Review Question - QID 102719

A fecal occult blood test is a secondary prevention measure. Secondary prevention is the early detection of disease through identification of pre-clinical pathologic changes, thereby allowing for control of disease progression to mitigate future morbidity and/or mortality.

Primordial prevention is population-wide public health policies aimed to reduce future hazards to health mitigate the development of risk factors for disease. While primordial prevention addresses broad health determinants, primary prevention seeks to prevent the development of disease by reducing exposure, altering behaviors, and improving resistance to disease. Tertiary prevention attempts to reduce morbidity and mortality after symptoms of disease have already developed or after a disease has already been treated in its acute phase. Quaternary prevention is action taken to prevent or decrease the harm caused by the healthcare system; this involves identification of the patient at risk of over-medicalization and ensuring no unnecessary or excessive interventions are carried out.

Wilkins et al. review the screening and secondary prevention of colorectal cancer. The incidence and therefore morbidity and mortality of colorectal cancer may be reduced through population-wide screening of average-risk adults over 50 years of age. Potential screening modalities include: fecal occult blood test, flexible sigmoidoscopy, colonoscopy, double contrast barium enema, CT colonography, fecal DNA testing, and the "pillcam." Screening should be continued until age 75.

Pandve discusses the relatively new concept of quaternary prevention. In essence, quaternary prevention is the prevention of over medicalization. It relies on evidenced-based practice to limit the interventions a patient receives to only those items that will be most likely to provide benefit, and it also strives to conserve limited healthcare resources to reduce waste in spending.

Illustration A describes the various levels of prevention, with the exception of quaternary prevention. Illustration B gives specific examples or primary, secondary, and tertiary prevention of cardiovascular disease. Illustration C relates quaternary prevention to the other preventative strategies.

Incorrect Answers:
Answer 1: Examples of primordial prevention include improved city sanitation, the development of childhood nutrition programs, or outlawing alcohol or smoking in certain venues/areas.
Answer 2: Examples or primary prevention include vaccination or smoking cessation.
Answer 4: Tertiary prevention examples include cardiac rehabilitation or beta blockers after a heart attack.
Answer 5: An example of quaternary prevention is the avoidance of antibiotic use in a viral upper respiratory infection.