Screening Programmes Flashcards
what is screening
a test offered to an asymptomatic person to detect those who have a high probability of having a disease
what are the principles of early disease detection
Wilson + Junger
1- the condition should be an important problem for the individual and the community (IMPORTANT)
2- the disease should be an accepted treatment for patient with the disease (TREATMENT)
3- facilities for diagnosis and treatment should be available (FACILITIES)
4- there should be a recognisable latent or early stage (LATENT)
5- there should be suitable test or examination (TEST)
6- the test should be acceptable to the population (ACCEPTABLE)
7- the natural history of the condition, including development from latent to declared disease, should be adequately understood (UNDERSTANDING)
8- there should be an agreed policy on whom to treat as patients (PATIENTS)
9- the cost of the case finding programme should be economically balanced in relation expenditure on medical care as a whole (COST)
10- case finding should be a continuing process (CONTINUING)
I take flowers (lilies) to another undertaker past crematory casket
How is cervical cancer an important problem for the individual and community
incidence has fallen since the early 1980s
death has also fallen (5 year survival was 50% in the early 70%)
- now 60%
causes 105 deaths in Scotland and 852 in the UK/ year
what is the accepted treatment for cervical cancer (rule 1)
all cancers are staged using clinical exams, pathology and radiology
gynaecology/ oncology multidisciplinary team meeting
- 1 a week
management is based on the stage/ fitness
what are the differences in treatment for different stages of cervical cancer (rule 2)
small cancers = outpatient
larger tumours = radical hysterectomy
inoperable tumours = chemotherapy and radiotherapy
what are the facilities for diagnosis for cervical cancer (rule 3)
if abnormality is detected, a formal diagnosis is then required
- a biopsy for cervical cancer
in CSP (cervical screening programmes), referred to colposcopy for both diagnosis and treatment
what is the suitable test for cervical cancer (rule 5)
Cervical Smear Test
- carried out at a GP/ sexual health centres
- a brush is used to remove cells from the cervix
- these are transferred to a pot of preservative
- then tested for HPV (human papilloma virus) +/- cytology
speculum used to hold open the cervix/ lubricant
how is the cervical cancer test acceptable to the population (rule 6)
depends on perceived risk and how inconvenient/ unpleasant the test is
promotion -> posters to show
- speed
- normality
- effectiveness
how is case finding a continuing process for cervical cancer
Scottish Cervical Call Recall System (SCCRS)
- generates invitations for women to attend for a smear test
- 25-65 invited every 5 years
- women who have abnormal tests are called more frequently
- computer system interacts with other software to refer patients to colposcopy when required
- colposcopy visits are documented and follow up in the community (GP) can be organised by SCCRS once the patient is discharged
what are the components of cervical cancer screening
Call Recall office and SCCRS
smear takers
laboratories
colposcopy service
what are the risk factors associated with cervical cancer
smoking
poor immune function (e.g. immunosuppression)
multiple sex partners
what is HrHPV
a high risk subtype of HPV
- majority of cervical cancers
what type of virus is HPV
DNA
- high risk and low risk
- over 200 types (40 are STIs)
what circumstances create risk of someone developing pre-cancerous changes with cervical cancer
patients who have persisting infection with a high risk oncogenic subtype of HPV
what does the endocervix look like
rough area
inner
what does the ectocervix look like
smooth + shiny
ouer
what is the epithelium of the endocervix
simple cuboidal epithelium
- musin
what is the epithelium of the ectocervix
squamous epithelium
describe the progression of an HPV infection
1- micro abrasions expose the BM
2- allows for infection of HPV
3- HPV replicates in maturing squamous cells
4- produces koilocytes
describe the end result of low risk HPV infection
free rival DNA within the cell
responsible for viral warts (e.g. 6, 11, 42, 44)
describe the end result of high risk HPV
incorporate their DNA into that of the host cell
viral E6 and E7 proteins are responsible for reactivating the cell cycle in cells which are not normally proliferating
persistent infection/ disruption of cell cycle -> proliferation of epithelial cells -> precursor lesions for cervical cancer (CIN and CGIN)
list examples of high risk subtypes of HPV
16, 18, 31 and 45
what is CIN
cervical intraepithelial neoplasia
- CIN1, CIN2, CIN3
how does CIN1 resolve in most patients
without treatment
patients are monitored
