Screening in SRH Flashcards
What is the most common cause of anal cancer?
HPV
What is the most common type of anal cancer?
Squamous cell carcinoma (SCC) - accounts for 90%
HPV infection, is associated and accounts for with what types of cancer?
Cervical >99%
Anal - 90%
Penile - 40%
Vulval/vaginal - 40%
AIN (anal intraepithelial neoplasia) is associated with which types of HPV?
16; 18; 31; 53; 58
Which type of HPV is most commonly associated with AIN?
HPV type 16
What are the low-risk types of HPV (associated only with warts)?
6; 11; 42; 44
Which type of HPV is most associated with PIN (penile intraepithelial neoplasia)?
HPV type 16
High risk HPV types are associated with which oncogenes?
E6 and E7
What is the function of the E6 oncogene?
E6 inhibits p53 which normally activates DNA repair, arrests the cell cycle at G1/S and can initiate apoptosis
What is the function of the E7 oncogene?
E7 inhibits Retinoblastoma protein which also normally arrests the cell cycle at G1/S and regulates chromatin/histone modification
What type of vaccine is the HPV vaccine?
Recombinant protein vaccin
How do recombinant vaccines work?
Bacteria or yeast are used to synthesise viral proteins or polysaccharides
These act as antigens following immunisation and provoke an immune response
What is the HPV vaccination schedule in the UK?
x1 dose Gardasil 9 to all children aged 11-13 years old
Over what age range is cervical cancer screening offered?
25-65 years old
In what circumstances may cervical screening invites continue beyond age 65?
- The most recent smear was abnormal
- The most recent smear was before the age of 50
- The patient has never had a smear
How long after pregnancy should one wait before getting their smear?
12 weeks
How are completely excised lesions of CGIN followed-up?
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.
What is the lifetime risk for breast cancer in the UK?
1 in 7
What is the most common form of breast cancer in the UK?
Invasive ductal carcinoma
What is the 2nd most common form of breast cancer in UK?
Invasive lobular carcinoma
What are the different types of breast cancer receptors?
Oestrogen (70-80% of breast cancers)
Progesterone
HER2
None of the above (triple negative)
Where does breast cancer most commonly arise?
Upper outer quadrant of the breast
What is the lifetime risk of breast cancer for women with the BRCA1 mutation?
65-85%
What are the different types of VIN?
Usual-type VIN and differentiated VIN
Which type of VIN is most associated with HPV?
Usual-type
Which type of VIN is more common post-menopause?
Differentiated VIN
Which type of VIN is more likely to progress to cancer?
Differentiated VIN
What are the typical features of usual-type VIN?
- 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
What are the typical features of differentiated VIN?
- 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)
What are the risk factors for penile cancer?
- Age >50
- Chronic skin disease e.g. lichen planus, lichen sclerosus
- High risk HPV infection (HPV-16 is the most common)
- Immunosuppression
- Smoking
- Uncircumcised
What are Wilson and Jungner’s principles for disease screening?
- The condition should be important.
- There must be a recognisable latent or early symptomatic stage.
- The natural course of the condition, including development from latent to declared disease, should be adequately understood.
- Suitable test or examination.
- Test acceptable to population.
- Case finding should be continuous (not just a ‘once and for all’ project).
- Accepted treatment for patients with recognised disease.
- Facilities for diagnosis and treatment available.
- Agreed policy concerning whom to treat as patients.
- Costs of case finding (including diagnosis and treatment of patients diagnosed) economically balanced in relation to possible expenditures on medical care as a whole.
What depth of LLETZ should be taken in CIN I?
> 7mm, but aim for less than 10mm in women of reproductive age
What depth of LLETZ should be taken in CIN II?
10-15mm
What depth of LLETZ should be taken in CIN III?
15-25mm
What is the recall frequency of the cervical cancer screening programme?
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
What age group of women are invited for breast screening?
Age 50, up to their 71st birthday
