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Question 1
A large company institutes a new wellness program aimed at improving the health of its 50, employees. As a part of the program, all employees are given physical examinations and screening tests. One of the tests given to male employees is the prostate specific antigen (PSA) test with all employees testing positive being referred to their private physician for a thorough examination involving the standard test, a digital rectal examination (DRE). What will happen to the apparent incidence rate of prostate cancer in the company during the first year of this program?
- Incidence rate will stay the same
• Incidence rate will increase
- Incidence rate will decrease
- Incidence rate will equal the general population rate
- Not enough information is available
Given that prostate cancer is one of the most common cancers of men, it is highly prevalent but often undiagnosed. Any effort to intensify screening for prostate cancer will increase the number of cases found in a local population.
Question 2
A large company institutes a new wellness program aimed at improving the health of its 50, employees. As a part of the program, all employees are given physical examinations and screening tests. One of the tests given to male employees is the prostate specific antigen (PSA) test with all employees testing positive being referred to their private physician for a thorough examination involving the standard test, a digital rectal examination (DRE). On referral to their private physician, approximately 30% of men with a positive PSA are found to be negative for prostate cancer following the DRE. What is the sensitivity of the PSA test if DRE is assumed to be the gold standard?
- 0.3 times the sensitivity of DRE
- 0.7 times the sensitivity of DRE
• Cannot be calculated due to missing information
Cervical cancer is one of the most common cancers of women. The most important risk factor is infection with human papillomavirus (HPV). Since the incidence rates for the cancer varies for each group in both age categories, this cancer is determined primarily by environmental factors.
Question 4
The following table shows data describing age-standardized incidence rates for cervical and breast cancer among Irish women living in Ireland, Irish immigrants to the United States, and daughters of Irish immigrants in the United States. The rates are reported for two age categories: adult women less than 40 years of age and greater than 40 years of age. Which cancer appears to be determined primarily by genetic factors?
Question 5
The following table shows data describing age-standardized incidence rates for cervical and breast cancer among Irish women living in Ireland, Irish immigrants to the United States, and daughters of Irish immigrants in the United States. The rates are reported for two age categories: adult women less than 40 years of age and greater than 40 years of age. Among women less than 40 years of age, what is the relative risk for cervical cancer comparing daughters of Irish immigrants to women in Ireland?
• Cannot be calculated with the information provided
- Cannot be calculated with the information provided
This question asks for the percent attributable risk which is equal to the incidence in the “exposed” group (Irish immigrants to the United States) less the incidence in the “nonexposed” group (Irish women in Ireland) divided by the incidence in the nonexposed group. This calculation represents the proportion of cervical cancer risk that can be attributed to the risk factor of immigration to the United States.
Question 7
The following table shows data describing age-standardized incidence rates for cervical and breast cancer among Irish women living in Ireland, Irish immigrants to the United States, and daughters of Irish immigrants in the United States. The rates are reported for two age categories: adult women less than 40 years of age and greater than 40 years of age. Which cancer has a greater risk after the onset of menopause?
• Breast
- Both
- Neither
- Cannot be calculated with the information provided
The relative risks for cervical cancer among older women (> 40 years) compared to younger women are approximately 1.2 for each subgroup. The relative risks for breast cancer for this comparison are approximately 1.9. Therefore, the risk of breast cancer is more substantial with the onset of menopause as denoted by increasing age.
Question 8
The data in the table below are from a case-control study of a genetic factor associated with neurologic disease. Cases are newly diagnosed persons with the rare neurologic condition, and
population controls were used for comparison. Investigators have hypothesized that a single point mutation in a gene on the 10th chromosome is strongly related to the disease. In the table, subjects who are homozygous for the mutation are denoted as m/m; subjects with only one mutated gene (heterozygous for the mutation) are denoted as A/m; and subjects with two normal alleles (homozygous for the absence of the mutation) are denoted as A/A. The unexposed category for the study is the A/A genotype. The neurologic condition is thought to be autosomal dominant with respect to the gene; therefore, one copy of the m allele should induce the development of the condition. What is the odds ratio for subjects with at least one copy of the mutant allele?
Question 9
The data in the table below are from a case-control study of a genetic factor associated with neurologic disease. Cases are newly diagnosed persons with the rare neurologic condition, and population controls were used for comparison. Investigators have hypothesized that a single point mutation in a gene on the 10th chromosome is strongly related to the disease. In the table, subjects who are homozygous for the mutation are denoted as m/m; subjects with only one mutated gene (heterozygous for the mutation) are denoted as A/m; and subjects with two normal alleles (homozygous for the absence of the mutation) are denoted as A/A. The unexposed category for the study is the A/A genotype. The neurologic condition is thought to be autosomal
dominant with respect to the gene; therefore, one copy of the m allele should induce the development of the condition.
Using the odds ratio calculated above, what is the population attributable risk percent for the mutation?
- Cannot be calculated due to nonestimable odds ratio
To estimate this percentage, one must use Levin’s formula with the odds ratio representing risk and the proportion of the mutation in controls representing the proportion of population with the exposure. In these data, the controls are representative of the population frequency of at least one m allele. The proportion having at least one m allele is 0.11 (48 divided by 433). When this proportion is placed in Levin’s formula using the odds ratio of 75.4 as the risk, then the calculation is (0.11 multiplied by 74.4) divided by ((0.11 multiplied by 74.4) plus 1). This gives
the answer as 0.89, or 89%.
subjects who are homozygous for the mutation are denoted as m/m; subjects with only one mutated gene (heterozygous for the mutation) are denoted as A/m; and subjects with two normal alleles (homozygous for the absence of the mutation) are denoted as A/A. The unexposed category for the study is the A/A genotype. The neurologic condition is thought to be autosomal dominant with respect to the gene; therefore, one copy of the m allele should induce the development of the condition.
Does this study confirm the hypothesis that the condition is caused by an autosomal dominant mutation? Why or why not?
- Yes, the strength of association is very large
- Yes, all homozygous persons for the mutation are cases
• No, the odds of disease among heterozygotes is 0.
- No, the investigators have not done a prospective study
- No, some of the cases are homozygous for the normal allele
If the mutation were autosomal dominant, then we would expect all persons with the m mutation to have the neurologic disease. Since this is not evidenced by the data, then the hypothesis cannot be accepted.
Question 11
The basis for the healthy worker effect is that:
- Having a job makes people healthier and less susceptible to disease
• Employment status is correlated with health status
- Persons who work are less likely to be exposed to harmful agents
- Persons who work have health insurance and receive better treatment
- Studies of persons who work are confounded by socioeconomic status
The ability to obtain and keep a job depends upon some level of good health. Since persons who are in the workforce are more likely to have better health status, studies which compare worker populations to the general population typically find that workers have fewer adverse health outcomes than the general population. This leads to a self-selection bias in that persons who are selected into employment are more likely to be in good health
