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PUBH211 > Lecture 9: Cervical Cancer > Flashcards

Lecture 9: Cervical Cancer Flashcards

1
Q

What is significant about cervical cancer?

A
  • Important global cancer
  • global inequities
  • preventable (primary and seconday)
  • screening programme
  • research ethics
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2
Q

what are the 2 main types of cervical cancer?

A
  • squamous cell cancer (80% of cases)
  • adenocarcinoma (glandular cell cancer)
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3
Q

what does this graph show?

A

estimated age-standardised incidence and mortality rates in 2018, worldwide, females, all ages

cervical cancer remains one of the important cancers in females.

incidence- ~13 per 100,000 women
mortality - ~7 per 100,00 women

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4
Q

what do these graphs show? what does it imply?

A

top:

  • age standardised incidence rate, cervix uteri, all ages

bottom:

  • age standardised mortality rate, cervix uteri, all ages

shows/implies that there is a clear inequity based on income of the country
high income countries such as NZ, Australia, USA have low incidence and mortality rate
low income countries such as Africa have very high incidence and mortality rates

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5
Q

what does this graph show?

A
  • High income countries have lowest incidence and mortality
  • based on access to primary and secondary preventions and access to treatment
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6
Q

What does this graph show?

A

The mortality rate from cervical cancer in NZ has decreased from 1950-2012. still decreasing today

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7
Q

what does this graph show?

A
  • can see a decrease in incidence rate in NZ as well
  • shows important inequities within NZ (Rate in Maori have always been higher)
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8
Q

What are the most important risk factors for cervical cancer?

A
  • age
  • socieconomic status
  • immunosupression (including HIV/AIDS)
  • smoking
  • HPV infection! - genital wart virus
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9
Q

What are the events leading to cervical cancer? include characteristics, management and prevention.

A
  • can start as HPV infection which in common among women of reproductive age. There is no treatment that eradicates HPV. Sometimes HPV can lead to dysplasia. Primary preventions include condoms and vaccination!
  • low-grade dysplasia is usually temporary and disappears. Should be monitored instead of treated as most legions don’t progress. However it can progress to highgrade dysplasia. Secondary prevention is screening!
  • high-grade dysplasia is the precurser to cervical cancer. this should be treated as it can easily progress to cancer. Screening strategies are intended to identify abnormalities in the low-grade to high-grade dysplasia range.
  • women with high-grade dysplasia are at risk of developing invasive cancer. treatment is very expensive and not very effective in advanced stages.
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10
Q

how does HPV relate to the history of cervical cancer?

A
  • Human papilloma virus is a necessary but not sufficient cause (types 16,18,31,45,58)
  • HPV 11 and 16 are genital wart types
  • HPV infection is highly prevalent
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11
Q

what is the history of the HPV vaccination?

A
  • 2008: immunisation with Gardasil quadrivalent vaccine began for year 8 girls
  • Gardasil 9 contains virus-like particles of HPV types 6,11,16,18,31,33,45,52,58
  • programme extended to boys in 2017
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12
Q

why was year 8 decided for the HPV vaccination age?

A

research found that 8% of youth’s who have had sexual intercourse before the age of 13, 24% by 15 and 46% by 17.

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13
Q

how many doses recommended for 14 and under?

A

2

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14
Q

how many doses recommended for 15-26 years?

A

3

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15
Q

how many doses recommended for 9-26 years with confirmed HIV infection?

A

3

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16
Q

which groups are recommended to have 3 doses which are not funded?

A
  • 27years and over
  • little previous exposure to HPV and now likely to be exposed
  • men who have sex with men
  • people with HIV
17
Q

what shows the effectiveness of the vaccine?

A
  • RCT’s show protection against HPV types included in vaccine but not other types
  • also provides protection against cervical cancer and pre-cancer
  • population studies show decrease in HPV cervical lesions in vaccianted women
18
Q

what is the outline of the screening pathway of the National Cervical Screening Programme and Register?

A

health promotion initiatives - no point in screening if not all women participate. operates through primary care facilities

  • needs a system of invitation and recall
  • need smear takers and labs to support the test
  • need the capacity for diagnosis and treatment
  • all this needs to be underpinned by the national screening register.
19
Q

what are some of the important events of the unfortunate experiment?

A
  • study conducted at National Women’s hospital from mid 1960’s as Dr Herbert Green wanted to “prove that Carcinoma in situ (CIS) is not a premalignant disease
  • hospital medical commitee approved it (1966)
  • other medical staff expressed concern (1969) and formal complaints (1973)
  • reviewed by internal working party at national womens but experiment was still allowed to go ahead.
  • a paper was published which led to the cartwright inquiry.
20
Q

what were the findings of the cartwright inquiry?

A

many ethical failures

  • harm to women
  • no consent
  • scientific misconduct
  • no monitoring and stopping
21
Q

what were the outcomes of the cartwright inquiry

A
  • formation of the office of the health and disability comissioner
  • code of health consumers rights
  • independent health ethics committees
  • national cervical screening programme
22
Q

what are the implications for research that came from the cartwright inquiry?

A
  • independent health ethics committee
  • separation of clinical practice and research
  • informed consent
  • the right to withdraw from a clinical study at any time
23
Q

what are forms of primary preventions for cervical cancer?

A
  • immunisation against HPV
  • sexual health care (condoms/barriers)
  • sexual health education
24
Q

what are forms on secondary preventions for cervical caner?

A
  • screening
  • smoking cessation
25
Q

what are forms of tertiary preventions for cervical cancer?

A
  • surgery
  • radio/chemotherapy
  • rehabilitation
26
Q

what are the screening changes likely to happen in the future?

A

HPV smear will likely be a self swab!

  • this will help reduce inequities and provide more access
  • especially for Maori and Pasifika women + vulnerable women with sexual assault/abuse history.

PUBH211 (31 decks)

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