• Age range:
o 25–49 years: every 3 years
o 50–64 years: every 5 years
• Method: HPV testing as primary screening (detects high-risk HPV types 16, 18)
• Impact: significant reduction in cervical cancer incidence and mortality
• Key risk factors:
o Early sexual activity
o Multiple partners
o Smoking
o Immunosuppression
• Age range:
o 50–70 years: every 3 years (with gradual extension 47–73 in some areas)
• Method: two-view mammography
• BRCA carriers: annual MRI + mammography from ~30
• Age range (England):
o FIT (faecal immunochemical test) every 2 years, 60–74 years
o Flexible sigmoidoscopy offered once at 55 in some areas
• FIT: detects occult blood → lower threshold for positivity than gFOBT
• High-risk groups (e.g., Lynch, FAP): earlier colonoscopy screening
Smoking
• Cancers:
o Lung (85% of cases)
o Bladder
o Oesophageal (squamous)
o Pancreatic
o Renal
o Head and neck (oral cavity, larynx)
o Cervix
• Mechanism: polycyclic aromatic hydrocarbons, nitrosamines → DNA adducts
Alcohol
• Cancers:
o Oropharyngeal, laryngeal, oesophageal (squamous cell carcinoma)
o Liver (via cirrhosis)
o Breast (dose-dependent; risk increases even with 1 drink/day)
o Colorectal
HPV
• Cancers:
o Cervical (>99%)
o Vulvar, vaginal, penile, anal
o Oropharyngeal (esp. tonsil and base of tongue)
EBV
• Cancers:
o Nasopharyngeal carcinoma (common in SE Asia)
o Burkitt lymphoma (endemic type)
o Hodgkin lymphoma (esp. mixed cellularity subtype)
o Post-transplant lymphoproliferative disorder (PTLD)
Asbestos
• Cancers:
o Mesothelioma (pleura > peritoneum)
o Lung cancer (synergistic with smoking; multiplicative risk)
• Other risks: asbestosis (interstitial lung disease)
• Breast cancer: lifetime risk ~60–85% (BRCA1 slightly higher than BRCA2)
• Ovarian cancer: ~20–60% risk
• Other cancers: prostate (esp. BRCA2), pancreatic, male breast cancer
• Mutation: mismatch repair genes (MLH1, MSH2, MSH6, PMS2)
• Colorectal cancer: ~80% lifetime risk, often proximal colon, younger age
• Endometrial cancer: ~60%
• Other cancers: ovarian (~12%), gastric, small bowel, upper urinary tract, hepatobiliary, brain (Turcot variant)
• Mutation: APC gene (chromosome 5q)
• Colorectal cancer: near 100% lifetime risk if untreated
• Other associated tumours:
o Duodenal and periampullary cancers
o Desmoid tumours
o Papillary thyroid cancer
o Congenital hypertrophy of the retinal pigment epithelium (CHRPE)
• Screening vs surveillance:
o Screening: asymptomatic, general population
o Surveillance: high-risk individuals or post-treatment monitoring
• Lead-time bias: apparent survival benefit due to earlier detection, not true improvement
• Length-time bias: screening more likely to detect slower-growing, less aggressive cancers
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Author & Educational Disclaimer
Author:
Dr Phillip Cockrell BM FRCP DipClinEd
Dr Phillip Cockrell is a UK Consultant Physician in Internal Medicine, currently working at Queen Alexandra Hospital, Portsmouth University Hospitals NHS Trust. He has previously worked as a registrar across Intensive Care Medicine, Gastroenterology, Cardiology, Stroke Medicine, Acute Medicine, and Respiratory Medicine.
He has held senior leadership roles including Associate Clinical Director of the Acute Medical Unit, Clinical Director of Internal Medicine, and Chief of Medicine. Dr Cockrell has over 15 years’ experience in postgraduate medical education, having lectured extensively across the MRCP syllabus and contributed to MRCP revision teaching and course development.
Dr Cockrell holds a Bachelor of Medicine (BM), Fellowship of the Royal College of Physicians (FRCP), and a Diploma in Clinical Education (DipClinEd). His teaching approach is based on structured consolidation of complex medical topics to support efficient and effective revision for postgraduate examinations.
Purpose of this content:
The material on this page is intended solely for educational purposes to support revision for the MRCP (UK) Part 1 examination. It reflects examination-relevant principles of internal medicine and is designed to aid learning and pattern recognition.
Medical disclaimer:
This content is designed for postgraduate medical examination revision and does not constitute medical advice, diagnosis, or treatment guidance and must not be used as a substitute for professional clinical judgement, local guidelines, or specialist consultation. Clinical decisions should always be made in the context of individual patient circumstances and current national guidance.
