Cancer Report by SVCT Intern Neetu yadav(JBS)Document Transcript
Jaypee Business School A constituent of Jaypee Institute of Information Technology (Deemed University) A-10, Sector 62, Noida (UP) India 201 307 www.jbs.ac.in Social Internship Report On CANCER AWARENESSSubmitted as a partial fulfillment for the award of the Two year Full Time Program in Master of Business Administration Name: NEETU YADAV MBA 2009-11 NGO- SIDDHARTHA VASHISHTA CHARITABLE TRUST Supervisor’s Name: Mr. A.K Passy Contact Details : 011- 45751984, 9971796526 Start Date for Internship: 23-02-2011 End Date for Internship: 25-03-2011
Cancer is a class of diseases in which a group of cells display uncontrolled growth, invasionthat intrudes upon and destroys adjacent tissues, and sometimes metastasis, or spreading toother locations in the body via lymphor blood. These three malignant properties of cancersdifferentiate them from benign tumors, which do not invade or metastasize.Researchers divide the causes of cancer into two groups: • Those with an environmental cause • Those with a hereditary genetic cause. Cancer is primarily an environmental disease, though genetics influence the risk of somecancers.Common environmental factors leading to cancer include: tobacco, dietand obesity, infections, radiation, lack of physical activity, and environmentalpollutants. These environmental factors cause or enhance abnormalities in the geneticmaterial of cells. Cell reproduction is an extremely complex process that is normally tightlyregulated by several classes of genes, including oncogenes and tumor suppressor genes.Hereditary or acquired abnormalities in these regulatory genes can lead to the development ofcancer. A small percentage of cancers, approximately five to ten percent, are entirelyhereditary.The presence of cancer can be suspected on the basis of symptoms, or findings on radiology.Definitive diagnosis of cancer, however, requires the microscopic examination ofa biopsy specimen. Most cancers can be treated. Possible treatmentsinclude chemotherapy,radiotherapy and surgery. The prognosis is influenced by the type ofcancer and the extent of disease. While cancer can affect people of all ages, and a few typesof cancer are more common in children, the overall risk of developing cancer increases withage. In 2007 cancer caused about 13% of all human deaths worldwide (7.9 million). Rates arerising as more people live to an old age and lifestyles change in the developing world.Cancers are classified by the type of cell that the tumor resembles and is therefore presumedto be the origin of the tumor. These types include: Carcinoma: Cancer derived from epithelial cells. This group includes many of the most common cancers, including those of the breast, prostate, lung and colon. Sarcoma: Cancer derived from connective tissue, or mesenchymal cells. Lymphoma and leukemia: Cancer derived from hematopoietic (blood-forming) cells
Germ cell tumor: Cancer derived from pluripotent cells. In adults these are most often found in the testicle and ovary, but are more common in babies and young children. Blastoma: Cancer derived from immature "precursor" or embryonic tissue. These are also commonest in children.Cancers are usually named using -carcinoma, -sarcoma or -blastoma as a suffix, with theLatin or Greek word for the organ or tissue of origin as the root. For example, a cancer of theliver is called hepatocarcinoma; a cancer of fat cells is called a liposarcoma. For somecommon cancers, the English organ name is used. For example, the most common typeof breast cancer is called ductal carcinoma of the breast. Here, the adjective ductal refers tothe appearance of the cancer under the microscope, which suggests that it has originated inthe milk ducts.Benign tumors (which are not cancers) are named using -oma as a suffix with the organ nameas the root. For example, a benign tumor of smooth muscle cells is called a leiomyoma(thecommon name of this frequently occurring benign tumor in the uterus is fibroid).Confusingly, some types of cancer also use the -oma suffix, examplesincluding melanoma and seminoma. Signs and symptoms
Symptoms of cancer metastasis depend on the location of the tumor.Cancer symptoms can be divided into three groups: Local symptoms: are restricted to the site of the primary cancer. They can include lumps or swelling (tumor), hemorrhage (bleeding from the skin, mouth or anus), ulceration and pain. Although local pain commonly occurs in advanced cancer, the initial swelling is often painless. Metastatic symptoms: are due to the spread of cancer to other locations in the body. They can include enlarged lymph nodes (which can be felt or sometimes seen under the skin), hepatomegaly (enlarged liver) or splenomegaly (enlarged spleen) which can be felt in the abdomen, pain or fracture of affected bones, and neurological symptoms. Systemic symptoms: occur due to distant effects of the cancer that are not related to direct or metastatic spread. Some of these effects can include weight loss (poor appetite and cachexia), fatigue, excessive sweating (especially night sweats), anemia (low red blood cell count) and other specific conditions termed paraneoplastic phenomena. These may be mediated by immunological or hormonal signals from the cancer cells. CausesCancers are primarily an environmental disease with 90-95% of cases attributed toenvironmental factors and 5-10% due to genetics.Environmental, as used by cancerresearchers, means any cause that is not genetic. Common environmental factors thatcontribute to cancer death include: tobacco (25-30%), dietand obesity (30-35%), infections (15-20%), radiation (both ionizing and non ionizing, up to10%), stress, lack of physical activity, and environmental pollutants.
