Cervical Screening

Question 1

How many types of HPV

Answer 1

100

Question 2

HPV can cause…

Answer 2

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

Question 3

Which types of HPV cause genital warts?

Answer 3

6, 11

Question 4

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

Answer 4

CIN1
CIN2
CIN3

Question 5

Severity of CIN1?

Answer 5

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

Question 6

Severity of CIN2/3?

Answer 6

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

Question 7

If confirmed high grade changes on biopsy recommend…

Answer 7

Treatment (LLETZ) to remove affected area of cervix

Question 8

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

Answer 8

10 years

Question 9

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

Answer 9

60%

Question 10

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

Answer 10

160 cases
60 deaths

Question 11

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

Answer 11

85%

Question 12

What is the HPV vaccine called?

Answer 12

Gardasil-9

Question 13

Gardasil-9 has been used in NZ since…

Answer 13

2017

Question 14

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

Answer 14

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

Question 15

How effective is the HPV vaccine?

Answer 15

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

Question 16

How long does the protection last from the HPV vaccine?

Answer 16

Ongoing studies suggest protection will be long lasting

Question 17

Effectiveness of HPV vaccine is optimum when vaccinated when?

Answer 17

<15yo and prior to sexual interactions

Question 18

Who is HPV vaccine funded for?

Answer 18

Funded for males and females aged 9-27yo

Question 19

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

Answer 19

2 doses given over a 6-12 month period

Question 20

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

Answer 20

3 doses given over a 6 month period

Question 21

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

Answer 21

Cost of full 3 doses ~$600

Question 22

Is the HPV vaccine safe?

Answer 22

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

Question 23

Common side effects from HPV vaccine

Answer 23

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

Question 24

What is the risk of anaphylaxis with HPV vaccine?

Answer 24

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

Question 25

Who should not have the HPV vaccine?

Answer 25

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

Question 26

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

Answer 26

Yes

Question 27

Can the HPV vaccine be given to breastfeeding women?

Answer 27

Yes

Question 28

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

Answer 28

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

Question 29

When was the cervical screening programme established?

Answer 29

1990

Question 30

Why was the cervical screening programme established?

Answer 30

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

Question 31

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

Answer 31

60%

Question 32

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

Answer 32

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

Question 33

Smear results are reported using what system?

Answer 33

Bethesda Reporting System

Question 34

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

Answer 34

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

Question 35

Adequacy of a smear is reported as...

Answer 35

Satisfactory or unsatisfactory

Question 36

3 main factors cause unsatisfactory smear samples

Answer 36

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

Question 37

What to do if you get an unsatisfactory smear result?

Answer 37

Repeat in 6 weeks - 3 months time

Question 38

After 3x unsatisfactory smear results what would you do?

Answer 38

Refer to colposcopy

Question 39

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

Answer 39

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.

Question 40

What is the recommended age to start cervical screening?

Answer 40

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

Question 41

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

Answer 41

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

Question 42

Four indications for referral to colpscopy

Answer 42

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

Question 43

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

Answer 43

~20%

Question 44

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

Answer 44

~30%

Question 45

If colposcopy confirms low grade changes then what?

Answer 45

Return to primary care for a repeat smear in 12 months

Question 46

If colposcopy confirms high grade changes then what?

Answer 46

Treatment is recommended - LLETZ