Health Promotion and Prevention of Cancer
Core concepts
Primary prevention targets modifiable risk: tobacco, alcohol, obesity, physical inactivity, ultraviolet exposure, occupational carcinogens, and oncogenic infections (HPV, hepatitis B and C, H. pylori). Secondary prevention is screening: mammography, cervical cytology and HPV testing, colorectal screening, low-dose CT for high-risk smokers, and prostate discussion-based screening. Tertiary prevention limits disability and recurrence in survivors.
Traps in questions
- Screening versus diagnostic testing: a screening test is offered to asymptomatic average-risk people; a diagnostic test investigates symptoms.
- Vaccine timing: HPV vaccine is most effective before sexual debut but is recommended into the mid-twenties and beyond in shared decision-making for some adults.
- Overdiagnosis: prostate and thyroid screening can detect indolent disease; questions may test the concept of harms from screening.
- Risk factor attribution: most cancers are multifactorial; a single exposure rarely explains a case.
Rule of thumb
Prevention before detection, detection before symptoms. If the stem describes symptoms, the correct next step is diagnostic evaluation, not screening.
Worked example
A 58-year-old smoker with a 40 pack-year history asks about lung cancer screening. Low-dose CT is appropriate for high-risk asymptomatic adults under program criteria; the nurse should confirm eligibility, explain benefits and harms (false positives, incidental findings, radiation), and support shared decision-making rather than ordering the scan.