Breast Cancer Edit

Risk factors Edit

  • female, age (increase with age), family history, personal history, history of chest radiation, benign breast disease, early menarche, late menopause (>55 years old), nulliparity, no breast feeding, obesity, HRT, ETOH, smoking

Screening Edit

  • Mammogram age 50-74 q 2years (NNT 400)
  • High risk annual mammogram/MRI (if have personal history of genetic mutation, first degree relative with gene mutation, history of radiation therapy to chest prior to age 30

Complications Edit

  • mets bone>lung>liver>brain

Cervical Cancer Edit

Etiology Edit

  • Human Papilloma Virus

Risk factors Edit

  • Multiple sexual partners, sexual activity at young age, high risk partners, smoking, immunosupression, multiple pregnancies, long term OCP use, ?family history

Screening Edit

  • Pap test starting at age 21 q 3 years until age 70 (if 3 or more negative results)
  • Pap testing should only be performed if sexually active/history of sexual activity
  • Guidelines do not apply to immunocompromised (annual), history of dysplasia (individualized)
  • Recommended for routine screening as per guideliens: women who have undergone subtotal hysterectomy with retained cervix, pregnant woman, women who have sex with women, received HPV vaccine

Interpreting Pap Results Edit

  • Atypical squamous Cells of Undertermined Significance (ASCUS)
    • < 30 years old: Repeat cytology in 6 months
      • Negative --> Repeat cytology in 6 months
        • Negative --> Routine screening
        • Positive >/+ ASCUS--> Colposcopy
      • Positive>/= ASCUS --> Colposcopy
    • >30 years old:
      • HPV testing available
        • Negative --> Repeat cytology in 12 months
          • Negative --> routine screening
          • Positive --> colposcopy
        • Positive --> Colposcopy
      • HPV testing not available
        • As per age < 30 guidelines
  • Atypical Squamous Cells Cannot Exclude HSIL (ASC-H) --> colposcopy
  • Atypical glandular cells/atypical endocervical cells/ atypical endometrial cells --> colposcopy and/or endometrial sampling
  • Low-Grade Squamous Intraepithelial Lesion (LSIL)
    • Repeat cytology in 6 months
      • Negative - repeat cytology in 6 months
        • Negative - routine screening
        • Positive >/=ASCUS - colposcopy
      • Positive - colposcopy
    • OR Colposcopy (can be used after first LSIL)
  • High- Grade Squamous Intraepithelial Lesion (HSIL) --> colposcopy
  • Squamous carcinoma/adenocarcinoma/malignant neoplasm -->colposcopy
  • Unsatisfactory for Evaluation --> repeat cytology in 3 months
  • Satisfactory for evaluation, No transformation Zone present --> routine screening in 3 years
  • Benign endometrial cells:
    • Pre-menopausal (asymptomatic): routine screening
    • Post-menopausal: endometrial sampling

Ontario Cervical Screening Guidelines

Prevention Edit