Which screening interval for cervical disease is consistently identified in cost-effectiveness analyses as associated with small gains in life-expectancy for a high cost?

• a)
  

  Screening every 5 years.

  
  
• b)
  

  Screening every 4 years.

  
  
• c)
  

  Screening every 3 years.

  
  
• d)
  

  Screening every 2 years.

  
  
• e)
  

  Screening every year.

Which factor(s) is/are considered most responsible for the limitation(s) of cytology-based screening?

• a)
  

  Reproducibility.

  
  
• b)
  

  Specificity.

  
  
• c)
  

  Sensitivity.

  
  
• d)
  

  Positive predictive value.

  
  
• e)
  

  Negative predictive value.

Which of the following has been lower in reality than when modeled, in published cost-effectiveness analyses of human papilloma virus vaccines to date?

• a)
  

  Vaccine efficacy.

  
  
• b)
  

  Vaccine coverage.

  
  
• c)
  

  Vaccine cost.

  
  
• d)
  

  Vaccine induced antibody levels.

  
  
• e)
  

  Vaccine side effects.

Which of the following factors is/are most likely to improve the effect of an ovarian cancer screening test on reducing cancer deaths?

• a)
  

  Improving the sensitivity of the screening test.

  
  
• b)
  

  Improving the specificity of the screening test.

  
  
• c)
  

  Carrying out the test more frequently.

  
  
• d)
  

  Carrying out the test less frequently.

  
  
• e)
  

  Using sequential screening tests rather than single ones.

The following statement(s) about vulvar squamous cell carcinoma (VSCC) is/are true:

• a)
  

  Screening is effective and has decreased mortality.

  
  
• b)
  

  Cancers associated with differentiated vulval intraepithelial neoplasia (VIN) are more common.

  
  
• c)
  

  Women with tumours positive for human papilloma virus have a worse prognosis.

  
  
• d)
  

  VSCC is a more common in elderly people.

  
  
• e)
  

  Both types of VIN have equal malignant potential.

Further regarding vulval cancer and screening the following statement(s) is/are true:

• a)
  

  Vulval cytology provides principally a diagnostic tool.

  
  
• b)
  

  Staining methods, such as acetic acid and toluidine blue, are effective methods of screening.

  
  
• c)
  

  Up 30% of normal vulvas have been shown to take-up aceto-white.

  
  
• d)
  

  The incidence of differentiated VIN is increasing principally due to a true increase in disease incidence.

  
  
• e)
  

  The risks for disease recurrence in women with VSCC are potentiated by the presence of lichen sclerosus.

Regarding the incidence of cervical cancer the following is/are true:

• a)
  

  The age-specific incident rate of cervical cancer worldwide is 15 per 100,000 women.

  
  
• b)
  

  The lowest burden of cervical cancer in the world is in Australia and New Zealand.

  
  
• c)
  

  Cervical cancer is the most common cancer cause of death in women.

  
  
• d)
  

  Cervical cancer incidence correlates well with the existence of screening programmes.

  
  
• e)
  

  The highest incidence of cervical cancer is in East Africa.

Regarding successful cytology-based programmes; on which of the following are they dependent:

• a)
  

  Coverage of the population.

  
  
• b)
  

  Screening women at young ages.

  
  
• c)
  

  Defining the target age group.

  
  
• d)
  

  Functioning referral systems.

  
  
• e)
  

  Built in quality control of screening tests.

Regarding the history of cervical cytology the following is/are true:

• a)
  

  Papanicolaou classified cytology classes I–V based on how closely the cells resembled malignant cells.

  
  
• b)
  

  The term dysplasia was introduced in the 1950s.

  
  
• c)
  

  The term ‘cervical intraepithelial neoplasia’ recognised that lesions progressed from milder to more severe states of abnormality.

  
  
• d)
  

  Low-grade squamous intraepithelial lesions are regarded as true cervical cancer precursors.

  
  
• e)
  

  No longitudinal studies have been published on the natural history using cancer as an end point.

Regarding the effect of screening the following is/are true:

• a)
  

  Cytology-based screening programmes have had no effect on cervical cancer incidence and mortality.

  
  
• b)
  

  Successful screening must be linked to treatment and follow up.

  
  
• c)
  

  Liquid-based cytology is unequivocally superior to conventional cytology.