The incidence of lung cancer is highly correlated with smokingCancer pathogenesis is traceable back to DNA mutations that impact cell growth andmetastasis. Substances that cause DNA mutations are known as mutagens, and mutagens thatcause cancers are known as carcinogens. Particular substances have been linked to specifictypes of cancer. Tobacco smoking is associated with many forms of cancer, and causes 90%of lung cancer.Many mutagens are also carcinogens, but some carcinogens are not mutagens. Alcohol is anexample of a chemical carcinogen that is not a mutagen. Such chemicals may promotecancers through stimulating the rate of cell division. Faster rates of replication leaves lesstime for repair enzymes to repair damaged DNA during DNA replication, increasing thelikelihood of a mutation.Decades of research has demonstrated the link between tobacco use and cancer inthe lung, larynx, head, neck, stomach, bladder, kidney, esophagus and pancreas. Tobaccosmoke contains over fifty known carcinogens, including nitrosamines and polycyclicaromatic hydrocarbons. Tobacco is responsible for about one in three of all cancer deaths inthe developed world and about one in five worldwide. Lung cancer death rates in the UnitedStates have mirrored smoking patterns, with increases in smoking followed by dramaticincreases in lung cancer death rates and, more recently, decreases in smoking followed bydecreases in lung cancer death rates in men. However, the numbers of smokers worldwide isstill rising, leading to what some organizations have described as the tobacco epidemic.Cancer related to ones occupation is believed to represent between 2-20% of all cases. Everyyear, at least 200,000 people die worldwide from cancer related to their workplace. Currently,most cancer deaths caused by occupational risk factors occur in the developed world. It is
estimated that approximately 20,000 cancer deaths and 40,000 new cases of cancer each yearin the U.S. are attributable to occupation. Millions of workers run the risk of developingcancers such as lung cancer and mesothelioma from inhaling asbestos fibers and tobaccosmoke, or leukemia from exposure to benzene at their workplaces. Diet and exerciseDiet, physical inactivity, and obesity are related to approximately 30-35% of cancer cases. Inthe United States excess body weight is associated with the development of many types ofcancer and is a factor in 14-20% of all cancer death. Physical inactivity is believed tocontribute to cancer risk not only through its effect on body weight but also through negativeeffects on immune system and endocrine system.Diets that are low in vegetables, fruits and whole grains, and high in processed or red meatsare linked with a number of cancers. A high salt diet is linked to gastric cancer, aflatoxin B1,a frequent food contaminate, with liver cancer, and Betel nut chewing with oral cancer.Thismay partly explain differences in cancer incidence in different countries for examplegastriccancer is more common in Japan with its high salt diet and colon cancer is more common inthe United States. Immigrants develop the risk of their new country, often within onegeneration, suggesting a substantial link between diet and cancer. InfectionWorldwide approximately 18% of cancers are related to infectious diseases. This proportionvaries in different regions of the world from a high of 25% in Africa to less than 10% in thedeveloped world. Viruses are usual infectious agents that cause cancerbut bacteria and parasites may also have an effect.A virus that can cause cancer is called an oncovirus. These include humanpapillomavirus (cervical carcinoma), Epstein-Barr virus (B-cell lymphoproliferative
