Public Health Issues in O&G

Question 1

What is the most common cancer in women <35?

Answer 1

Cervical cancer

Question 2

Why is screening done for cervical cancer?

Answer 2

Aims to reduce the incidence on invasive cancer of the cervix

Question 3

What are the advantages of screening?

Answer 3

Reduces disease incidence and mortality
Allows for less radical treatment due to early detection
Cost effective and has overall population benefit

Question 4

What does cervical screening identify?

Answer 4

Cell changes which may develop to be pre-cancerous = beneficial as women may otherwise have no symptoms

Question 5

What women should receive diagnostic testing for cervical cancer instead of screening?

Answer 5

Those with symptoms = unusual vaginal discharge or bleeding, bleeding after sex or between periods, dyspareunia

Question 6

What women are offered cervical screening?

Answer 6

Those aged between 25-64

Question 7

How often is cervical screening performed?

Answer 7

Age 25-49 = every 3 years

Age 50-64 = every 5 years

Question 8

What examination is performed during cervical screening?

Answer 8

Speculum examination = visual examination of cervix, brush samples of cells, primary HPV testing

Question 9

Where are brush samples taken from during cervical screening?

Answer 9

Transformation zone of cervix

Question 10

How is the coverage of a screening programme calculated?

Answer 10

Screened population/eligible population x100

Question 11

How is the usage of a screening programme calculated?

Answer 11

Screened population/invited population x100

Question 12

What are the challenges of optimising the coverage a screening programme

Answer 12

Minority ethnic groups, immigrants, travellers, prisoners, students

Question 13

What are the challenges of optimising the uptake of a screening programme?

Answer 13

Change of address, communication, health literacy, deprivation, vulnerable groups

Question 14

What are some ways to increase coverage and uptake of a screening programme?

Answer 14

Promotion of screening programme, GP incentives, material in variety of languages, local and national incentives

Question 15

How many types of HPV are there?

Answer 15

More than 80 types have been identified = about 40 are known to infect the genital tract

Question 16

What can HPV infection cause?

Answer 16

Low risk types cause genital warts

High risk types cause invasive cervical cancer

Question 17

What types of HPV are covered by the vaccine?

Answer 17

Quadrivalent vaccine (gardasil) = cover types 16 and 18, plus types 6 and 11 (so protects against genital warts)

Question 18

What is responsible for most cases pf cervical cancer?

Answer 18

HPV types 16 and 18 = cause about 70% of cervical cancers

Question 19

Who gets the HPV vaccine?

Answer 19

Girls in S1-S3, male/male sex, boys in S1

Question 20

Why is cervical screening still important even though there is a vaccine for HPV?

Answer 20

Vaccine doesn’t protect against 30% of cervical cancers

Question 21

What are some public health issues related to O & G?

Answer 21

Teenage pregnancy, female genital mutilation, obesity, exercise, smoking, substance use, infertility, breastfeeding, increasing maternal age

Question 22

What is female genital mutilation defined as?

Answer 22

All procedures that involve partial or total removal of external female genitalia, or other injury to female genitalia for non-medical reasons

Question 23

What is female genital mutilation recognised as internationally?

Answer 23

A violation of human rights

Question 24

Who tends to suffer from female genital mutilation most commonly?

Answer 24

Nearly always carried out on minors

Question 25

What are some O & G cancers that are related to obesity?

Answer 25

4% of ovarian cancers and 38% of womb cancers could be prevented if everyone was a healthy weight

Question 26

What are the impacts of obesity on O & G?

Answer 26

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

Question 27

How does smoking cessation improve O & G outcomes?

Answer 27

Decreased risk of complications in pregnancy and birth
Reduces risk of stillbirth, premature birth and SIDS
Reduced risk of developing cervical cancer
Improved prognosis following diagnosis of cervical cancer

Question 28

What are the medical impacts of teenage pregnancy on the mother?

Answer 28

UTI, STD complications, premature death, preterm birth, pre-eclampsia/eclampsia, anaemia, depression

Question 29

What are the social impacts of teenage pregnancy on the mother?

Answer 29

Social isolation, lack of qualifications, not completing education, receiving welfare benefits, not living independently

Question 30

What are the impacts of teenage pregnancy on the child?

Answer 30

Reduced birth weight, higher risk of death, growth restriction, not breastfed, infection, SIDS, more likely to become teenage mother

Question 31

What are some of the benefits to the child of breastfeeding?

Answer 31

Reduced risk of developing diabetes, fewer and less severe URTIs, lower cholesterol as adult, less risk of Crohn’s and UC in later life, fewer UTIs, decreases risk of childhood cancers, higher visual acuity

Question 32

What protective benefit does folic acid offer?

Answer 32

Helps prevent neural tube defects, including spina bifida

Question 33

How much folic acid should be prescribed during pregnancy?

Answer 33

400mg daily pre-conception until 12 weeks gestation

Question 34

What are some foods that contain folate?

Answer 34

Green leafy veg, fortified bread and cereals