TEALE FENNING

EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

Justify Cervical screening inWomen under 25 years Old?? Confused

vani s · Century Club Joined: 20 Jan 2007 Posts: 141

not justifiable..

too costly, no use..
Laughing

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

How many marks you think this is Vani? And how do we fill in the rest of the A4 page? There was a nice answer in busy SpR site but my subscription is expired.. Embarassed

Anybody has it available?

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

Basically you have to include that:
Cervical Ca before 25 is extremely rare
HPV has a high prevalence in young age groups and most of them regress alone. Cervical screening will innevitably lead to a lot of unnecessary interventions to this group which increases short and long term morbidity.
The length of the natural history of cervical Ca allows most of the already developed Ca to be picked up in early stages even when screening starts at 25
Cost implications
What else a good candidate should know??

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

intro ---

cervical ca is second commonest female cancer and if detected in the preCa or early stage can be fully cured. The NHS-Cervical Screening Programme was introduced in 1988 with a computerised call and recall system. All women between the ages of 25 and 64 are eligible for a free cervical smear test.

reasons for entry age to screening?

HPV is very common in young women with a peak prevalence in the 20-24 years age group. The majority of HPV induced cytological changes resolve without treatment. screening before the age of 25 will detect these cytological abnormalities & will cause anxiety and result in unnecessary treatment with it's associated morbidity.

Cervical cancer is very rare in women below the age of 25 years and cervical screening is poor at detecting these tumours.

The immature cervix may sometimes show changes on cervical smear which can be mistaken for dyskaryosis, will cause anxiety and unnecessary treatment.

Screening young women increases work load and is not cost-effective

Smear taking as soon as a girl becomes sexually active may deter them from seeking contraceptive advice.

even when screening is started at 25yrs most of the establishing cancers will be in early stages and will picked up anyway, thus allowing early treatment

down side---

by the time screening is offered some women may have been sexually active for more than 10yrs and may also have had multiple sexual partners, STIs, Smoking etc.

special consideration must be given to these cases and earlier screening should be considered oin view of risk factors.
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

Nick Raine-Fenning · Posted: Thu Feb 15, 2007 6:48 pm Post subject:

Good attempt guys but this cannot come up as it is not justifiable Smile

They may change it around and ask you to justify delaying entry to the programme until 25 and the reason for continuing smears until 65 years of age.

Even so this would have to form a small part (7 marks) of a more extensive question which could include reasons for programme failures (8 marks) and future plans to address this and reduce the incidence of cervical cancer further (5 marks).

Now that's a nice question Wink

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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

bronwyn · Posted: Fri Feb 16, 2007 9:54 pm Post subject:

Here we are

A 27 year old woman is seen in GOPD requesting the new HPV vaccine which she has read about on the internet. Her grandmother died of cervical cancer and she is concerned about her risk of developing the disease

a) debate the role of the prophylactic HPV vaccine in the national cervical screening programme (12)
b) discuss risk factors for developing cervical cancer and your advice to her on how to reduce her risk? (8 )

Shocked

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Bronwyn Bell
SpR
Portsmouth