7. What is the most appropriate initial management approach?
- A. Reassure that her drinking is within safe limits and requires no intervention
- B. Provide brief advice about reducing alcohol consumption and give information on unit guidelines (Correct Answer)
- C. Refer immediately to community alcohol services for specialist assessment
- D. Prescribe thiamine and arrange follow-up in 2 weeks
- E. Arrange liver function tests and liver ultrasound before discussing reduction
Explanation: ***Provide brief advice about reducing alcohol consumption and give information on unit guidelines*** - An **AUDIT-C score of 7** indicates **increasing risk** drinking (hazardous drinking), for which the primary intervention is **brief advice** or a brief intervention (BI). - The patient consumes roughly **24 units per week**, which significantly exceeds the recommended limit of **14 units per week** for women, necessitating education on **health risks** and reduction strategies. *Reassure that her drinking is within safe limits and requires no intervention* - Reassurance is incorrect because her intake of **24 units per week** is well above the **14-unit threshold** for women, indicating hazardous drinking. - Failing to intervene in a patient with an elevated **AUDIT-C score** (7) neglects the opportunity to prevent progression to **alcohol dependence** or serious health complications. *Refer immediately to community alcohol services for specialist assessment* - Specialist referral is typically reserved for **high-risk/dependent** drinkers (e.g., AUDIT score 20+) or those requiring **supervised detoxification** due to withdrawal symptoms. - This patient, while drinking hazardously, shows no immediate signs of **physical dependence** or severe social dysfunction that would justify immediate **specialist intervention** at this initial stage. *Prescribe thiamine and arrange follow-up in 2 weeks* - **Thiamine supplementation** is indicated for those with **chronic alcohol dependence**, signs of **malnutrition**, or risk of **Wernicke’s encephalopathy**, none of which are explicitly evident here. - This patient does not meet the criteria for **high-risk dependence** or nutrient deficiency based on her clinical profile, and brief advice is the first step. *Arrange liver function tests and liver ultrasound before discussing reduction* - While **LFTs** can be a useful tool for monitoring, the delivery of **brief advice** about alcohol reduction should not be delayed by waiting for diagnostic investigations. - **Liver ultrasound** is not a primary screening tool for hazardous drinking; it is generally reserved for suspected **cirrhosis** or significantly abnormal blood results warranting further investigation.
Question 43: A 29-year-old woman who is 9 weeks pregnant attends for booking. She previously had a termination of pregnancy 4 years ago and declined antenatal screening at that time. She now wishes to have all recommended screening tests. Her booking bloods include screening for infectious diseases. Which combination of infections is routinely screened for in all pregnant women in the UK?
- A. HIV, hepatitis B, hepatitis C, syphilis, and toxoplasmosis
- B. HIV, hepatitis B, syphilis, and rubella immunity (Correct Answer)
- C. HIV, hepatitis B, hepatitis C, and group B streptococcus
- D. HIV, syphilis, rubella immunity, and cytomegalovirus
- E. Hepatitis B, hepatitis C, syphilis, and chlamydia
Explanation: ***HIV, hepatitis B, syphilis, and rubella immunity*** - In the UK, the **NHS Infectious Diseases in Pregnancy Screening (IDPS)** program routinely offers screening for **HIV**, **hepatitis B**, and **syphilis** at the booking appointment to prevent **vertical transmission**. - Screening for **rubella immunity** is standard practice to identify susceptible women for **postpartum MMR vaccination**, protecting against congenital rubella syndrome. *HIV, hepatitis B, hepatitis C, syphilis, and toxoplasmosis* - **Toxoplasmosis** screening is not routinely recommended in the UK due to its low prevalence and concerns about test **specificity and sensitivity**. - **Hepatitis C** is not universally screened for in all pregnant women, though it may be offered to those at **high risk** or in specific pilot programs. *HIV, hepatitis B, hepatitis C, and group B streptococcus* - **Group B Streptococcus (GBS)** is not routinely screened for in the UK using antenatal swabs; instead, a **risk-based approach** guides intrapartum antibiotic prophylaxis. - As mentioned, **Hepatitis C** is not part of the national universal antenatal screening program. *HIV, syphilis, rubella immunity, and cytomegalovirus* - **Cytomegalovirus (CMV)** is not included in routine screening as there is currently no universally effective **prenatal treatment** or vaccine to prevent congenital infection. - This option incorrectly omits **Hepatitis B**, which is a crucial part of routine screening to ensure timely **neonatal vaccination** and immunoglobulin administration if needed. *Hepatitis B, hepatitis C, syphilis, and chlamydia* - **Chlamydia** screening is part of the **National Chlamydia Screening Programme** for sexually active individuals under 25, but it is not a routine universal booking blood test for all pregnant women. - Critically, **HIV** screening is absent from this list, despite being a fundamental component of antenatal screening for preventing **mother-to-child transmission**.
