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Fortis Hospital, Shalimar Bagh
Dr. Ajay MehtaMBBS, MD, DTCD, DPMR
Sr. Consultant & HODDepartment of Medical Oncology
FORTIS HEALTHCARE
CANCER SCREENING AND PREVENTION
HEADINGS • CANCER FACTS • CANCER GLOBAL BURDEN
• CAUSES OF CANCER
• 7 DANGER SIGNALS • SCREENING DEFINITION
• SCREENING BASICS
• PRINCIPLES OF SCREENING • COMMONLY SCREENED DIAGNOSIS
CANCER SCREENING AND PREVENTION
• CANCER PREVENTION DEFINITION • • LEVELS OF PREVENTION •
• PRIMARY PREVENTION • SECONDARY PREVENTION • TERTIARY PREVENTION
• FUTURE TRENDS
CANCER SCREENING AND PREVENTION
CANCER FACTS
FACTS ABOUT CANCER
70 – 80 % CANCER CASES ARE DETECTED AT LATE
STAGE WHEN TREATMENT IS NOT POSSIBLE
EARLY DETECTION OF CANCER HELPS IN COMPLETE
CURE OF SOME CANCER
PREVENTION BY TAKING SOME PRECAUTIONARY
MEASURES IS THE BEST WAY TO PREVENT CANCER
CANCER GLOBAL BURDEN
By 2015,
66 % of all cancers will be in the developing world !
GLOBAL SCENARIOMALES FEMALES
INDIA: SCENARIO
Males Females
Globocan database
DELHI: SCENARIO
CANCER DEFINITION
What Is Cancer?
Cancer is a large group of diseases (over 200) characterized by uncontrolled growth and spread of abnormal cells.*
*American Cancer Society, Cancer Facts and Figures 2005
Normal cell vs cancer cell
NORMAL CELL CHARACTERISTICS:
Metabolism. Strictly controlled & predictable
Maturation & Specialisation. Occurrs before dividing. Strictly controlled.
Reproduction = Cell deathContact Inhibition. Mechanism for
switching off division when in contact with different cells
Recognition. Like cells stay together.
Cancer Cell Characteristics:
Unchecked & Uncontrolled GrowthLoss of contact inhibitionLoss of capacity to differentiateIncreased growth fractionChromosomal InstabilityCapacity to metastasiseAltered biochemical properties
Normal Cells Vs. Cancer Cells
Cancer cells: Lose control over growth and
multiplication
Do not self-destruct when they become worn out or damaged
Crowd out healthy cells
GROWTH OF CANCER CELLS
Size of cancer cells: One million cancer
cells = head of a pin
One billion cancer cells = a small grape
230 = 1,073,741,824 = 1 billion cells
2-6 weeks
Cancer cells reproduce every 2-6 weeks.
2-6 weeks
2-6 weeks
CAUSES OF CANCER
CAUSES - TOBACCO
CIGARETTE SMOKING IS A MAJOR CAUSE OF CANCER
SMOKING MAY BE – ACTIVE OR PASSIVE – BOTH ARE
HARMFUL
CONSUMPTION OF TOBACCO IN FORM OF KHAINI,
ZARDA AND GHUTKA ALSO CAUSES CANCER
TOBACCO NOT ONLY CAUSES CANCER BUT ALSO
OTHER DISEASES
CAUSES – BETELNUT
BETELNUT CONTAINS CARCINOGENS
THE NUTS KEPT BURRIED IN THE GROUND FOR LOND
PERIOD LEADS TO THE GROWTH OF FUNGUS WHICH
IS CARCINOGENIC
PEOPLE CONSUMING BETELNUT ALSO HAVE THE
HABIT OF CONSUMING TOBACCO
CAUSES - ALCOHOL
ALCOHOL CONSUMPTION LEADS TO CANCER OF
ORAL CAVITY, PHARYNX, LARYNX, ESOPHAGUS,
STOMACH, LIVER
PEOPLE WHO DRINK ALSO SMOKES FURTHER
INCREASING THE RISK OF DEVELOPING CANCER
CAUSES – FAT/FIBRE
HIGH INTAKE OF FAT (ANIMAL) INCREASES THE RISK OF DEVELOPING CANCER (BREAST AND COLON)