disease and nasopharyngeal carcinoma), Kaposis sarcoma herpesvirus (KaposisSarcoma and primary effusion lymphomas), hepatitis B and hepatitis C viruses(hepatocellular carcinoma), and Human T-cell leukemia virus-1 (T-cell leukemias). Bacterialinfection may also increase the risk of cancer, as seen in Helicobacter pylori-induced gastriccarcinoma. Parasitic infections strongly associated with cancer include Schistosomahaematobium (squamous cell carcinoma of the bladder) and the liver flukes, Opisthorchisviverrini and Clonorchis sinensis (cholangiocarcinoma). RadiationUp to 10% of cancers are related to radiation exposure either ionizing ornonionizing. Sources of ionizing radiation, include medical imaging, and radon gas.Radiation can cause cancer in most parts of the body, in all animals, and at any age, althoughradiation-induced solid tumors usually take 10–15 years, and up to 40 years, to becomeclinically manifest, and radiation-induced leukemias typically require 2–10 years toappear. Some people, such as those with nevoid basal cell carcinomasyndrome or retinoblastoma, are more susceptible than average to developing cancer fromradiation exposure. Children and adolescents are twice as likely to develop radiation-inducedleukemia as adults; radiation exposure before birth has ten times the effect. Ionizing radiationis not a particularly strong mutagen. Residential exposure to radon gas, for example, hassimilar cancer risks as passive smoking. Low-dose exposures, such as living near a nuclearpower plant, are generally believed to have no or very little effect on cancerdevelopment. Radiation is a more potent source of cancer when it is combined with othercancer-causing agents, such as radon gas exposure plus smoking tobacco.Unlike chemical or physical triggers for cancer, ionizing radiation hits molecules within cellsrandomly. If it happens to strike a chromosome, it can break the chromosome, result inanabnormal number of chromosomes, inactivate one or more genes in the part of thechromosome that it hit, delete parts of the DNA sequence, cause chromosome translocations,or cause other types of chromosome abnormalities. Major damage normally results in the celldying, but smaller damage may leave a stable, partly functional cell that may be capable ofproliferating and developing into cancer, especially if tumor suppressor genes were damagedby the radiation. Three independent stages appear to be involved in the creation of cancerwith ionizing radiation: morphological changes to the cell, acquiring cellular
immortality (losing normal, life-limiting cell regulatory processes), and adaptations that favorformation of a tumor. Even if the radiation particle does not strike the DNA directly, ittriggers responses from cells that indirectly increase the likelihood of mutations.Medical use of ionizing radiation is a growing source of radiation-induced cancers. Ionizingradiation may be used to treat other cancers, but this may, in some cases, induce a secondform of cancer. It is also used in some kinds of medical imaging. One report estimates thatapproximately 29,000 future cancers could be related to the approximately 70 million CTscans performed in the US in 2007. It is estimated that 0.4% of current cancers in the UnitedStates are due to CTs performed in the past and that this may increase to as high as 1.5-2%with 2007 rates of CT usage.Prolonged exposure to ultraviolet radiation from the sun can lead to melanoma and other skinmalignancies. Clear evidence establishes ultraviolet radiation, especially the mediumwave UVB, as the cause of most non-melanoma skin cancers, which are the most commonforms of cancer in the world.Non-ionizing radio frequency radiation from mobile phones, electric power transmission, andother similar sources has also been proposed as a cause of cancer, but there is currently littleestablished evidence of such a link. HeredityLess than 0.3% of the population are carriers of a genetic mutation which has a large effecton cancer risk. They cause less than 3-10% of all cancer.  Some of these syndromesinclude: certain inherited mutations in the genes BRCA1 and BRCA2 with a more than 75% risk of breast cancer and ovarian cancer tumors of various endocrine organs in multiple endocrine neoplasia (MEN types 1, 2a, 2b) Li-Fraumeni syndrome (various tumors such as osteosarcoma, breast cancer, soft tissue sarcoma, brain tumors) Turcot syndrome (brain tumors and colonic polyposis) Familial adenomatous polyposis an inherited mutation of the APC gene that leads to early onset of colon carcinoma.
