Cancer Screening and Referral Guidelines Flashcards
What system is used for cervical cancer screening?
HPV first system, i.e. a sample is tested for high-risk strains of human papillomavirus (hrHPV) first and cytological examination is only performed if this is positive
Who is screened for cervical cancer in the UK?
A smear test is offered to all women between the ages of 25-64 years
25-49 years: 3-yearly screening
50-64 years: 5-yearly screening
cervical screening cannot be offered to women over 64 (unlike breast screening, where patients can self-refer once past screening age)
What are the special situations in cervical cancer screening?
cervical screening in pregnancy is usually delayed until 3 months post-partum unless missed screening or previous abnormal smears
women who have never been sexually active have a very low risk of developing cervical cancer therefore they may wish to opt out of screening
Who is offered screening for breast cancer in the UK? How often are they screened?
The NHS Breast Screening Programme is offered to women between the ages of 50-70 years.
Women are offered a mammogram every 3 years. After the age of 70 years women may still have mammograms but are ‘encouraged to make their own appointments’.
Women who are at an increased risk of breast cancer due to their family history may be offered screening from a younger age. The following patients should be referred to the breast clinic for further assessment:
one first-degree female relative diagnosed with breast cancer at younger than age 40 years
or
one first-degree male relative diagnosed with breast cancer at any age
or
one first-degree relative with bilateral breast cancer where the first primary was diagnosed at younger than age 50 years
Who is offered screening for colorectal cancer in the UK?
screening is offered every 2 years to all men and women aged 60 to 74 years in England, 50 to 74 years in Scotland. Patients aged over 74 years may request screening
What is the protocol for colorectal cancer screening in the UK?
eligible patients are sent Faecal Immunochemical Test (FIT) tests through the post
a type of faecal occult blood (FOB) test which uses antibodies that specifically recognise human haemoglobin (Hb)
used to detect, and can quantify, the amount of human blood in a single stool sample
patients with abnormal results are offered a colonoscopy
hrHPV +ve and cytologically abnormal =
patient referred for colposcopy
hrHPV +ve but cytologically normal =
the test is repeated at 12 months
if the repeat test is now hrHPV -ve → return to normal recall
if the repeat test is still hrHPV +ve and cytology still normal → further repeat test 12 months later:
If hrHPV -ve at 24 months → return to normal recall
if hrHPV +ve at 24 months → colposcopy
What should be done if the smear sample for cervical cancer screening is inadequate?
repeat the sample within 3 months
if two consecutive inadequate samples then → colposcopy
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer if they are:
aged 30 and over and have an unexplained breast lump with or without pain or
aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer in people:
with skin changes that suggest breast cancer or
aged 30 and over with an unexplained lump in the axilla
NICE recommend a FIT is used to guide referral in the following scenarios:
with an abdominal mass, or a change in bowel habit, or iron-deficiency anaemia
aged 40 and over with unexplained weight loss and abdominal pain
aged 50 and over with any of the following unexplained symptoms:
rectal bleeding
abdominal pain
weight loss
aged 60 and over with anaemia even in the absence of iron deficiency
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for lung cancer if they:
have chest x-ray findings that suggest lung cancer
are aged 40 and over with unexplained haemoptysis
Offer an urgent chest x-ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 and over if they have 2 or more of the following unexplained symptoms, or if they have ever smoked and have 1 or more of the following unexplained symptoms:
cough
fatigue
shortness of breath
chest pain
weight loss
appetite loss