DIETARY FIBRE OF PLANT ORIGIN HAS A PROTECTIVE ROLE AGAINST CANCER
CAUSES – BARBEQUED FOOD
HIGH FAT AND HIGH PROTEIN FOOD WHEN GRILLED AT HIGH
TEMPARATURE PRODUCES A CHEMICAL KNOWN TO BE
HAVING CARCINOGENIC EFFECT
HIGHLY BROWN AND CHARRED FOOD HAS CANCER CAUSING
COMPOUNDS
CAUSES - POLLUTION
AIR POLLUTION – MAY ALSO CAUSE CANCER (ASBESTOS)
INDUSTRIAL WORKERS ARE EXPOSED TO VARIOUS CHEMICALS WHICH ARE KNOWN TO BE CARCINOGEN
CAUSES – WATER POLLUTION
WATER MAY CONTAIN A NUMBER OF CANCER CAUSING SUBSTANCE AS THE INDUSTRIES DUMP CHEMICAL DIRECTLY INTO WATER OR BURRY THEM IN THE GROUND
CAUSES – X-RAY
X-RAYS MAY STIMULATE THE DEVELOPMENT OF CANCER
REPEATED X-RAYS SHOULD BE AVOIDEDX-RAY DONE ON PREGNANT WOMEN MAY
INCREASE THE FREQUENCY OF CHILDHOOD CANCER
CAUSES - VIRUS
CERTAIN VIRUSES MAY CAUSE CANCER
THESE VIRUSES ARE – HEPATITIS –B & C, EPSTEIN
BARR VIRUS, HUMAN PAPILLOMA VIRUS, CMV. Etc.
THESE VIRUSES CAN BE TRANSMITTED BY BLOOD
TRANSFUSION, USE OF CONTAMINATED NEEDLES,
FROM MOTHER TO CHILD DURING PREGNANCY OR
BREAST FEEDING AND THROUGH SEXUAL
INTERCOURSE
CAUSES - HEREDITY
FEW CANCER LIKE RETINOBLASTOMA (EYE), COLON CANCER ARISING FROM GENETICALLY CAUSED POLYPS
EVEN BREAST CANCER AND ESOPHAGEAL CANCER
HOW TO DETECT DISEASE EARLY
SEVEN DANGER SIGNALS
CHANGE IN BLADDER & BOWEL HABITS
SORE THROAT NOT HEALING
UNUSUAL BLEEDING OR DISCHARGE
THICKENING OR LUMP IN BREAST OR ANYWHERE
INDIGESTION AND DIFFICULTY IN SWALLOWING
OBVIOUS CHANGE IN WART OR MOLE
NAGGING COUGH OR HOARSENESS OF VOICE
SCREENING DEFINITION
CANCER SCREENING
Screening is the process whereby Asymptomatic
Individuals are Tested to Detect a disease that is YET
to be Symptomatic.
CRITERIA laid down for
- Disease in question
- Screening test
- Screening problem .
CANCER SCREENING
Disease natural history is well understood. has a recognizable early stage .Treatment at early stage is more successful
than at late stage . it is sufficiently common in target population
to warrant screening.
CANCER SCREENING
Test Sensitive and specific . Acceptable .Safe . inexpensive.
CANCER SCREENING
Programme adequate facilities for diagnosis in those with
a positive test . high quality of Treatment for screen detected
disease . benefit outweighs physical and psychological
harm . benefit must justify financial cost.
SCREENING BASICS
SCREENING TESTS
Universal screening Screening all individuals of a certain category (e.g. PKU
screening in kids)
Case finding Screening a small group of individuals based on the
presence of risk factors (e.g cancer clusters, family members diagnosed with hereditary disease)
SCREENING TESTS
Biases
Lead time bias
Length time bias
Selection bias
Overdiagnosis bias
Avoid bias by using Randomized Control Trials (RCTs)
THE PRINCIPLES OF SCREENING
The choice of disease for which to
screen;
The nature of the screening test or tests
to be used;
The availability of a treatment for those
found to have the disease;
The relative costs of the
screening
The disease must be an important health problem.