Hereditary nonpolyposis colorectal cancer (HNPCC, also known as Lynch syndrome) can include familial cases of colon cancer, uterine cancer, gastric cancer, and ovarian cancer, without a preponderance of colon polyps. Retinoblastoma, when occurring in young children, is due to a hereditary mutation in the retinoblastoma gene. Down syndrome patients, who have an extra chromosome 21, are known to develop malignancies such as leukemia and testicular cancer, though the reasons for this difference are not well understood. Physical agentsSome substances cause cancer primarily through their physical, rather than chemical, effectson cells.A prominent example of this is prolonged exposure to asbestos, naturally occurring mineralfibers which are a major cause of mesothelioma, a type of lung cancer. Other substances inthis category include both naturally occurring and synthetic asbestos-like fibers, suchas wollastonite, attapulgite, glass wool, and rock wool, are believed to have similar effects.Nonfibrous particulate materials that cause cancer include powderedmetallic cobalt and nickel, and crystalline silica (quartz, cristobalite, and tridymite).Usually, physical carcinogens must get inside the body (such as through inhaling tiny pieces)and require years of exposure to develop cancer. Physical trauma and inflammationPhysical trauma resulting in cancer is relatively rare. Claims that breaking bone resulted inbone cancer, for example, have never been proven. Similarly, physical trauma is not acceptedas a cause for cervical cancer, breast cancer, or brain cancer.One accepted source is frequent, long-term application of hot objects to the body. It ispossible that repeated burns on the same part of the body, such as those producedby kanger and kairo heaters (charcoal hand warmers), may produce skin cancer, especially ifcarcinogenic chemicals are also present. Frequently drinking scalding hot tea may produceesophageal cancer.
Generally, it is believed that the cancer arises, or a pre-existing cancer is encouraged, duringthe process of repairing the trauma, rather than the cancer being caused directly by thetrauma. However, repeated injuries to the same tissues might promote excessive cellproliferation, which could then increase the odds of a cancerous mutation. There is noevidence that inflammation itself causes cancer. HormonesSome hormones cause cancer, primarily by encouraging cell proliferation. Hormones are animportant cause of sex-related cancers such as cancer of the breast, endometrium, prostate,ovary, and testis, and also of thyroid cancer and bone cancer.An individuals hormone levels are mostly determined genetically, so this may at least partlyexplains the presence of some cancers that run in families that do not seem to have anycancer-causing genes. For example, the daughters of women who have breast cancer havesignificantly higher levels of estrogen and progesterone than the daughters of women withoutbreast cancer. These higher hormone levels may explain why these women have higher riskof breast cancer, even in the absence of a breast-cancer gene. Similarly, men of Africanancestry have significantly higher levels of testosterone than men of European ancestry, andhave a correspondingly much higher level of prostate cancer. Men of Asian ancestry, with thelowest levels of testosterone-activating androstanediol glucuronide, have the lowest levels ofprostate cancer.However, non-genetic factors are also relevant: Obese people have higher levels of somehormones associated with cancer, and a higher rate of those cancers. Women whotakehormone replacement therapy have a higher risk of developing cancers associated withthose hormones. On the other hand, people who exercise far more than average have lowerlevels of these hormones, and lower risk of cancer. Osteosarcoma may be caused by growthhormones Some treatments and prevention approaches leverage this cause by artificiallyreducing hormone levels, and thus discouraging hormone-sensitive cancers.
Cancers are caused by a series of mutations. Each mutation alters the behavior of the cellsomewhat.Cancer is fundamentally a disease of failure of regulation of tissue growth. In order for anormal cell to transform into a cancer cell, the genes which regulate cell growth anddifferentiation must be altered.The affected genes are divided into two broad categories. Oncogenes are genes whichpromote cell growth and reproduction. Tumor suppressor genes are genes which inhibit celldivision and survival. Malignant transformation can occur through the formation of noveloncogenes, the inappropriate over-expression of normal oncogenes, or by the under-expression or disabling of tumor suppressor genes. Typically, changes in many genes arerequired to transform a normal cell into a cancer cell.
