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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