Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Practice bulletins > #168 Cervical Cancer Screening and Prevention > Flashcards

#168 Cervical Cancer Screening and Prevention Flashcards

1
Q

What is the incidence of cervical cancer in the US?

A

6.7 per 100,000 women.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the mortality from cervical cancer in the US per 100,000 women?

A

2.3 per 100,000 women (not per cases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

About how many new cases of cervical cancer are diagnosed in the US per year. And how many deaths per year from cervical cancer in the US?

A

12,900 new cases per year. 4,100 deaths per year.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What percent of women diagnosed with cervical cancer never had cervical cytology?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What percentage of women diagnosed with cervical cancer never had cervical cytology or had not been screened within the 5 years prior to diagnosis?

A

60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Does HPV infection typically transient or persistent?

A

Transient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Persistent HPV infections after what amount of time strongly predicts subsequent risk of CIN3 or cancer regardless of age?

A

1 year and 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

HPV 16 accounts for what % of cervical cancer worldwide?

A

55-60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

HPV 18 accounts for what % of cervical cancer worldwide?

A

10-15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How many genotypes of HPV are associated with cervical cancer?

A

15-18, (13-14 most common) genotypes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What cofactors increase the likelihood of persistent HPV infection?

A

Cigarette smoking, a compromised immune system, HIV infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In women younger than 21, how long does it take on average to clear HPV infection?

A

8 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Is newly acquired HPV infection more likely to persist when acquired at age 35 vs 22?

A

No, appears to have same low change of persistence regardless of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why do we cotest for HPV infection at >30yrs when newly aquired HPV infection has same low chance of persistence regardless of age?

A

HPV infection detected in women older than 30yrs is more likely to reflect persistent infection (correlates with increasing rates of HSIL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

With untreated CIN3, what is the risk of invasive cancer after 30years

A

30.1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What materials can interfere with pap smear specimen interpreteration

A

Blood, discharge, and some lubricants (including personal lubricants used by patients)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the conventional technique for pap smears?

A

Exfoliated cells from transformation zone of cervix are transferred directly to a slide and fixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the liquid-based technique for pap smears?

A

Exfoliated cells from transformation zone of cervix are transferred to a vial of liquid preservative that is processed in a lab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What percentage of pap smears have obscuring material that caused misinterpretation of results? What percentage of these cases are caused by lubricant use?

A

0.4% with obscuring material, one half of these possibly related to lubricant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which pap smear screening technique (liquid-based vs conventional) has higher sensitivity, higher specificity?

A

No appreciable difference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the benefit of liquid-based pap smear compared to conventional?

A

Single specimen can be used for cytology, HPV testing, and testing for gc/ct infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which HPV vaccines are available (what do they cover)?

A

Bivalent: HPV 16 and 18
Quadrivalent: HPV 16, 18, 6, and 11
9-valent: Above 4 plus additional 5 high-risk genotypes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Does the bivalent offer any protection against cervical cancers not caused by HPV 16 or HPV 18, if so how many?

A

Offer limited cross-protection against approximately 30% of cases of cervical cancer caused by other HPV genotypes

24
Q

At what age can you start vaccinated females against HPV?

A

Age 9

25
Q

At what age do you start cervical cancer screening in the general population? What is the exception?

A

21yo.

Exception of HIV positive or otherwise immunocompromised women

26
Q

What % of cervical cancer occurs before age 20?

A

Only 0.1% (approximately 1-2 cases per year per 1,000,000 females 15-19yo)

27
Q

At what age can you discontinue cervical cancer screening given previously normal testing?

A

65yo

28
Q

For which patients >65yo would you continue cervical cancer screening?

A

Inadequate previous testing.

Hx CIN 2, CIN 3, or adenocarcinoma in situ (<20 yrs prior)

29
Q

What are the options for cervical cancer screening based on age (method and timing) for general population?

A

21-29: cytology q3 yrs

30+: cotesting q5yrs or cytology q3yrs

30
Q

In regards to cervical cancer screening, is cytology or HPV testing more sensitive? More specific?

