Screening for gynaecological cancers – Multiple choice questions for Vol. 26, No. 2

  • 1.

    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.

  • 2.

    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.

  • 3.

    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.

  • 4.

    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.

  • 5.

    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.

  • 6.

    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.

  • 7.

    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.

  • 8.

    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.

  • 9.

    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.

  • 10.

    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.

  • 11.

    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.

  • 12.

    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.

  • 13.

    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.

  • 14.

    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.

  • 15.

    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.

  • 16.

    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.

  • 17.

    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.

  • 18.

    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.

  • 19.

    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.

  • 20.

    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%.

  • 21.

    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.

  • 22.

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

    • a)

      Zimbabwe.

    • b)

      Thailand.

    • c)

      Bangladesh.

    • d)

      Peru.

    • e)

      Malawi.

  • 23.

    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%.

  • 24.

    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.

  • 25.

    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.

  • 26.

    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.

  • 27.

    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.

  • 28.

    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.

  • 29.

    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.

  • 30.

    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.

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Nov 9, 2017 | Posted by in OBSTETRICS | Comments Off on Screening for gynaecological cancers – Multiple choice questions for Vol. 26, No. 2

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