Genetic changes can occur at different levels and by different mechanisms. The gain or lossof an entire chromosome can occur through errors in mitosis. More common are mutations,which are changes in the nucleotide sequence of genomic DNA.Large-scale mutations involve the deletion or gain of a portion of a chromosome. Genomicamplification occurs when a cell gains many copies (often 20 or more) of a smallchromosomal locus, usually containing one or more oncogenes and adjacent geneticmaterial. Translocation occurs when two separate chromosomal regions become abnormallyfused, often at a characteristic location. A well-known example of this is the Philadelphiachromosome, or translocation of chromosomes 9 and 22, which occurs in chronicmyelogenous leukemia, and results in production of the BCR-abl fusion protein, anoncogenic tyrosine kinase.Small-scale mutations include point mutations, deletions, and insertions, which may occurin the promoter region of a gene and affect its expression, or may occur in the genes codingsequence and alter the function or stability of its protein product. Disruption of a single genemay also result fromintegration of genomic material from a DNA virus or retrovirus, andresulting in the expression of viral oncogenes in the affected cell and its descendants.Replication of the enormous amount of data contained within the DNA of living cellswill probabilistically result in some errors (mutations). Complex error correction andprevention is built into the process, and safeguards the cell against cancer. If significant erroroccurs, the damaged cell can "self destruct" through programmed cell death,termed apoptosis. If the error control processes fail, then the mutations will survive and bepassed along to daughter cells.Some environments make errors more likely to arise and propagate. Such environments caninclude the presence of disruptive substances calledcarcinogens, repeated physical injury,heat, ionising radiation, or hypoxia. The errors which cause cancer are self-amplifying and compounding, for example: A mutation in the error-correcting machinery of a cell might cause that cell and its children to accumulate errors more rapidly A further mutation in an oncogene might cause the cell to reproduce more rapidly and more frequently than its normal counterparts. A further mutation may cause loss of a tumour suppressor gene, disrupting the apoptosis signalling pathway and resulting in the cell becoming immortal.
A further mutation in signaling machinery of the cell might send error-causing signals to nearby cellsThe transformation of normal cell into cancer is akin to a chain reaction caused by initialerrors, which compound into more severe errors, each progressively allowing the cell toescape the controls that limit normal tissue growth. This rebellion-like scenario becomes anundesirable survival of the fittest, where the driving forces of evolution work against thebodys design and enforcement of order. Once cancer has begun to develop, this ongoingprocess, termed clonal evolution drives progression towards more invasive stages. DiagnosisChest x-ray showing lung cancer in the left lung. PathologyA cancer may be suspected for a variety of reasons, but the definitive diagnosis of mostmalignancies must be confirmed by histologicalexamination of the cancerous cells bya pathologist. Tissue can be obtained from a biopsy or surgery. Many biopsies (such as thoseof the skin, breast or liver) can be done in a doctors office. Biopsies of other organs areperformed under anesthesia and require surgery in anoperating room.
The tissue diagnosis given by the pathologist indicates the type of cell that is proliferating,its histological grade, genetic abnormalities, and other features of the tumor. Together, thisinformation is useful to evaluate the prognosis of the patient and to choose the besttreatment. Cytogenetics and immunohistochemistry are other types of testing that thepathologist may perform on the tissue specimen. These tests may provide information aboutthe molecular changes (such as mutations, fusion genes, and numerical chromosome changes)that has happened in the cancer cells, and may thus also indicate the future behavior of thecancer (prognosis) and best treatment. An invasive ductal carcinoma of the breast (pale area at the center) surrounded by spikes ofwhitish scar tissue in the surrounding yellow fatty tissue. An invasive colorectal carcinoma (top center) in acolectomy specimen. A squamous cell carcinoma (the whitish tumor) near the bronchi in a lung specimen.
