Best Practice & Research Clinical Obstetrics and Gynaecology 26 (2012) A1–A5

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Best Practice & Research Clinical

Obstetrics and Gynaecology
journal homepage: www.elsevier.com/locate/bpobgyn

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 anal-
yses 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.

1521-6934/$ – see front matter

doi:10.1016/j.bpobgyn.2012.01.007
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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 malig-
nant 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.
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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.
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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) careHPVÔ.
e) E2F transcription factor.

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