Public health Screening Flashcards
What is the most common cancer in women <35?
Cervical cancer
Describe the incidence of cervical cancer
It increases upto a peak at 30-34yrs old and then the incidence decreases as you get older
What is the purpose of cervical cancer screening ?
To decrease the incidence of invasive cancer of the cervix
What are thr advantages of screening for cervical cancer and in general ?
- Decreased disease incidence
- Decreased disease mortality (caught earlier)
- Less radical treatment needed (caught earlier)
- Cost-effective
If a women has symptoms suggestive of cervical cancer do they undergo screening test?
NO they need to have diagnostic testing
What are the symptoms of cervical cancer ?
- Unusual vaginal discharge/bleeding this includes bleeding after sex/between periods
- Dysparenuria (difficult/painful sex)
What is the cervical screening programme in scotland ?
Women aged 25-64 are screened:
- Women 25-49 every 3 years
- Women 50-64 every 5 years
Describe the screening test for cervical cancer ?
- Speculum used to visually examine the cervix, a brush sample is then taken of the cells from the transformation zone (msoe common area for cervical cancers to arise)
- Sample then sent off for cytology
- HPV testing may or may not be done alone with the cytology
If the cytology results show no changes (normal) following cervical smear what follow-up is done ?
Normal screening protocol cotinued to be followed
If the cytology results from cervical smear come back as unsatisfactory then what follow-up is required ?
The patient is asked to come back for a cervical smear in 3 months time
If the cytology results from cervical smear come back as borderline or mild dyskaryosis, what follow-up is required ?
They are asked to come back for a cervical smear in 6 months time
If cervical smear shows moderate or severe dyskaryosis, or glandular abnormalities (high grade changes) what follow-up is needed ?
Referral to colposcopy
If the cytology results of the cervical smear shows invasive changes what follow-up is required ?
Urgent referral to colposcopy (within 2 weeks)
What are the challenges to optimisign coverage ?
- Minority ethnic groups
- Immigrants, travellers
- Prisoners
- Students
- Reduced uptake
What are the challenges to optimising uptake ?
- Chnage of address
- Communication
- Health literacy
- Deprivation
- Accessibility
- Vulnerable groups
What are the 2 main low risk HPV types associated with genital warts ?
6&11
What are the 2 main high risk HPV types associated with cervical cancer ?
16&18
How is the HPV vaccine offered to and when ?
Girls aged 11-13
What does the HOV vaccine protect against ?
HPV types 6,11,16&18
Why is cervical screening still key even in those with HPV vaccine, vaccinating them against the 2 main causes of cervical cancer ?
Becuase HPV types 16&18 account for 70% of the cause of cervical cancer so there is still 30% of the causes of cervical cancer not protected against ==> cervical screening is key
What is colposcopy ?
It is a magnified inspection of cervix, stains and biopsy are then used to identify abnormality.
The options include:
- Biopsy and follow up
- Biopsy and treat with cold coagulation
- LLETZ (this procedure gives biopsy results)
How is cervical cancer diagnosed ?
Cervical cancer is diagnosed with colpscopy + biopsies for histopathological study
What treatment can be given for high grade changes in cervucak smear when at colposcopy ?
- Cold Coagulation (Destructive) = Hot probe which causes cells to burst OR
- LLETZ (Excisional) = Electosurgical wire can cut through tissue (loop)
Following treatment of high grade changes (not cancer) at colposcopy what follow-up is needed?
A test of cure is needed:
- Combined smear and HPV test after 6 months
- Double negative – 3 yearly repeat smear
If either is positive need further colposcopic assessment
