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Print date: September 13, 2016
2.
3.
You are trying to counsel Mrs. Jones, a thin, 55 year old, post-menopausal women to stop smoking. She has
been a pack-a-day smoker for 32 years, but feels fit and healthy and walks 3 miles every day. Her family
history and physical exam is unremarkable. She refuses to discuss taking menopausal estrogens, since her
sister had a bad reaction to them, and she defends her smoking habit by quoting a magazine article that
says smoking reduces the risk of endometrial cancer by one half. In order to make a convincing case for
her to quit, you do the following calculations:
You estimate the 10-year risk of lung cancer, coronary heart disease (CHD) and endometrial
cancer in a similar non-smoking women to be 0.1%, 8% and 1%, respectively. You find out the
relative risks (RR) for a pack-a-day smoker for lung cancer, CHD, and endometrial cancer to be
10, 2.5 and 0.5, respectively.
a. Complete the following table (4):
Lung CA
CHD
Endometrial CA.
b. Which of the three diseases is more causally related to smoking? Which measure indicates that? (2)
c. Which of the three diseases is more important in terms of clinical impact to Mrs. Jones? Which measure
tells you that? (2)
d. In words that Mrs. Jones can understand (she is after all, only a U of M graduate), explain what the data
in the table mean to her and why they make a convincing argument that she should quit smoking. (2)
4. The West of Scotland Coronary Prevention Trial (WOSCOP) study was a randomized clinical trial that tested the
efficacy of Pravastatin (a cholesterol lowering statin drug) in several thousand men with hypercholesterolemia, but
no previous history of coronary heart disease, over a 5 year period. There were 172 events in the 3,302 men in the
intervention arm, and 284 events in the 3,293 men in the placebo arm.
a. What was the Relative Risk Reduction of Pravastatin in this study? (2)
c. What do you think would happen to the NNT if this trial were repeated in Scottish men who had neither
hypercholesterolemia nor a history of coronary heart disease? (1)
d. What do you think would happen to the NNT if this trial were repeated in Scottish men who had both
hypercholesterolemia and a history of coronary heart disease? (1)
5. Two radiologists (Dr. Possibly and Dr. Maybe) independently reviewed 65 cervical radiographs for the presence
of vertebral canal stenosis. The two radiologists both agreed that stenosis was present in 7 cases and absent in 44.
Dr. Maybe identified 11 cases as having stenosis that Dr. Possibly called normal, while Dr. Possibly identified 3
cases as abnormal that Dr. Maybe called normal.
a. Construct the two-by-two agreement table (4).
6.
7.
8.
it is rare.
a 100% specific test is negative.
a 100% sensitive test is negative.
a test for a competing disease is positive.
a test for a competing disease is negative.
9.
it is very common.
a 100% specific test is positive.
a 100% sensitive test is positive.
the case resembles the classic disease pattern.
all of the above.
A test for the presence of cancer has an 80% true positive rate and a 2% false positive rate.
a. Of 25 patients with cancer, how many can be expected to have a negative result? (2)
b. Of 50 patients known not to have cancer, how many will have a negative result? (2)
c. When used to screen 5000 people, only 1% of which have cancer, how many positive tests will be found?
Of these how many will actually have cancer? What is this measure called? (4)