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Screening for gynaecological conditions Curr Obstet Gynecol(2006) 16,337-343 Summary

Screening for gynaecological conditions Curr Obstet Gynecol(2006) 16,337-343 Summary Well-organised cervical screening programmes have reduced the mortality from cervical cancer by up to 50% in the developed world.

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Screening for gynaecological conditions Curr Obstet Gynecol(2006) 16,337-343 Summary

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  1. Screening for gynaecological conditions Curr Obstet Gynecol(2006) 16,337-343 Summary • Well-organised cervical screening programmes have reduced the mortality from cervical cancer by up to 50% in the developed world. • Despite the successful development of human papilloma virus vaccines, there is likely to remain a need for cervical screening for the foreseeable future. • In contrast, the value of mass screening for ovarian cancer remains unproven, although current screening methods can detect early-stage disease in asymptomatic individuals. • Testing for sexually transmitted infections is effective in reducing morbidity but tends to be selective at present because of concerns over the cost and psychosocial implications of general population screening.

  2. Ovarian cancer: aim of screening is the detection of asymptomatic early-stage disease • CA-125: premenopausal:65U/ml post-menopausal:35U/ml • Ultrasound: premenopausal~ovarian vol.>20cm3 post-menopausal ~ovarian vol.>10cm3 • Multimodal screening: elevated level+normal sonar~0.15%(95%CI) elevated level+abnormal sonar~24%(95%CI) • Genetic testing: BRCA1 ~25-60% BRCA2~15-25% • Screening at risk population: hereditary ovarian cancer syndrome: prophylatic oophorectomy after childbearing or F/U by sonar +CA-125

  3. Cervical cancer • Pap smear: reduced the incidence 40-50% and mortality by 60% sensitivity:0.51(95%CI),specificity:0.98(95%CI) • Liquid-based cytology: false-negative:0.75(95%CI) • Human papilloma virus testing :HPV 16,18,31,33,35 High risk~20-24y/o:20-25% ,>35y/o:4-5% HPV(+):15-28% normal smear developed CIN within 2 yrs HPV(-):1-3% normal smear developed CIN within 2 yrs Endometrial cancer • annual endometrial biopsy screening hereditary non-polyposis colorectal carcinoma • Educate the significance of post-menopausal bleeding • Screening for women taking tamoxifen

  4. Conclusion • Screening asymptomatic women in gynaecology conditions: provide health benefits • Screening cervical cancer: reducing mortality • With new technologies and a better use of existing methods, the positive and negative predictive values of screening tests have been improved • Additional screening programmes remain unproven in low incidenc gynaecological cancer

  5. VGH comment • Regular screening in gynecology condition is necessary especially post-menopausal women • The introduction of HPV vaccination will not remove the need of cervical screening • Annual Pap smear encourged for all women after sexual exposure 3 years later • High specificity with multimodal screening in ovarian cancer and high risk group • The incidence of endometrial cancer increase at recent years, take care of abnormal vaginal bleeding at pre- or post- menopausal women

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