There should be a recognizable latent or early symptomatic stage.
The natural history of the disease, including latent to declared disease, should be adequately understood
SCREENING TESTS
Universal screening Screening all individuals of a certain category (e.g. PKU
screening in kids)
Case finding Screening a small group of individuals based on the
presence of risk factors (e.g cancer clusters, family members diagnosed with hereditary disease
SCREENING TESTS
Adverse effects
Stress and anxiety caused by false positive results Unnecessary radiation/chemical exposure and test
discomfort Prolonged knowledge of a disease with no treatment False sense of security over false negative results Overuse of medical resources
ADVERSE EFFECTS
SCREENING TESTS
Adverse effects
Stress and anxiety caused by false positive results Unnecessary radiation/chemical exposure and test
discomfort Prolonged knowledge of a disease with no treatment False sense of security over false negative results Overuse of medical resources
PITFALLS OR BIASES
SCREENING TESTS
Biases
Lead time bias
Length time bias
Selection bias
Overdiagnosis bias
Avoid bias by using Randomized Control Trials (RCTs)
COMMONLY SCREENED DIAGNOSIS
COMMONLY SCREENED DIAGNOSES Cancer (Breast, lung, colorectal, prostate, pancreatic, cervical, ovarian,
skin, testicular, thyroid) Cardiovascular (AAA, Blood pressure, Lipid disorders, carotid artery
stenosis, PAD) Infectious disease (HIV, Hep B/C, STDs, Tuberculosis) Injury and violence (domestic violence, Youth violence/gang activity,
seatbelt use) Mental health/substance abuse (Etoh, illicit drugs, tobacco, depression,
suicide risk) Endocrine/Metabolism (Diabetes, IDA, obesity, physical activity) MSK –osteoporosis OB/Gyn (Pre-eclampsia, Rh incompatibility, neural tube defects,
asymptomatic bacteruria, Down’s syndrome) Pediatrics (PKU, sickle cell disease, visual impairment, lead intoxication,
hearing loss, dental caries)
CANCER PREVENTION DEFINITION
INTRODUCTION
CANCER IS PREVENTABLE
80 – 90% CANCER ARE DUE TO OUR HABITS AND ACTIVITIES
CANCER INVOLVES ALMOST EVERY PARTS OF THE BODY
CANCER CELLS MULTIPLY IN AN UNCONTROLLABLE &
HAPAZARD MANNER
SCENARIO
CANCER IS THE CAUSE OF 12% OF ALL DEATHS
IN INDIA 1.5 – 2 MILLION ESTIMATED CANCER CASES
AT ANY POINT OF TIME
EVERY YEAR 8 LAKHS NEW CASES ARE DETECTED IN
INDIA
EVERY YEAR 5.5 LAKHS CANCER PATIENTS DIE IN OUR
COUNTRY
LEVELS OF PREVENTION
CANCER PREVENTION
LEVELS OF PREVENTION 1 PRIMARY PREVENTION . 2 SECONDARY PREVENTION . 3 TERTIARY PREVENTION .
PRIMARY PREVENTION
CANCER PREVENTION
PRIMARY PREVENTION Is when there is NO ABNORMALITY OBJECTIVES - Strengthening Healthy Lifestyle . - Decreasing Weakness . - Preventing and Minimizing Risk Factors of
CARCINOGENESIS Exposure .
SECONDARY PREVENTION
CANCER PREVENTION
SECONDARY PREVENTION Is when Abnormality is found . OBJECTIVES - Early Diagnosis // Investigations for
Abnormality . - Assessment of Risk Groups . - CANCER SCREENINGS . - Early Detection .
TERTIARY PREVENTION
CANCER PREVENTION
TERTIARY PREVENTION EXAMPLES : Use of Vit. A in prevention of Lung
Ca/Leukemias , Tamoxifen in Breast Ca/Uterine Ca.
Visionary’s Dream
Our Values
Presentation Overview
• Land Area 7.50 acre• Built-Up Area 3.50 Lac sq.ft.• No. of Floors 7 floors• ICUs 5
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