A large invasive ductal carcinoma in amastectomy specimen. PreventionCancer prevention is defined as active measures to decrease the incidence of cancer. The vastmajority of cancer risk factors are environmental or lifestyle-related, thus cancer is largely apreventable disease. Greater than 30% of cancer is preventable via avoiding risk factorsincluding: tobacco, overweight or obesity, low fruit and vegetable intake, physicalinactivity, alcohol, sexually transmitted infections, and air pollution. DietaryDietary recommendations to reduce the risk of developing cancer, including:(1) reducing intake of foods and drinks that promote weight gain, namely energy-dense foodsand sugary drinks(2) eating mostly foods of plant origin(3) limiting intake of red meat and avoiding processed meat(4) limiting consumption of alcoholic beverages(5) reducing intake of salt and avoiding mouldy cereals (grains) or pulses (legumes). MedicationThe concept that medications could be used to prevent cancer is an attractive one, and manyhigh-quality clinical trials support the use of such chemoprevention in definedcircumstances. Aspirin has been found to reduce the risk of death from cancer. Daily useof tamoxifen or raloxifene has been demonstrated to reduce the risk of developing breastcancer in high-risk women by about 50%. Finasteride has been shown to lower the risk ofprostate cancer, though it seems to mostly prevent low-grade tumors. The effect of COX-2
inhibitors such as rofecoxib and celecoxib upon the risk of colon polyps have been studiedin familial adenomatous polyposis patients and in the general population. In both groups,there were significant reductions in colon polyp incidence, but this came at the price ofincreased cardiovascular toxicity.Vitamins have not been found to be effective at preventing cancer, although low levelsof vitamin D are correlated with increased cancer risk. Whether this relationship is causal andvitamin D supplementation is protective is yet to be determined. Beta-carotene supplementation has been found to increase slightly, but not significantly, risksof lung cancer. Folic acid supplementation has not been found effective in preventing coloncancer and may increase colon polyps. VaccinationVaccines have been developed that prevent some infection by some viruses that areassociated with cancer, and therapeutic vaccines are in development to stimulate an immuneresponse against cancer-specific epitopes. Human papillomavirusvaccine (Gardasil and Cervarix) decreases the risk of developing cervicalcancer. The hepatitis B vaccine prevents infection with hepatitis B virus and thus decreasesthe risk of liver cancer.Advances in cancer research have made a vaccine designed to prevent cancers available. In2006, the U.S. Food and Drug Administration approved a human papilloma virus vaccine,called Gardasil. The vaccine protects against 6,11,16,18 strains of HPV, which together cause70% of cervical cancers and 90% of genital warts. It also lists vaginal and vulvar cancers asbeing protected. In March 2007, the US Centers for Disease Control andPrevention (CDC) Advisory Committee on Immunization Practices (ACIP) officiallyrecommended that females aged 11–12 receive the vaccine, and indicated that females asyoung as age 9 and as old as age 26 are also candidates for immunization. There is a secondvaccine from Cervarix which protects against the more dangerous HPV 16,18 strains only. In2009, Gardasil was approved for protection against genital warts. In 2010, the Gardasilvaccine was approved for protection against anal cancer for males and reviewers stated therewas no anatomical, histological or physiological anal differences between the genders sofemales would also be protected.
Unlike diagnosis efforts prompted by symptoms and medical signs, cancer screening involvesefforts to detect cancer after it has formed, but before any noticeable symptoms appear. Thismay involve physical examination, blood or urine tests, or medical imaging.Cancer screening is not currently possible for some types of cancers, and even when tests areavailable, they are not recommended to everyone. Universal screening or massscreeninginvolves screening everyone. Selective screening identifies people who are knownto be at higher risk of developing cancer, such as people with a family history of cancer.Several factors are considered to determine whether the benefits of screening outweigh therisks and the costs of screening. These factors include: Possible harms from the screening test: Some types of screening tests, such as X-ray images, expose the body to potentially harmful ionizing radiation. There is a small chance that the radiation in the test could cause a new cancer in a healthy person. Screening mammography, used to detect breast cancer, is not recommended to men or to young women because they are more likely to be harmed by the test than to benefit from it. Other tests, such as a skin check for skin cancer, have no significant risk of harm to the patient. A test that has high potential harms is only recommended when the benefits are also high. The likelihood of the test correctly identifying cancer: If the test is not sensitive, then it may miss cancers. If the test is not specific, then it may wrongly indicate cancer