Screening Relevant to Sexual and Reproductive Health Flashcards
Describe the epidemiology and aetiology of CIN
HPV responsible for 99% of CINs
HPV double stranded DNA, 8 genes
HPV 16+18 responsible for 2/3 of cases of HPV infection
90% of HPV infections self-resolve
Name some risk factors for having HPV
- Increased number of sexual partners
- Immunocompromised
- Smoking
- Prolonged OCP
Describe the regression and progression rates of CIN 1, 2, and 3
CIN 1 - 57% regress, 11% progress, 1% turn to invasive carcinoma
CIN 2 - 42% regress, 22% progress, 5% turn to invasive carcinoma
CIN 3 - 32% regress, >12% turn into invasive carcinoma
Describe the aetiology of VIN
Usual type / low grade
- HPV (mainly 16)
- Smoking
- Immunodeficiency
- Usually pre-menopausal
- Low risk of SCC
High grade / differentiated
- High risk of SCC (2-14%)
- Associated with lichen sclerosis and planus
How is VIN managed?
- Wide local excision
- Imiquimod 5%
- Vulvectomy
Describe vaginal intraepithelial neoplasia (VaIN)
- Most common in 50-60 year olds who have had previous VIN/CIN
- Risk factors include CIN, immunocompromised, DES exposure, radiotherapy
- Occurs in upper 1/3 of vagina usually
- Incidental finding
- Management: WLE, imiquimod cream 5%
Describe penile intraepithelial neoplasia (PIN)
Erythroplasia of Queyrat / Bowens
Rare
Aetiology/risk factors
- Uncircumcised men >50
- HPV 16
- Lichen planus or LS
- Smoking
- Chronic irritation from urine/injury/friction
Diagnosis
- Red plaques on glans or under foreskin, itchy, painful, ulcerated, bleeding
Management
- Biopsy to confirm
- Imiquimod / 5-fluorouracil/ cryo / laser / excision
- 10-30% would develop into SCC
Describe anal intraepithelial neoplasia
Rare
HPV 16
Anal canal has same SCJ as cervix
Risk factors
- HIV / immunocompromised
- Receptive anal sex
- VIN/CIN history
Diagnosis
- Itching, discharge, scaly area, can be asymptomatic
Management
- Laser, imquimod, f-fluorouracil
What criteria must be met for a screening programme to happen?
- Condition is important health problem and natural history understood
- Test must be simple, acceptable, and able to conduct on large populations
- Must be treatment available for the condition
- Must be financially viable; cost effective
- Must be evidence-based
- Must not cause harm
How is a UK screening programme approved?
National Screening Committee
- Make recommendations based on evidence
Ministers
- Make decisions and set policy
NHS England
- Implements the screening programme
UK HSA
- Quality assurance, commissioning, public health awareness, education and guidance, collect KPI data
Describe the NHS cervical screening pathway
HPV primary triage - cytology - colposcopy
Age 25-49: every 3 years
Age 50-65: every 5 years
>65 only if one of last 3 smears were abnormal OR if never had one OR if last smear was under age 50
What cervical screening is offered to HIV +ve individuals?
Annual
What is DES exposure and what change has that led to cervical screening?
DES (diethylstilbestrol) was used to prevent miscarriage / pre-term delivery before 1971
- Daughters and granddaughters of DES exposed patients are at increased risk of clear cell cancer of cervix and vagina
- DES exposure in utero caused abnormal uterine tract formation and these women have annual colposcopy
- No change to cervical screening
Describe the histology of CIN
CIN 1: changes in basal 3rd epithelium +/- HPV changes
CIN 2: changes in basal 2/3 of epithelium and marked nuclear atypia
CIN 3: changes to entire epithelium
Describe the UK breast screening programme
- Mammograms
- Every 3 years from 50 years old to 71st birthday
- Prevents 1300 deaths a year
- However, for every death prevented, 3 women are treated for a cancer which would not have harmed them
