Screening

Question 1

Cervical cancer

1. where does it fit with other cancers in Aus - incidence and deaths?
2. what is the 2-year and 3-year participation rate in screening?
3. what proportion of cervical ca’s are linked to HPV 16 and 18?
4. how much has mortality reduced since introduction of NCSP?
5. how to ATSI fit in terms of incidence and mortality?

Answer 1

1. Cervical cancer is 15th most common cancer in Aus and 21st most common cancer death
2. 2-year: 58%, 3-year: 70%
3. 70% of cervical ca linked to HPV 16 and 18
4. Mortality has halved since introduction of NCSP
5. ATSI have 2 x the incidence of cervical cancer and 4 x mortality rate compared to non-ATSI Australians

Question 2

What are some potential issues with the new cervical screening program using HPV testing?

Answer 2

• reduction in 25-29 year participation
• reduction in cytology skills
• importance of quality assurance of HPV testin
• colposcopy standards need to be assured (increased dependence on colposcopy)
• practical issues around 5 year interval (reminders etc.)
• non-HPV assoc. cancers will be missed

Question 3

How does HPV testing compare to traditional cytology in sensitivity and specificity, PPV and NPV?

Answer 3

HPV testing is more sensitive (less false neg) but less specific.
NPV is very high but PPV is lower
This makes sense because changing to 5 year interval you wouldn’t want to miss any cases

Question 4

Breast cancer:

1. how does it rank in cancer indidence for women?
2. how does it rank for cancer deaths?
3. Lifetime risk

Answer 4

1. Most common cancer in women
2. Second most common cancer death for women after lung cancer
3. Lifetime risk 1 in 8

Question 5

What are the main harms associated with breast cancer screening with mammography?

Answer 5

• overdiagnosis of cancers that wouldn’t have caused health problems
• psychological distress
• unnecessary biopsies and appointments