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Gynae > Cervical Screening > Flashcards

Cervical Screening Flashcards

1
Q

How many types of HPV

A

100

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2
Q

HPV can cause…

A

Genital warts
Changes to the cells on the cervix that can lead to cervical cancer

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3
Q

Which types of HPV cause genital warts?

A

6, 11

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4
Q

Changes to the cells on the cervix due to HPV are labelled as…

A

CIN1
CIN2
CIN3

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5
Q

Severity of CIN1?

A

Low grade (LSIL)
90% return to normal in 12-18 months

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6
Q

Severity of CIN2/3?

A

High grade (HSIL)
Less sure whether they will return to normal/stay the same/progress to cancer

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7
Q

If confirmed high grade changes on biopsy recommend…

A

Treatment (LLETZ) to remove affected area of cervix

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8
Q

If cancer was to occur, the average time from virus (HPV) to cancer is ______

A

10 years

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9
Q

By being in a cervical screening programme you reduce your risk of cervical cancer by _____

A

60%

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10
Q

Despite a national regulated screening programme there are still ____ cases of cervical cancer every year in NZ and ____ deaths

A

160 cases
60 deaths

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11
Q

How many of the cases/deaths from cervical cancer in NZ are under-screened or unscreened women

A

85%

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12
Q

What is the HPV vaccine called?

A

Gardasil-9

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13
Q

Gardasil-9 has been used in NZ since…

A

2017

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14
Q

Gardasil-9 protects against __ types of HPV. Of that how many cause cancer and how many cause genital warts?

A

9 types of HPV
7 that cause HPV related cancers and 2 that cause genital warts

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15
Q

How effective is the HPV vaccine?

A

Covers the types of HPV responsible for 90% cervical cancers + 90% genital warts

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16
Q

How long does the protection last from the HPV vaccine?

A

Ongoing studies suggest protection will be long lasting

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17
Q

Effectiveness of HPV vaccine is optimum when vaccinated when?

A

<15yo and prior to sexual interactions

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18
Q

Who is HPV vaccine funded for?

A

Funded for males and females aged 9-27yo

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19
Q

How many doses of HPV vaccine do 9-14yo get? and in what timeframe?

A

2 doses given over a 6-12 month period

20
Q

How many doses of HPV vaccine do 15yo+ get? and in what timeframe?

A

3 doses given over a 6 month period

21
Q

How much does HPV vaccine cost for those outside of the funded groups?

A

Cost of full 3 doses ~$600

22
Q

Is the HPV vaccine safe?

A

Research covering hundreds of thousands of vaccine recipients continues to confirm its safety profile as being similar to any other childhood vaccine

23
Q

Common side effects from HPV vaccine

A

Mild pain
Redness and swelling around injection site
Fainting (more common in adolescent girls)

24
Q

What is the risk of anaphylaxis with HPV vaccine?

A

Risk of anaphylaxis is very rare (1-3 in every 1 million doses)

25
Q

Who should not have the HPV vaccine?

A

The vaccine is not recommended in pregnancy or those with severe allergy (anaphylaxis) to a previous dose of this vaccine or a component of the vaccine

26
Q

Can the HPV vaccine be given at the same time as other vaccines?

A

Yes

27
Q

Can the HPV vaccine be given to breastfeeding women?

A

Yes

28
Q

Does the HPV vaccine have any effect on current HPV infection?

A

Will not treat existing HPV infection or HPV-related disease, or make this any worse

29
Q

When was the cervical screening programme established?

A

1990

30
Q

Why was the cervical screening programme established?

A

To reduce the number of people who develop cervical cancer and the number who die from it

31
Q

Since the cervical screening programme was established the incidence of cervical cancer in NZ has dropped by ____

A

60%

32
Q

How does the cervical screening programme work? What is it aiming to detect?

A

Through routine screening at regular intervals it aims to detect precancerous squamous cell changes that if not treated may lead to cancer

33
Q

Smear results are reported using what system?

A

Bethesda Reporting System

34
Q

What are the three main components of the Bethesda Reporting System for smears?

A

Adequacy of sample
General categorisation and diagnosis (HPV/cytology)
Recommendation on follow up

35
Q

Adequacy of a smear is reported as…

A

Satisfactory or unsatisfactory

36
Q

3 main factors cause unsatisfactory smear samples

A

Sample taking - inadequate numbers of cells sampled, contact bleeding or contaminants e.g. lubricant
Clinical factors e.g. bleeding, inflammation or cytolysis
Lab technical processing issues

37
Q

What to do if you get an unsatisfactory smear result?

A

Repeat in 6 weeks - 3 months time

38
Q

After 3x unsatisfactory smear results what would you do?

A

Refer to colposcopy

39
Q

What has been the big change to cervical screening this year?

A

The primary test for cervical screening has changed from cytology (testing the cells of the vagina or cervix) to HPV testing, with the option of self-testing.

40
Q

What is the recommended age to start cervical screening?

A

25 years for any person with a cervix or vagina who has ever been sexually active

41
Q

It’s important to remember that cervical screening is good at picking up ________ but does not perform well in detecting ____________

A

Good at picking up pre-cancerous conditions
Not good at picking up carcinoma in situ or invasive cervical cancer

42
Q

Four indications for referral to colpscopy

A

Abnormal appearance of the cervix
LSIL + HrHPV positive
LSIL + repeat LSIL (within 5 years)
HSIL

43
Q

_____of women with an LSIL smear however will have HSIL found at colposcopy

A

~20%

44
Q

If left untreated ______ of women with HSIL (CIN 2/3) would progress to invasive cervical cancer over 10 years.

A

~30%

45
Q

If colposcopy confirms low grade changes then what?

A

Return to primary care for a repeat smear in 12 months

46
Q

If colposcopy confirms high grade changes then what?

A

Treatment is recommended - LLETZ

Gynae (4 decks)

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