  
  
• d)
  

  Human papilloma virus DNA testing is less sensitive than cytology.

  
  
• e)
  

  Cytology is recommended for triage of positive human papilloma virus tests.

Visual inspection with acetic acid is a point-of-care test. Its advantages include:

• a)
  

  A similar sensitivity to cytology.

  
  
• b)
  

  A high positive predictive value.

  
  
• c)
  

  Quality control is easy to carry out.

  
  
• d)
  

  It is successful in reducing cervical cancer precursors.

  
  
• e)
  

  It has a relatively high negative predictive value.

Failure to establish cytology-based screening programmes in developing countries has been shown to be due to:

• a)
  

  High cost of cervical cytology.

  
  
• b)
  

  Complexity of infrastructure required.

  
  
• c)
  

  Poor sensitivity of test unless used repetitively.

  
  
• d)
  

  Limited access to colposcopy.

  
  
• e)
  

  Competing health needs.

Advantages of testing for high-risk human papillomavirus deoxyribonucleic acid types include:

• a)
  

  Objective testing.

  
  
• b)
  

  Very high sensitivity and negative predictive value.

  
  
• c)
  

  Low cost.

  
  
• d)
  

  Currently being a point-of-care test.

  
  
• e)
  

  That it identifies women at higher risk of developing cervical intraepithelial neoplasia.

Key issues for establishing screening programmes in low-resource settings include:

• a)
  

  High-quality laboratory-based tests.

  
  
• b)
  

  Developing point-of-care tests that allow women to be screened and treated in one visit.

  
  
• c)
  

  Creating reliable systems for monitoring and evaluating the effect of any new screening programme.

  
  
• d)
  

  Using visual inspection with acetic acid rather than molecular (human papillomavirus testing) as the primary screening test.

  
  
• e)
  

  Establishing national cancer-control programmes.

Advantages of HPV screening over conventional cytology include:

• a)
  

  Results not dependent on a high quality sample being collected during examination.

  
  
• b)
  

  The test requires identification of morphological changes within cells.

  
  
• c)
  

  The interpretation is subjective.

  
  
• d)
  

  This method of screening does not need frequent repetition like cytology.

  
  
• e)
  

  It has the advantage of detecting more CIN cases.

HPV test characteristics include:

• a)
  

  Sensitivity is independent of age.

  
  
• b)
  

  Specificity decreases with age.

  
  
• c)
  

  The positive predictive value is higher in younger age groups.

  
  
• d)
  

  The transient nature of infection leads to a decrease in specificity.

  
  
• e)
  

  Higher negative predictive value helps to decrease the screening interval.

An appropriate algorithmic approach to primary screening with HPV DNA and cytology could be:

• a)
  

  Women aged 30-64 years testing negative can be recalled every year.

  
  
• b)
  

  Women with borderline cytology should be called for immediate colposcopy.

  
  
• c)
  

  HPV positive, cytology negative women need colposcopy immediately.

  
  
• d)
  

  Women with HSIL on cytology should undergo HPV testing.

  
  
• e)
  

  Women with LSIL cytology are called for immediate colposcopy.

Regarding techniques of HPV detection:

• a)
  

  Hybrid Capture 2 (HC2) probe B detects high- risk HPV DNA of five hrHPV types.

  
  
• b)
  

  HC2’s high-risk probe cocktail may cross-react with HPV types that are not represented in the probe mix and yield false positive results.

  
  
• c)
  

  Cervista HPV HR is a DNA test for 14 carcinogenic HPV genotypes.

  
  
• d)
  

  It is possible to detect of E6/E7 mRNA transcripts of 14 HPV types.

  
  
• e)
  

  The sensitivity of the test can be improved by increasing the threshold for declaring the test positive.

Visual inspection with acetic acid (VIA) is a suitable screening test for:

• a)
  

  All women in developing countries.

  
  
• b)
  

  Postmenopausal women.

  
  
• c)
  

  Women aged 30–50 years with fully visible squamocolumnar junction.

  
  
• d)
  

  Women aged 25–59 years.

  
  
• e)
  

  Women aged under 25.

The sensitivity of a quality-assured, single VIA test to detect cervical intraepithelial neoplasia (CIN) 2–3 lesions is around:

• a)
  

  50%.

