Cancer screening programmes

Question 1

Which female gynae cancers are screened for in the UK?

Answer 1

Cervical cancer

Breast cancer

Question 2

What is the purpose of cervical cancer screening?

Answer 2

To detect precancerous changes in the cervix

- i.e. cervical intraepithelial neoplasia (CIN)

Question 3

What is the purpose of breast cancer screening?

Answer 3

To detect small tumours before they are large enough to be palpable

Question 4

What are the possible causes of breast lumps?

Answer 4

Fibroadenoma.
Breast cysts.
Infection.
Fat necrosis.
Lipoma.
Breast cancer.
(also normal physiology with menstrual cycle)

Question 5

How is breast cancer diagnosed?

Answer 5

Triple therapy;

• clinical examination
• imaging
• FNA cytology

Question 6

Who is eligible for cervical screening?

Answer 6

Women aged 25 - 64 (must be registered with a GP otherwise will not be notified)

Question 7

Who is eligible for breast screening?

Answer 7

Women aged 50 - 70 (must be registered with a GP otherwise will not be notified)

Question 8

What are the risk factors for cervical cancer?

Answer 8

HPV, especially types 16 and 18
Early age at first intercourse
Multiple sexual partners
Prolonged oral contraceptive use
Cigarette smoking
STDs
Immunodeficiency

Question 9

What are the risk factors for breast cancer?

Answer 9

Family history (1st degree relatives)
Genetics - BRCA1/2, TP53 genes
Not breast-feeding
Early menarche / late menopause
Rasiation to chest
Obesity, alcohol
HRT

Question 10

Which genes are associated with an increased risk of breast cancer?

Answer 10

Breast Cancer type 1 (BRCA1)
Breast Cancer type 2 (BRCA2)
Tumour protein P53 (TP53) gene

Question 11

How frequently is cervical screening carried out?

Answer 11

Age 25-49: every 3 years

Age 50-64: every 5 years

Question 12

How frequently is breast screening carried out?

Answer 12

Every 3 years

Question 13

What is the screening test for CIN?

Answer 13

Cervical smear and cytology

Question 14

What is the screening test for breast cancer?

Answer 14

Mammogram (x-ray)
2 images taken from 2 views:
- craniocaudal view
- mediolateral oblique view

Question 15

Give two changes on mammography that suggest breast malignancy?

Answer 15

Calcifications

Lesions with high density

Question 16

What happens if there is an abnormal result? (cervical screening)

Answer 16

If low grade dyskaryosis:
 - repeat in 6 months
 - test for HPV infection
If high grade dyskaryosis:
 - refer to colposcopy
 - biopsy
If CIN on biopsy --> LLETZ

Question 17

What happens if there is an abnormal result? (breast cancer)

Answer 17

Triple assessment:

• clinical examination
• fine needle aspiration and cytology
• imaging (ultrasound first, then repeat mammography and/or MRI)

Question 18

Which tumour markers are associated with breast cancer?

Answer 18

Cancer Antigen (CA) 27.29
Carcinoembryonic antigen (CEA)
Cancer Antigen (CA) 125

Question 19

Which tumour marker is associated with cervical and endometrial cancer?

Answer 19

Carcinoembryonic antigen (CEA)

Question 20

Which tumour marker is associated with ovarian cancer?

Answer 20

Cancer Antigen (CA) 125

Question 21

Prostate cancer is not routinely screened for in the UK, however what marker is associated with it?

Answer 21

PSA (prostate specific antigen)

Question 22

What conditions may be associated with a raised PSA?

Answer 22

Acute urinary retention.
Benign prostatic hyperplasia.
Old age.
Prostatitis.
Prostate cancer.
Transurethral resection of the prostate.
Urinary catheterisation.

Question 23

What percentage of men with prostate cancer have a normal PSA?

Answer 23

15%

Question 24

How many men vs women are diagnosed with breast cancer per year in the UK?

Answer 24

350 men vs 50 000 women

Question 25

Give two types of invasive breast carcinoma

Answer 25

Ductal: arise from the epithelial lining of ducts
Lobular: arise from the epithelium of the terminal ducts of the lobules