Cancer

Risk factors

 * 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

 * 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

 * mets bone>lung>liver>brain

Etiology

 * Human Papilloma Virus

Risk factors

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

Screening

 * 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
Ontario Cervical Screening Guidelines
 * 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