Screening in SRH

Question 1

What is the most common cause of anal cancer?

Answer 1

HPV

Question 2

What is the most common type of anal cancer?

Answer 2

Squamous cell carcinoma (SCC) - accounts for 90%

Question 3

HPV infection, is associated and accounts for with what types of cancer?

Answer 3

Cervical >99%
Anal - 90%
Penile - 40%
Vulval/vaginal - 40%

Question 4

AIN (anal intraepithelial neoplasia) is associated with which types of HPV?

Answer 4

16; 18; 31; 53; 58

Question 5

Which type of HPV is most commonly associated with AIN?

Answer 5

HPV type 16

Question 6

What are the low-risk types of HPV (associated only with warts)?

Answer 6

6; 11; 42; 44

Question 7

Which type of HPV is most associated with PIN (penile intraepithelial neoplasia)?

Answer 7

HPV type 16

Question 8

High risk HPV types are associated with which oncogenes?

Answer 8

E6 and E7

Question 9

What is the function of the E6 oncogene?

Answer 9

E6 inhibits p53 which normally activates DNA repair, arrests the cell cycle at G1/S and can initiate apoptosis

Question 10

What is the function of the E7 oncogene?

Answer 10

E7 inhibits Retinoblastoma protein which also normally arrests the cell cycle at G1/S and regulates chromatin/histone modification

Question 11

What type of vaccine is the HPV vaccine?

Answer 11

Recombinant protein vaccin

Question 12

How do recombinant vaccines work?

Answer 12

Bacteria or yeast are used to synthesise viral proteins or polysaccharides
These act as antigens following immunisation and provoke an immune response

Question 13

What is the HPV vaccination schedule in the UK?

Answer 13

x1 dose Gardasil 9 to all children aged 11-13 years old

Question 14

Over what age range is cervical cancer screening offered?

Answer 14

25-65 years old

Question 15

In what circumstances may cervical screening invites continue beyond age 65?

Answer 15

1. The most recent smear was abnormal
2. The most recent smear was before the age of 50
3. The patient has never had a smear

Question 16

How long after pregnancy should one wait before getting their smear?

Answer 16

12 weeks

Question 17

How are completely excised lesions of CGIN followed-up?

Answer 17

A test of cure for high risk HPV at 6 and 18 months post-treatment. If these are both negative, the patient can be recalled for screening in 3 years.

Question 18

What is the lifetime risk for breast cancer in the UK?

Answer 18

1 in 7

Question 19

What is the most common form of breast cancer in the UK?

Answer 19

Invasive ductal carcinoma

Question 20

What is the 2nd most common form of breast cancer in UK?

Answer 20

Invasive lobular carcinoma

Question 21

What are the different types of breast cancer receptors?

Answer 21

Oestrogen (70-80% of breast cancers)
Progesterone
HER2
None of the above (triple negative)

Question 22

Where does breast cancer most commonly arise?

Answer 22

Upper outer quadrant of the breast

Question 23

What is the lifetime risk of breast cancer for women with the BRCA1 mutation?

Answer 23

65-85%

Question 24

What are the different types of VIN?

Answer 24

Usual-type VIN and differentiated VIN

Question 25

Which type of VIN is most associated with HPV?

Answer 25

Usual-type

Question 26

Which type of VIN is more common post-menopause?

Answer 26

Differentiated VIN

Question 27

Which type of VIN is more likely to progress to cancer?

Answer 27

Differentiated VIN

Question 28

What are the typical features of usual-type VIN?

Answer 28

- Associated with HPV infection, smoking or immunosuppression - More common in pre-menopausal women (40’s) - A small proportion may resolve spontaneously - Average time to SCC 6-7 years (if HPV related) - Less likely to progress to SCC than differentiated VIN

Question 29

What are the typical features of differentiated VIN?

Answer 29

- Associated with vulval inflammatory conditions such as lichen sclerosus, lichen planus - More common in post-menopausal women (>60) - More likely to progress to SCC (average time 2-4 years)

Question 30

What are the risk factors for penile cancer?

Answer 30

1. Age >50 2. Chronic skin disease e.g. lichen planus, lichen sclerosus 3. High risk HPV infection (HPV-16 is the most common) 4. Immunosuppression 5. Smoking 6. Uncircumcised

Question 31

What are Wilson and Jungner's principles for disease screening?

Answer 31

1. The condition should be important. 2. There must be a recognisable latent or early symptomatic stage. 3. The natural course of the condition, including development from latent to declared disease, should be adequately understood. 4. Suitable test or examination. 5. Test acceptable to population. 6. Case finding should be continuous (not just a 'once and for all' project). 7. Accepted treatment for patients with recognised disease. 8. Facilities for diagnosis and treatment available. 9. Agreed policy concerning whom to treat as patients. 10. Costs of case finding (including diagnosis and treatment of patients diagnosed) economically balanced in relation to possible expenditures on medical care as a whole.

Question 32

What depth of LLETZ should be taken in CIN I?

Answer 32

>7mm, but aim for less than 10mm in women of reproductive age

Question 33

What depth of LLETZ should be taken in CIN II?

Answer 33

10-15mm

Question 34

What depth of LLETZ should be taken in CIN III?

Answer 34

15-25mm

Question 35

What is the recall frequency of the cervical cancer screening programme?

Answer 35

The first invitation is sent to eligible people at the age of 24.5 years. People aged 25 to 49 receive invitations every 3 years. People aged 50 to 64 receive invitations every 5 years

Question 36

What age group of women are invited for breast screening?

Answer 36

Age 50, up to their 71st birthday