Question 44: A 66-year-old man with a 50 pack-year smoking history quit smoking 3 months ago using varenicline. He remains abstinent and attends for follow-up. He asks about his ongoing cancer risk now that he has stopped smoking. Which statement most accurately describes his lung cancer risk following smoking cessation?
- A. His lung cancer risk returns to that of a never-smoker within 5 years of stopping
- B. His lung cancer risk immediately begins to decline but remains elevated compared to never-smokers for at least 20 years (Correct Answer)
- C. His lung cancer risk plateaus at current levels and does not decrease after stopping smoking
- D. His lung cancer risk decreases by 50% within the first year of stopping smoking
- E. His lung cancer risk equals that of a never-smoker once he reaches 10 years of abstinence
Explanation: ***His lung cancer risk immediately begins to decline but remains elevated compared to never-smokers for at least 20 years*** - **Smoking cessation** initiates a progressive decline in lung cancer risk; however, due to **cumulative DNA damage** and cellular changes, it never fully reverts to that of a **never-smoker**. - For a heavy smoker with a **50 pack-year history**, significant residual risk persists, often remaining elevated for **20-25 years or more**, still approximately double that of a never-smoker. *His lung cancer risk returns to that of a never-smoker within 5 years of stopping* - The **carcinogenic effects** of long-term smoking, including **mutations** and tissue damage, are not fully reversible within just **5 years**. - While other health benefits accrue rapidly, a 5-year period is too short for a heavy smoker's lung cancer risk to equalize with that of a **never-smoker**. *His lung cancer risk plateaus at current levels and does not decrease after stopping smoking* - This statement is inaccurate; stopping smoking immediately halts further exposure to **carcinogens**, preventing new damage and allowing some **repair mechanisms** to begin. - Numerous **epidemiological studies** consistently show a **gradual reduction** in lung cancer risk with increased duration of **abstinence**. *His lung cancer risk decreases by 50% within the first year of stopping smoking* - While improvements in **cardiovascular risk** are rapid post-cessation, the reduction in **lung cancer risk** is much more protracted. - It typically takes **10 to 15 years** of sustained abstinence for a former smoker to achieve a **50% reduction** in lung cancer risk compared to someone who continues to smoke. *His lung cancer risk equals that of a never-smoker once he reaches 10 years of abstinence* - Even after **10 years of abstinence**, a former heavy smoker's risk of lung cancer remains **significantly elevated** compared to an individual who has never smoked. - This persistent risk is why **lung cancer screening guidelines** often recommend continued screening for individuals with a substantial smoking history for many years post-cessation.
Question 45: A 54-year-old woman with a BMI of 36 kg/m² attends for weight management support. She has tried multiple diets over the years with temporary success but regains weight. She has no other comorbidities. Her HbA1c is 40 mmol/mol. She is motivated to lose weight but feels she needs additional support beyond lifestyle advice. Which pharmaceutical intervention is most appropriate to offer alongside lifestyle modification?