A

HPV testing more sensitive.

Cytology more specific

31
Q

Is cervical cytology better at identifying adenocarcinoma or squamous cell better?

A

Squamous cell

32
Q

Is adenocarcinoma of the cervix better detected by cytology or HPV testing?

A

HPV testing

33
Q

What is the definition of adequate negative prior screening test results for cervical cancer screening?

A

Three consecutive negative cytology results or two consecutive negative cotest results within the previous 10 years, with the most recent test performed within the past 5 years

34
Q

What % of new cases of cervical cancer occur in women 65yo or older (and what % of US population does this age group represent)?

A

19.6% of new cases. 14.1% of US female population.

35
Q

What is the median #years after HPV infection until cervical cancer occurs?

A

15-25years

36
Q

When is it appropriate to discontinue cervical cancer screening for women who have had a hysterectomy?

A

If cervix removed and have never had CIN2 or higher. Do not restart screening for any reason

37
Q

What is the rarest gynecologic malignancy?

A

Primary vaginal cancer

38
Q

When should women continue to be screened for cervical cancer after a total hysterectomy?

A

If history of CIN2+ within the past 20years or ever cervical cancer

39
Q

What guidelines are available for HPV-only screening for cervical cancer?

A

SGO and ASCCP interim guidelines: can do HPV only on patients 25+, q3 years. If HPV+, negative 16 and 18, do cytology. If genotyping and cytology negative follow up testing in 1 year.

40
Q

Is ASCUS, HPV- associated with increased, decreased, or same risk for CIN 3+ as negative cotesting?

A

Increased risk, although still very low risk

41
Q

What is the next step in management for women 30-65 with ASCUS, HPV- pap?

A

Cotesting in 3 years, followed by return to age-appropriate screening if neg results

42
Q

What is the next step in management for women 30+ with NILM, HPV+ pap?

A

Option 1. Repeat cotesting in 12 months, if ASCUS or higher or HPV+ do colpo
Option 2. HPV genotyping, if 18 or 18 do colpo

43
Q

Should patients who received HPV vaccine have different cervical cancer screening?

A

No

44
Q

For women with HIV, when should you start cervical cancer screening?

A

Within 1 year of onset of sexual activity or, if already sexually active, within the first year after HIV diagnosis, but no later than 21yo

45
Q

At what age do you stop cervical cancer screening in women with HIV?

A

Continue through a women’s lifetime, do not stop screening

46
Q

At what age do you start cotesting (pap smears) for women with HIV?

A

30yo

47
Q

How frequently do you do pap smears in women with HIV?

A

If < 30: three consecutive annual cytology negative paps, then q3 yrs
If >30: If cytology only same as above. For cotesting, if negative q3 yrs

48
Q

With which cytology abnormalities would you perform colpo on a women with HIV?

A

LSIL+

49
Q

What is the next step in management for woman >21yr with HIV with ASCUS, HPV+ pap?

A

Colpo

50
Q

What is the next step in management for woman >21yr with HIV with ASCUS and no HPV testing available?

A

Repeat cytology in 6-12 months, colpo for anything ASCUS or worse

51
Q

What is next step in management for woman <21yo with HIV with ASCUS on pap?

A

Repeat cytology in 6-12mo (no HPV testing)

52
Q

What is recommended cervical cancer screening for patients with exposure to diethylsteilbestrol in utero?

A

Annual cervical cytology screening is reasonable

53
Q

What is the recommendation for cervical cancer screening in patients who are immunocompromised because of non-HIV causes?

A

No major society recommendations exist, but reasonable to extrapolate recommendations for women with HIV infection to this group

54
Q

Women with a history of treatment for CIN2 or higher are at a ***-fold increased risk for invasive disease for up to 20 years after treatment.

A

2.8

55
Q

When should women s/p total hysterectomy, who have never had CIN2+, resume cervical cancer screening?

A

Never resume

Practice bulletins (83 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions