Cervical Screening and O&G Public Health

Question 1

Cervical cancer is the most common cancer in women under what age?

Answer 1

35

Question 2

Patients over the age of 65 can still get cervical cancer. TRUE/FALSE?

Answer 2

TRUE

Screening only takes place between 25-64 so sometimes these patients are not identified

Question 3

Why does cervical screening only take place between the ages of 25-64?

Answer 3

• This is the most cost effective

- most cases emerge in this age group

Question 4

Why is cervical screening done?

Answer 4

• to reduce the incidence of invasive cases

=> to catch abnormalities earlier for treatment

Question 5

What are the advantages of cervical screening?

Answer 5

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

Question 6

If a woman presents symptomatically i.e. with discharge/ bleeding/dyspareunia, should she still be offered cervical screening?

Answer 6

No she should be offered diagnostic testing

this is usually carried out by gynaecology

Question 7

How often do women have to attend for cervical screening?

Answer 7

Every 3 years if aged 25 - 49 years

Every 5 years if aged 50 – 64 years

Question 8

Roughly what percentage of invited women came for cervical screening in Scotland between 2017-2018?

Answer 8

73% uptake

Question 9

In what groups is uptake of cervical screening the lowest?

Answer 9

• Most deprived areas

- Younger 25-49 age group (who have higher risk)

Question 10

What new test will be rolled out in March 2020 to assist in cervical screening?

Answer 10

Primary HPV testing

Question 11

What are the aims of Primary HPV Testing?

Answer 11

• Faster investigation of those at higher risk of developing cervical cancer
• Reduce the number of unnecessary screening/ colposcopy appointments among women with borderline/low grade cytology results

Question 12

What is coverage and how is this concept different to uptake?

Answer 12

Coverage = percentage of those who have been screened out of all eligible for screening in the population
=> (screened pop./eligible pop. x100%)

Uptake = percentage of those who have been screened out of all patients who have been INVITED for screening
=> (screened pop./invited pop. x100%)

Question 13

Why is there a difference between the population eligible for a smear test and those who are invited for a smear test?

Answer 13

• If patients have moved to Scotland and not engaged with healthcare services (registering with GP/ attended hospital) then they wont have a CHI number
• CHI numbers are used to send out screening reminders to all eligible

- The people this often doesnt reach are:
Minority ethnic groups
Immigrants
Travellers
Prisoners
Students

Question 14

Why may patients who have been invited for cervical screening not engage with booking an appointment?

Answer 14

• Change of address
• Health literacy not adequate
• Deprivation
• Accessibility to service
• Vulnerable groups

Question 15

How are public health aiming to increase the coverage and uptake of cervical screening?

Answer 15

• Promotion of screening programme
• Material in various languages
• GP incentives
• Local and national initiatives

Question 16

What strains of HPV does the vaccine contain and which of these protects against cervical cancer?

Answer 16

• Vaccine contains strains 6, 11, 16 and 18
  Types 16, 18 HIGH RISK = cause 70% of cervical cancer
• Due to strains 6 and 11 being included in the vaccine, this also protects against genital warts

Question 17

Who is offered the HPV vaccine?

Answer 17

Girls S1 to S3

Boys in S1 (for herd immunity and protection from penile, oropharyngeal and rectal cancers)

Men who have Sex with Men (MSM) - offered this through the sexual health clinic

Question 18

Why is cervical screening still essential even after the development of the HPV vaccine?

Answer 18

• Vaccine does not protect against 30% cervical cancers

Question 19

What socio-economic group is least likely to be vaccinated against HPV, and why is this a risk?

Answer 19

Most deprived are less likely to be vaccinated

ALSO less likely to attend screening
=> high risk of developing invasive cancer that goes undetected

Question 20

What public health issues are common in obs and gynae?

Answer 20

• Teenage pregnancy
• Lifestyle => Obesity, exercise, smoking, substance use
• Female genital mutilation (FGM)
• Breastfeeding (benefits and support)
• Increasing maternal age
• Infertility
• Screening

Question 21

What is female genital mutilation and why should it ALWAYS be reported?

Answer 21

• FGM procedures involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons

They are:

• A violation of the human rights of girls and women.
• A violation of the rights of children.

Question 22

What impact does obesity have on obs and gynae?

Answer 22

• Increased length of time spent trying to conceive
• Increased infertility
• Decreased effectiveness of IVF
• Increased risk of miscarriage and pregnancy complications
• Obesity contributes to uterine and ovarian cancers

Question 23

HOw much physical activity is recommended for women per day during pregnancy?

Answer 23

150 minutes of moderate exercise

- e.g. climbing stairs, carrying shopping, swimming etc

Question 24

What are the advantages of smoking cessation in pregnancy?

Answer 24

• Decreased risk of pregnancy complications
• Reduced risk of stillbirth, premature birth, sudden infant death syndrome
• Reduced risk of developing cervical cancer
• Improved prognosis following diagnosis of cervical cancer

Question 25

Public health recommend how much folic acid should be taken daily during pregnancy?

Answer 25

400 micrograms every day before pre-conception, until 12 weeks pregnant.

=> Also eatfoods that contain folate (natural form of folic acid), such as green leafy vegetables