- A. Orlistat 120mg three times daily with meals (Correct Answer)
- B. Liraglutide 3mg subcutaneous injection once daily
- C. Metformin 500mg twice daily
- D. Semaglutide 2.4mg subcutaneous injection once weekly
- E. Naltrexone-bupropion combination therapy
Explanation: ***Orlistat 120mg three times daily with meals***- Per **NICE guidelines**, orlistat is the first-line pharmacological treatment for weight loss in adults with a **BMI ≥30 kg/m²** (or ≥28 kg/m² with comorbidities) who have failed lifestyle changes.- It acts as a **lipase inhibitor**, preventing the absorption of approximately 30% of dietary fat in the gastrointestinal tract.*Liraglutide 3mg subcutaneous injection once daily*- This **GLP-1 receptor agonist** is generally considered a second-line option and often requires an assessment of pre-diabetes or specific cardiovascular risk factors under specialist care.- While effective, it is much more **costly** and invasive than oral orlistat, making it less appropriate as the very first pharmaceutical step in primary care for this patient.*Metformin 500mg twice daily*- Metformin is primarily an **antihyperglycemic agent** and is not currently licensed in the UK specifically for weight loss in patients without diabetes.- The patient’s **HbA1c of 40 mmol/mol** is within the non-diabetic range, making this intervention inappropriate for her clinical profile.*Semaglutide 2.4mg subcutaneous injection once weekly*- While a powerful **GLP-1 analogue** for weight management, NICE restricts its use to specialist weight management services for those with a **BMI ≥35 kg/m²** and at least one weight-related comorbidity.- Since this patient has **no other comorbidities**, she does not meet the specific threshold for semaglutide initiation in many clinical pathways over orlistat.*Naltrexone-bupropion combination therapy*- This drug acts on the **reward system** in the brain to reduce cravings, but it is not typically initiated as a first-line therapy in standard primary care settings.- It carries a higher burden of **central nervous system side effects** and contraindications compared to the localized action of orlistat.
Question 46: A 27-year-old woman attends with her first cervical screening result. The hrHPV test is positive, and cytology shows low-grade dyskaryosis. She is anxious and asks what this means for her risk of cervical cancer. What is the most appropriate explanation regarding her current result?
- A. She has early cervical cancer and requires urgent colposcopy within 2 weeks
- B. She has pre-cancerous changes that will definitely progress to cancer without treatment
- C. She has HPV infection with mild cellular changes that may resolve spontaneously, but requires colposcopy for assessment (Correct Answer)
- D. She needs immediate treatment with loop excision to prevent cancer development
- E. She has normal cervical cells and can return to routine screening in 3 years
Explanation: ***She has HPV infection with mild cellular changes that may resolve spontaneously, but requires colposcopy for assessment***- A positive **hrHPV** test with **low-grade dyskaryosis** signifies an active HPV infection with mild cellular abnormalities that often **regress spontaneously** without intervention, especially in young women.- Current cervical screening protocols recommend **colposcopy** (typically within 6 weeks in the UK) for these findings to allow for a detailed visual assessment and biopsy if necessary, to rule out higher-grade lesions.*She has early cervical cancer and requires urgent colposcopy within 2 weeks*- **Low-grade dyskaryosis** (equivalent to LSIL or CIN1) indicates **mild cellular changes**, not early cervical cancer. Cervical cancer is a very rare outcome at this stage.- An **urgent 2-week referral** for colposcopy is usually reserved for cytology results indicating **high-grade glandular abnormalities**, suspicious of invasion, or persistent high-grade squamous lesions.*She has pre-cancerous changes that will definitely progress to cancer without treatment*- While **low-grade dyskaryosis** (CIN1) is considered a pre-cancerous change, it has a high rate of **spontaneous regression** (around 60-70%) within 1-2 years, especially in younger women.- Progression to **invasive cancer** is **not definite** and occurs in a small minority of untreated low-grade lesions, typically over many years.*She needs immediate treatment with loop excision to prevent cancer development*- **Loop Electrosurgical Excision Procedure (LEEP/LLETZ)** is generally reserved for confirmed **high-grade cervical intraepithelial neoplasia (CIN2/3)** or persistent low-grade lesions identified at colposcopy.- Immediate treatment for **low-grade dyskaryosis** without colposcopic assessment is not standard practice due to the high regression rate and to avoid potential side effects like **preterm birth** in future pregnancies.*She has normal cervical cells and can return to routine screening in 3 years*- The presence of **low-grade dyskaryosis** and a **positive hrHPV test** clearly indicates abnormal cervical cells, not normal cells.- Routine screening in 3 years would only be appropriate if both the **hrHPV test was negative** and cytology was normal. These results require further investigation.
Question 47: A 58-year-old man attends for NHS Health Check. His BMI is 32 kg/m², BP 136/84 mmHg, total cholesterol 5.8 mmol/L, HDL 1.0 mmol/L, non-smoker. His QRISK3 score is 8.5%. He asks about lifestyle modification to reduce his cardiovascular risk. Which lifestyle intervention would have the most significant impact on reducing his 10-year cardiovascular risk?
