Screening

Question 1

What characteristics make a tumour ideal for screening?

Answer 1

• Curable when detected early in the majority
• Relatively common
• Long pre-invasive or non-metastatic stage
• Distinct from benign lesions
• Detected by relatively simple tests

Question 2

What would make up the ideal screening test?

Answer 2

• Detect cancer early enough to implement effective treatment
• Sensitive & specific
• Well tolerated (improving compliance)
• Inexpensive
• Easy to administer/perform
• Well publicised (high uptake)

Question 3

What are the advantages of screening?

Answer 3

Reduction of mortality by detecting disease that is curable
Less radical treatment- reduced morbidity
Savinf on health service resources by inc cure rates
Reassurance given by negative test

Question 4

What are the disadvantages of screening?

Answer 4

Inc length of anxiety & morbidity if no effective intervention possible
Over-investigation of false positives (associated morbidity)
Over-treatment of borderline cases
False reassurance from a false negative
Possible harmful effects of screening
Cost

Question 5

What screening programmes are available in the UK?

Answer 5

Cervical Cancer: women 25-49 every 3years, 50-64 every 5years.
Breast Cancer: Mammography for women 50-70 every 3years
Colorectal Cancer: Men & women faecal occult blood every 2years from 60-69 to be extended to 74.

Question 6

What happens when the results of a mammogram are received?

Answer 6

Results to patient/GP in 2weeks

1in23 called back for further assessment (Triple assessment)- 1in4 of these has breast Ca

Question 7

How is a person counselled before going for a mammogram

Answer 7

Letter sent out with date (can be rearranged)
Lasts around 30mins
Procedure requires removal of clothes including bra
Avoid: Talc, spray on deodorant
Procedure: Breasts x-rayed one at a time flattened by a machine for good quality image, some find this uncomfortable/painful
Implants: Mammogram still the best way but early detection more difficult due to opacification- may need additional tests

Question 8

When should a cervical screen be rescheduled?

Answer 8

Menstruation
<12 weeks postnatal
<12 weeks after a TOP/miscarriage
Vaginal discharge or pelvic infection — Tx the infection 
If the woman is pregnant

Question 9

What should be done if the cervix appears abnormal?

Answer 9

Urgent referral for 2week review by gynaecologist

Question 10

What are the requirements of cervical screening post-CIN treatment?

Answer 10

Increased risk of developing Cervical cancer
Followed up for test of cure cytology 6m post-Tx
If -ve/low grade/borderline then HPV test taken
High grade: Refer to colposcopy no need for HPV test
+ve: Refer to colposcopy
-ve: Repeat cytology in 3y

Question 11

How are abnormal cervical screening results managed?

Answer 11

Borderline changes in squamous/endocervcial cells OR low grade dyskaryosis:
HPV test on cytology sample
+ve: Refer to colposcopy within 6weeks
-ve: Return to screening program

High grade dyskaryosis (mod-severe):
Colposcopy (2week wait)

Suspected invasive cancer/ glandular neoplasia:
Colposcopy (2week wait)

Question 12

What tests might be done at colposcopy?

Answer 12

Colposcope: Visualise any abnormalities
Acetic acid: Abnormal areas (CIN) turn white
Iodine solution: Normal tissue stains brown, pre-cancerous abnormalities may not stain, cells on inner cervix don’t stain
Biopsy: Confirm diagnosis

Question 13

What happens after an inadequate cervical screen occurs?

Answer 13

Repeat screen <3months

3 consecutive inadequate samples: Refer to colposcopy <6weeks