Kristyn Manley

Counselling of path_ BRCA carriers who are considering risk-reducing oophorectomy

path_ BRCA 1/2 increases a woman’s lifetime risk of breast and ovarian cancer. Interventions can be offered which manage cancer risk; annual breast screening from age 30, chemoprevention and, once a woman’s family is complete, risk-reducing surgery. The latter is the most effective method of reducing cancer in path_ BRCA carriers; salpingo-oophorectomy reduces breast and ovarian cancer, respectively, by up to 50% and 95%. Factors affecting a woman’s decision to undergo risk-reducing surgery are complex; dominant factors include risks of surgery, effect on cancer outcomes and menopausal sequelae. Specific information relating to hormone replacement and non-hormonal alternatives are an important consideration for women but, are often overlooked. Informative counselling is required to enable satisfaction with the chosen intervention whilst improving survival outcomes. This review paper outlines the current data pertaining to these decision-making factors and provides a proforma to enable effective counselling.

An audit of liquid‐based cytology samples reported as high‐risk human papillomavirus and borderline nuclear change in endocervical cells

AbstractIntroductionPrimary human papillomavirus (HPV) screening, testing for the virus responsible for 99% of cervical cancers, was introduced in 2018‐2020 in the UK. This was preceded by HPV triage of low‐grade cytology from 2012. Much of the evidence incorporated into current National Health Service (NHS) colposcopy guidance assessed outcomes prior to this change in screening. The aim of this paper is to assess adherence to NHS cervical screening programme standards, determine the incidence of cases reported as high‐risk HPV plus borderline nuclear change in endocervical cells, to calculate colposcopic accuracy and assess histological outcomes in this cohort.MethodA retrospective audit of women referred to a colposcopy clinic in one NHS trust from 2016 to 2018. Data relating to histological outcomes, cytological follow‐up and demographics were collected.ResultsOf 2001 referrals, 22 data sets identifying HPV‐positive borderline endocervical change were eligible for analysis (1.2% incidence). Median age was 29.5. Two‐thirds (68.2%, n = 15) had high‐grade dysplasia at diagnostic biopsy. Those women with reassuring histology had normal cytological follow‐up. Colposcopic accuracy was moderate (positive predictive value 43.8%, negative predictive value 100%).ConclusionsBorderline nuclear change in endocervical cells is an uncommon condition but should be treated as a high‐grade referral. All women should be offered a diagnostic biopsy at the initial colposcopy; if no histopathological abnormality is identified, alternative sources of pathology should be considered. Excisional treatment should be recommended to unreliable attenders, those with a complete family and inadequate colposcopy (TZ3) and considered in younger women with a TZ3.