Lecture 10 Flashcards
hpv 16 and 18 account for how many % of cases
70%
true or false: once you get hpv, you will get cancer for sure
nah usually it is persistent infections that cause cancer
true or false: most hpv infections spontaneously regress
true
true or false: grade 3 hpv infection is cancer
nah it is still pre-cancer but still very close to cancer
what is a colposcopy
-done after a weird pap test
-insert a vaginal speculum and then you insert a beam of light to see the cervix
what does a high grade hov infection looks like
-it looks super red and looks swollen
what is mostly used to see the state of the basal membrane in cervix
histology to see the fucked up cells
CIN grade 1: regression, persistence, progression to CIN 3 and progression towards cancer
-regression: 57%
-Persistence: 32%
-progression to cin3: 11%
-Progression towards invasive cancer: 1%
CIN grade 2: regression, persistence, progression to CIN 3 and progression towards cancer
-regression: 43%
-Persistence: 35%
-progression to cin3: 22%
-Progression towards invasive cancer: 5%
CIN grade 3: regression, persistence, progression to CIN 3 and progression towards cancer
-regression: 32%
-Persistence: <56%
-progression to cin3: we dunno %
-Progression towards invasive cancer: >12%
treatment of cervical pre-cancer: less invasive
-loop electrocautery: excisitional procedure; basically you take off what is the weird cells
-cold knife conization: you make a weird cone and you take off what is fucked up: more invasive
treatment of cervical pre-cancer: more invasive
-radical hysterectomy
-intensity modulated radiotherapy; basically targetted
what is the 4th common female malignancy wolrdwide
cervical cancer
how many deaths and new cases of cervical cancer a year
-570 000 cases per year
-311 000 deaths anually
where do cervical cancer deaths happen
mostly in poor countried 90%
what is the goal for elimination as a public health problem: cervical cancer
4 per 100 000 women-years for
elimination as a public health problem;
cervical cancer: 90-70-90 targets by 2030:
- 90% of girls fully vaccinated with HPV vaccine by age 15 years.
- 70% of women are screened with a high- performance test by 35 years of age and again by 45 years of age
- 90% of women identified with cervical disease receive treatment (90% of women with precancer treated, and 90% of women with invasive cancer managed).
Screening reduced cervical cancer incidence by
80%
true or false: pap smear has low sensitivity
yeah, a lot of false negatives
US spends more than $… on cervical cancer screening annually.
7 billion
hpv: Three screening options
- HPV with cytology (cotesting)
- HPV testing with genotyping and reflex cytology (primary HPV testing)
- Cytology alone
Primary hrHPV Testing: advantages
- Improved sensitivity for CIN3+ over cytology alone (↑detection by 50%)
- Potential for self-collection
- Improve access: you can do it at home
Primary hrHPV Testing: disadvantages
- Lack of specificity (↑colposcopy referral by ~50%)
- Requires change in infrastructure
- Requires healthcare provider and patient education
What happens after a positive HPV test result?
cytology and genotype to see which type of hpv
which hpv strain is the most dangerous
16
The positivity of p16/ki-67 strongly indicates the presence of ……
high-grade dysplasia.
ki 67 is a marker of what
cell proliferation
P16 is a marker of….
loss of cell cycle regulation- a hallmark of neoplastic transformation.
True or false: under normal physiologic conditions,
staining of p16 and Ki-67 should not show expression in the same cells.
true
Summary of current challenges: hpv edition
- Accessibility
- Low specificity of HPV DNA testing
- Limited biomarker detection capabilities
hpv: self sampling
- Not yet Health Canada or FDA-approved
- Multiple effectiveness studies and patient acceptability studies have shown
that self-sampling is effective, is cost-effective and is acceptable to women,
especially among under-screened populations - Sensitivity comparable to clinician-obtained samples with PCR-based HPV
tests.
what is mnbc
online platform to have the self sampling for hpv peeps
Indigenous women have a …… higher incidence of cervical cancer (27.7/100000) and …. more likely to die from cervical
cancer
-3.5x
-4 x