- A. Reducing dietary salt intake to less than 6g per day
- B. Achieving 5-10% weight loss through calorie restriction (Correct Answer)
- C. Increasing physical activity to 150 minutes of moderate intensity exercise per week
- D. Following a Mediterranean diet rich in fruits, vegetables, and olive oil
- E. Limiting alcohol consumption to 14 units per week
Explanation: ***Achieving 5-10% weight loss through calorie restriction*** - In an obese patient (**BMI 32 kg/m²**), weight loss is the most powerful intervention as it concurrently improves **blood pressure**, **lipid profiles**, and **insulin sensitivity**. - A modest reduction of **5-10% of body weight** has been shown to significantly lower the **QRISK3 score** by targeting the underlying metabolic drivers of cardiovascular disease. *Reducing dietary salt intake to less than 6g per day* - While effective for managing **hypertension**, this patient's blood pressure (136/84 mmHg) is only mildly elevated, making the impact of salt reduction secondary to overall weight loss. - This intervention primarily targets **systolic blood pressure** but has a less comprehensive impact on other metabolic markers like lipids compared to weight loss. *Increasing physical activity to 150 minutes of moderate intensity exercise per week* - **Physical activity** is critical for cardiovascular health, but without caloric restriction, it is often insufficient to achieve significant **weight reduction** in obese individuals. - While it improves **HDL cholesterol** and cardiovascular fitness, its independent effect on the 10-year risk score is generally smaller than that of significant weight loss. *Following a Mediterranean diet rich in fruits, vegetables, and olive oil* - The **Mediterranean diet** is highly recommended for cardioprotection, but its benefits are often maximized when used as a tool to achieve **weight loss** in obese patients. - On its own, dietary composition changes provide significant benefits, but **caloric restriction** and weight loss provide a more measurable reduction in global risk for this specific patient profile. *Limiting alcohol consumption to 14 units per week* - Reducing **alcohol intake** helps lower blood pressure and **caloric intake**, but it is a targeted intervention rather than a global metabolic stabilizer. - Unless the patient is currently consuming excessive amounts, limiting intake to **14 units** provides less overall risk reduction than achieving a healthy BMI.
Question 48: A 68-year-old man with type 2 diabetes attends following his routine diabetic eye screening. The report states: 'Proliferative diabetic retinopathy with extensive neovascularization at the optic disc (NVD) in the right eye. Left eye shows pre-proliferative changes. Graded R3 right eye, R2 left eye. Urgent ophthalmology referral recommended.' He is asymptomatic with normal visual acuity. What timeframe is defined as 'urgent' for this ophthalmology referral?
- A. Same day referral to emergency eye services
- B. Within 1 week (Correct Answer)
- C. Within 2 weeks
- D. Within 4 weeks
- E. Within 6 weeks
Explanation: ***Within 1 week*** - For **Proliferative Diabetic Retinopathy (R3)**, which is characterized by **neovascularization at the disc (NVD)** or elsewhere (NVE), the NHS guidelines mandate an urgent referral to be seen **within 1 week**. - This timeframe is critical to initiate treatments like **panretinal photocoagulation (PRP)** or **anti-VEGF therapy** to prevent catastrophic complications such as **vitreous hemorrhage** or tractional retinal detachment. *Same day referral to emergency eye services* - This is reserved for immediate sight-threatening complications such as **sudden severe vision loss**, **rubeosis iridis**, or acute **retinal detachment**. - Since the patient is currently **asymptomatic** with normal visual acuity, a same-day emergency referral is not clinically indicated over a 1-week urgent referral. *Within 2 weeks* - The **two-week window** is commonly associated with suspected malignancy pathways and is not the standard for **R3 graded** proliferative diabetic retinopathy. - Waiting 14 days increases the risk of **ischaemic triggers** causing further vessel growth and potential hemorrhage in a high-risk patient. *Within 4 weeks* - A **four-week** timeframe is considered too long for active **new vessel formation** (NVD/NVE), which requires more rapid intervention to stabilize the retina. - Prolonged delay at this stage significantly increases the likelihood of progressing to permanent **vision impairment**. *Within 6 weeks* - This timeframe is typically appropriate for **routine referrals**, such as for **maculopathy (M1)** or stable **pre-proliferative (R2)** changes that do not meet the R3 criteria. - While the left eye is graded **R2**, the urgency of the case is dictated by the more severe **R3 grading** in the right eye.
