Cervical Screening

Question 1

Describe the epidemiology of cervical cancer

Answer 1

12th most common in Scottish women
Most common cancer in women under 35
Approx 2% of female cancer cases

Question 2

Why screen for cervical cancer?

Answer 2

Aim is to reduce the incidence of invasive cancer of the cervix

Question 3

What are the advantages of screening?

Answer 3

Reduced disease incidence
Reduced disease mortality
Earlier, less radical treatment
Cost-effective
Overall population benefit

Question 4

What will cervical screening test for?

Answer 4

Identifys cell changes which may develop to be pre-cancerous in women who otherwise have no symptoms
If untreated -> cervical cancer
At the stage of screening, treatment is very effective

Question 5

Do symptomatic women require screening?

Answer 5

No; diagnostic tests

Symptoms; unusual vaginal discharge/ bleeding, bleeding after sex/ between periods, dyspareunia

Question 6

Who is screened for cervical cancer in scotland?

Answer 6

Women aged 25-64
Every 3 years; 25-49
Every 5 years 50-64

Question 7

How is the cervical smear performed?

Answer 7

Speculum exam
Visual examination of the cervix
Brush sample of the cells from the transformation zone of the cervix
Liquid based cytology (soon to be primary HPV testing)

Question 8

What is the screening uptake in scotland?

Answer 8

72.8%

Question 9

How will cervical screening change in 2020?

Answer 9

Primary HPV testing enabling faster investigations of those at higher risk of developing cervical cancer and reassurance to those at very low risk

Question 10

How is coverage calculated?

Answer 10

c/a x 100
Where
a = eligible population
c = screened population

Question 11

How is uptake calculated?

Answer 11

c/b x 100
Where
c = screened population
b = invited population

Question 12

What are the challenges with optimising coverage?

Answer 12

Minority ethnic groups
Immigrants
Travellers
Prisoners
Students
Reduced uptake

Question 13

What are the challenges with optimising uptake?

Answer 13

Change of address
Communication 
Health literacy
Deprivation 
Accessibility
Vulnerable groups

Question 14

How can coverage and uptake be increased?

Answer 14

Promotion in screening populations
Material in variety of languages
GP incentives
Local and national initiatives

Question 15

What is the difference between the low and high risk HPV types?

Answer 15

Low risk; genital warts

High risk; invasive cervical cancer

Question 16

What strains does the HPV vaccine cover?

Answer 16

6,11,16 and 18

Question 17

Who is the HPV vaccine given to?

Answer 17

Girls in S1-3
MSM <45
Boys from 2019 in S2

Question 18

How many cervical cancers does the HPV vaccine protect against?`

Answer 18

70%

Therefore 30% not protected, so screening still essential

Question 19

What is the impact of obesity in O&G?

Answer 19

Increased subfecundity
Increased infertility
Decreased effectiveness of IVF
Increased risk of miscarriage 
Increased risk of pregnancy complications

Question 20

How many children lost a parent to a drug death in tayside last year?

Answer 20

31

Question 21

Benefits of breastfeeding?

Answer 21

Immune system increased
Skin; less allergic eczema in breastfed infants
Juvenile rheumatoid less common
Less constipation, diarrhoea and gastroenteritis, less UC and crohn's 
Less resp infections
Lower cholesterol in adulthood 
Less orthodontics 
Higher IQ 
Reduced risk of diabetes 
Better visual acuity

Question 22

What is the recommendation surrounding breastfeeding length?

Answer 22

Exclusively for 6 months

Within one hour of birth