  
  
• b)
  

  90%.

  
  
• c)
  

  25%.

  
  
• d)
  

  75%.

  
  
• e)
  

  15%.

A positive VIA test is characterised by:

• a)
  

  Streak like aceto-whitening all over the cervix.

  
  
• b)
  

  Prominent aceto-whitening of the squamo-columnar junction.

  
  
• c)
  

  Satellite aceto-white lesions.

  
  
• d)
  

  Well-demarcated, opaque aceto-white lesions abutting the squamo-columnar junction.

  
  
• e)
  

  The presence of immature squamous metaplasia.

Large scale VIA ‘screen-and-treat’ programme has been implemented in:

• a)
  

  Zimbabwe.

  
  
• b)
  

  Thailand.

  
  
• c)
  

  Bangladesh.

  
  
• d)
  

  Peru.

  
  
• e)
  

  Malawi.

The cumulative reduction in the frequency of CIN 3 lesions at 36 months after VIA ‘screen-and-treat’ in the Cape Town trial, South Africa was:

• a)
  

  77%.

  
  
• b)
  

  36%.

  
  
• c)
  

  32%.

  
  
• d)
  

  55%.

  
  
• e)
  

  10%.

The following assay(s) is/are a type of human papilloma virus (HPV) diagnostic test:

• a)
  

  p16.

  
  
• b)
  

  CDC6.

  
  
• c)
  

  Telomerase RNA component (TERC).

  
  
• d)
  

  careHPV™.

  
  
• e)
  

  E2F transcription factor.

The following assay(s) has/have the potential for future use in low-resource settings:

• a)
  

  careHPV™.

  
  
• b)
  

  TERC.

  
  
• c)
  

  E6 testing strips.

  
  
• d)
  

  HPV mRNA assays.

  
  
• e)
  

  E2F transcription factor.

A disease is suitable for mass screening if:

• a)
  

  The incidence is high.

  
  
• b)
  

  The mortality, morbidity, or both, is low.

  
  
• c)
  

  The disease in preceded by a treatable precursor.

  
  
• d)
  

  A screening test is available with a high specificity and low sensitivity.

  
  
• e)
  

  The screening test is patient-friendly and affordable.

In the presence of a strong family history of breast and ovarian cancer:

• a)
  

  Ovarian cancer screening has been shown to prevent death from ovarian cancer.

  
  
• b)
  

  Ovarian cancer screening has better sensitivity when CA125 is combined with TV ultrasound than either modality alone

  
  
• c)
  

  Genetic testing for BRCA mutations is always informative and helpful.

  
  
• d)
  

  Combined oral contraceptives are contraindicated because of increased breast cancer risk.

  
  
• e)
  

  The progestogen-releasing intrauterine system is considered safe to use.

Are the following statements about hereditary non-polyposis colon cancer families true or false?

• a)
  

  Endometrial cancer screening is unnecessary as most woman die from colorectal cancer.

  
  
• b)
  

  Hysterectomy is indicated at the time of surgery for colorectal cancer in women from suspected families.

  
  
• c)
  

  Genetic counselling and testing for this syndrome is carried out widely.

  
  
• d)
  

  Colonoscopy and pelvic sonography should be carried out regularly as screening tests for colorectal and gynaecologic cancer.

  
  
• e)
  

  Screening for endometrial cancer has been shown to improve the survival from endometrial cancer.

Which of the following is/are true about breast cancer incidence:

• a)
  

  Breast cancer is the most common cause of cancer mortality for women in the developing world.

  
  
• b)
  

  Breast cancer incidence peaks at a younger age in developing countries.

  
  
• c)
  

  Breast cancer is less aggressive in African and black women compared to caucasian.

  
  
• d)
  

  Women in developing countries typically present with early breast cancer.

  
  
• e)
  

  The breast cancer:cervical cancer incidence ratio is reduced in developing countries.

Which of the following is/are true about mammographic screening?

• a)
  

  It decreases breast cancer mortality by 30%.

  
  
• b)
  

  It is harmless and cost effective for developing countries.

  
  
• c)
  

  It leads to an increased biopsy rate.

  
  
• d)
  

  It is associated with increased lung cancer from radiation exposure.

  
  
• e)
  

  It should be carried out every 6 months.