Question 49: A 55-year-old woman attends for cardiovascular risk assessment as part of her NHS Health Check. She is of South Asian ethnicity. Her blood pressure is 132/78 mmHg, BMI 27 kg/m², non-smoker. Fasting lipids show total cholesterol 5.8 mmol/L, HDL 1.1 mmol/L. HbA1c is 39 mmol/mol. When calculating her QRISK3 score, which adjustment should be applied based on her ethnicity?
- A. No adjustment is needed as QRISK3 automatically accounts for ethnicity (Correct Answer)
- B. Her calculated QRISK3 score should be reduced by 25%
- C. Her calculated QRISK3 score should be increased by approximately 40%
- D. She should be assessed using the Framingham score instead of QRISK3
- E. Her ethnicity only affects risk if she also has type 2 diabetes
Explanation: ***No adjustment is needed as QRISK3 automatically accounts for ethnicity*** - **QRISK3** is a sophisticated multivariable algorithm that includes **ethnicity** as an integrated variable, removing the need for manual multipliers. - It automatically incorporates **ethnicity-specific risk multipliers** based on large UK population datasets to reflect the higher cardiovascular risk in **South Asian** populations. *Her calculated QRISK3 score should be reduced by 25%* - South Asian ethnicity is associated with an **increased baseline risk** of cardiovascular disease, so a reduction in the score would be clinically incorrect and underestimate true risk. - Reductions are not standard for any ethnic group within the **NICE-recommended** risk assessment tools like QRISK3. *Her calculated QRISK3 score should be increased by approximately 40%* - While South Asian ethnicity does confer roughly a **1.4x higher risk** of cardiovascular disease, this adjustment is already **built into the software algorithm** of QRISK3. - Manual adjustments for ethnicity were used in older risk calculators (e.g., JBS2) but are obsolete with the implementation of **QRISK3**. *She should be assessed using the Framingham score instead of QRISK3* - The **Framingham score** is less accurate for UK-specific populations and lacks the comprehensive **ethnicity data** and other contemporary risk factors found in QRISK3. - **NICE guidelines** in the UK specifically recommend QRISK3 for cardiovascular risk assessment in patients between 25 and 84 years of age. *Her ethnicity only affects risk if she also has type 2 diabetes* - Ethnicity is an **independent risk factor** for cardiovascular disease regardless of the patient's glycemic status or **HbA1c** levels. - While the combination of South Asian ethnicity and **diabetes** significantly increases risk, each factor contributes independently to the overall QRISK3 calculation.
Question 50: A 61-year-old man completes his NHS bowel cancer screening FIT kit. The result is 110 micrograms Hb/g faeces (positive). He attends worried and asks about his likelihood of having bowel cancer. Based on NHS bowel screening data, approximately what proportion of people with a positive FIT result are found to have colorectal cancer at colonoscopy?
- A. Approximately 2-3%
- B. Approximately 8-10% (Correct Answer)
- C. Approximately 25-30%
- D. Approximately 50-55%
- E. Approximately 75-80%
Explanation: ***Approximately 8-10%*** - According to **NHS Bowel Cancer Screening Programme** data, roughly **1 in 10** or **1 in 11** patients with a positive **FIT result** are diagnosed with **colorectal cancer** during colonoscopy. - While the majority are cancer-free, this positive predictive value is high enough to mandate urgent investigation, typically via **colonoscopy** within two weeks. *Approximately 2-3%* - This figure significantly underestimates the risk associated with a positive **FIT result** in the **national screening cohort**. - Prevalence rates this low are more characteristic of asymptomatic populations before any screening kit is applied. *Approximately 25-30%* - This range is more reflective of the detection rate for **high-risk adenomas** (precancerous polyps) rather than confirmed invasive cancer. - Providing this figure to a patient would unnecessarily increase anxiety by overstating the actual likelihood of a **malignant diagnosis**. *Approximately 50-55%* - This would imply a 1-in-2 chance of cancer, which is significantly higher than actual outcomes for **FIT-positive** patients in the **UK screening program**. - Such high predictive values are usually only seen in patients with **extremely high FIT levels** (e.g., >400 μg/g) or overt clinical symptoms. *Approximately 75-80%* - Most patients with a positive **FIT** (e.g., ≥120 μg/g or ≥80 μg/g depending on region) do not have cancer, making this an incorrect assessment. - Screening is designed for **early detection** in a varied population, and while sensitive, it does not achieve this level of **positive predictive value** for cancer.
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