Cervical Screening

Question 1

HPV infections rates and different cancers

Answer 1

Cancer Site

Males

Females

% Cause by HPV

Cervix

0

282

>99%

Penis

45

0

40%

Vulva/vagina

0

117

40%

Anus

48

22

90%

Mouth

143

85

3%

Oropharynx

461

221

12%

Question 2

HPV infection leading to cancer in the cervix

Answer 2

Question 3

How does HPV infection affect the cervix

Answer 3

• Early infection may be accompanied by mild changes in the epithelium
  
  • An abnormal growth of squamous cell detectable on smear called a squamous intraepithelial lesion (SIL)
  • May be low grade (LSIL) or high grade (HSIL) depending on how much is affected and how abnormal the cells are
• Abnormal cells in the cervix detected by biopsy and histology are classified as cervical intraepithelial neoplasia (CIN)
  
  • Graded 1-3 according to proportion affected

Question 4

What is the HPV immunisation programme in the UK

Answer 4

• Girls born after
  
  • 1 sep 1990 - Bivalent vaccine HPV 16/18
  • 1 sep 2012 - Quadrivalent vaccine HPV 16/18/6/11
  • 1 sep 2014 - 2 dose regime

Question 5

What are the types of HPV

Answer 5

• Low risk - 6, 11, 42, 44
  
  • Genital warts and low grade CIN
  • Often transient and resolve
• High risk - 16, 18, 31, 45
  
  • Persistent infection increases risk fo developing cancer
  • High grade CIN and (more rarely) cancer

Question 6

what is the cervical screening programme in the UK

Answer 6

• Invited to attend at 25 years (to 64)
• Smear taken, sent to lab
• If positive for HBV
  
  • Cytology normal - repeat in 1 year
  • Dyskaryosis - seen at colposcopy for further investigation (3%)

Question 7

Cervical screening programme regime

Answer 7

• 25-64
• 5 yearly smear
• Liquid based cytology (LBC)
• Test for high risk HPV
• Triage with cytology

Question 8

Smear sample testing