Public health Screening

Question 1

What is the most common cancer in women <35?

Answer 1

Cervical cancer

Question 2

Describe the incidence of cervical cancer

Answer 2

It increases upto a peak at 30-34yrs old and then the incidence decreases as you get older

Question 3

What is the purpose of cervical cancer screening ?

Answer 3

To decrease the incidence of invasive cancer of the cervix

Question 4

What are thr advantages of screening for cervical cancer and in general ?

Answer 4

• Decreased disease incidence
• Decreased disease mortality (caught earlier)
• Less radical treatment needed (caught earlier)
• Cost-effective

Question 5

If a women has symptoms suggestive of cervical cancer do they undergo screening test?

Answer 5

NO they need to have diagnostic testing

Question 6

What are the symptoms of cervical cancer ?

Answer 6

• Unusual vaginal discharge/bleeding this includes bleeding after sex/between periods
• Dysparenuria (difficult/painful sex)

Question 7

What is the cervical screening programme in scotland ?

Answer 7

Women aged 25-64 are screened:

1. Women 25-49 every 3 years
2. Women 50-64 every 5 years

Question 8

Describe the screening test for cervical cancer ?

Answer 8

• Speculum used to visually examine the cervix, a brush sample is then taken of the cells from the transformation zone (msoe common area for cervical cancers to arise)
• Sample then sent off for cytology
• HPV testing may or may not be done alone with the cytology

Question 9

If the cytology results show no changes (normal) following cervical smear what follow-up is done ?

Answer 9

Normal screening protocol cotinued to be followed

Question 10

If the cytology results from cervical smear come back as unsatisfactory then what follow-up is required ?

Answer 10

The patient is asked to come back for a cervical smear in 3 months time

Question 11

If the cytology results from cervical smear come back as borderline or mild dyskaryosis, what follow-up is required ?

Answer 11

They are asked to come back for a cervical smear in 6 months time

Question 12

If cervical smear shows moderate or severe dyskaryosis, or glandular abnormalities (high grade changes) what follow-up is needed ?

Answer 12

Referral to colposcopy

Question 13

If the cytology results of the cervical smear shows invasive changes what follow-up is required ?

Answer 13

Urgent referral to colposcopy (within 2 weeks)

Question 14

What are the challenges to optimisign coverage ?

Answer 14

• Minority ethnic groups
• Immigrants, travellers
• Prisoners
• Students
• Reduced uptake

Question 15

What are the challenges to optimising uptake ?

Answer 15

• Chnage of address
• Communication
• Health literacy
• Deprivation
• Accessibility
• Vulnerable groups

Question 16

What are the 2 main low risk HPV types associated with genital warts ?

Answer 16

6&11

Question 17

What are the 2 main high risk HPV types associated with cervical cancer ?

Answer 17

16&18

Question 18

How is the HPV vaccine offered to and when ?

Answer 18

Girls aged 11-13

Question 19

What does the HOV vaccine protect against ?

Answer 19

HPV types 6,11,16&18

Question 20

Why is cervical screening still key even in those with HPV vaccine, vaccinating them against the 2 main causes of cervical cancer ?

Answer 20

Becuase HPV types 16&18 account for 70% of the cause of cervical cancer so there is still 30% of the causes of cervical cancer not protected against ==> cervical screening is key

Question 21

What is colposcopy ?

Answer 21

It is a magnified inspection of cervix, stains and biopsy are then used to identify abnormality.

The options include:

• Biopsy and follow up
• Biopsy and treat with cold coagulation
• LLETZ (this procedure gives biopsy results)

Question 22

How is cervical cancer diagnosed ?

Answer 22

Cervical cancer is diagnosed with colpscopy + biopsies for histopathological study

Question 23

What treatment can be given for high grade changes in cervucak smear when at colposcopy ?

Answer 23

1. Cold Coagulation (Destructive) = Hot probe which causes cells to burst OR
2. LLETZ (Excisional) = Electosurgical wire can cut through tissue (loop)

Question 24

Following treatment of high grade changes (not cancer) at colposcopy what follow-up is needed?

Answer 24

A test of cure is needed:

• Combined smear and HPV test after 6 months
• Double negative – 3 yearly repeat smear

If either is positive need further colposcopic assessment