in a healthy person. All cancer screening tests produce both false positives and false negatives, and most produce more false positives. Experts consider the rate of errors when making recommendations about which test, if any, to use. A test may work better in some populations than others. The positive predictive value is a calculation of the likelihood that a positive test result actually represents cancer in a given individual, based on the results of people with similar risk factors. Possible harms from follow-up procedures: If the screening test is positive, further diagnostic testing is normally done, such as a biopsy of the tissue. If the test produces many false positives, then many people will undergo needless medical procedures, some of which may be dangerous. Whether suitable treatment is available and appropriate: Screening is discouraged if no effective treatment is available. When effective and suitable treatment is not available, then diagnosis of a fatal disease produces significant mental and emotional harms. For
example, routine screening for cancer is typically not appropriate in a very frail elderly person, because the treatment for any cancer that is detected might kill the patient. Whether early detection improves treatment outcomes: Even when treatment is available, sometimes early detection does not improve the outcome. If the treatment result is the same as if the screening had not been done, then the only screening program does is increase the length of time the person lived with the knowledge that he had cancer. This phenomenon is called lead-time bias. A useful screening program reduces the number of years of potential life lost (longer lives) and disability-adjusted life years lost (longer healthy lives). Whether the cancer will ever need treatment: Diagnosis of a cancer in a person who will never be harmed by the cancer is called overdiagnosis. Overdiagnosis is most common among older people with slow-growing cancers. Concerns about overdiagnosis are common for breast and prostate cancer. Whether the test is acceptable to the patients:If a screening test is too burdensome, such as requiring too much time, too much pain, or culturally unacceptable behaviors, then people will refuse to participate. Cost of the test: Some expert bodies, such as the U.S. Preventive Services Task Force, completely ignore the question of money. Most, however, include a cost-effectiveness analysis that, all else being equal, favors less expensive tests over more expensive tests, and attempt to balance the cost of the screening program against the benefits of using those funds for other health programs. These analyses usually include the total cost of the screening program to the healthcare system, such as ordering the test, performing the test, reporting the results, and biopsies for suspicious results, but not usually the costs to the individual, such as for time taken away from employment. RecommendationsThe U.S. Preventive Services Task Force (USPSTF) strongly recommends cervicalcancer screening in women who are sexually active and have a cervix at least until the age of65. They recommend that Americans be screened for colorectal cancer via fecal occultblood testing, sigmoidoscopy, or colonoscopy starting at age 50 until age 75. There isinsufficient evidence to recommend for or against screening for skin cancer, oral cancer, lungcancer or prostate cancer in men under 75. Routine screening is not recommended forbladder
cancer, testicular cancer, ovarian cancer, pancreatic cancer, or prostate cancer in men over75.The USPTF recommends mammography for breast cancer screening every two years forthose 50–74 years old; however, they do not recommend either breast self-examination orclinical breast examination. A 2009 Cochrane review came to slightlydifferent conclusions with respect to breast cancer screening stating that routinemammography may do more harm than good.Japan screens for gastric cancer using photofluorography due to the high incidence there. Genetic testingSee also: Cancer syndrome Gene Cancer types BRCA1, BRCA2 Breast, ovarian, pancreatic Colon, uterine, small bowel, stomach, HNPCC, MLH1, MSH2, MSH6, PMS1, PMS2 urinary tractGenetic testing for individuals at high-risk of certain cancers is recommended. Carriers ofthese mutations may than undergo enhanced surveillance, chemoprevention, or preventativesurgery to reduce their subsequent risk. ManagementMany management options for cancer exist including: chemotherapy, radiationtherapy, surgery, immunotherapy, monoclonal antibody therapy and other methods. Whichtreatments are used depends upon the type of cancer, the location and grade of the tumor, andthe stage of the disease, as well as the general state of a persons health.Complete removal of the cancer without damage to the rest of the body is the goal oftreatment for most cancers. Sometimes this can be accomplished by surgery, but thepropensity of cancers to invade adjacent tissue or to spread to distant sites by microscopicmetastasis often limits its effectiveness. Surgery often required the removal of a wide surgical
margin or afree margin. The width of the free margin depends on the type of the cancer, themethod of removal (CCPDMA, Mohs surgery, POMA, etc.). The margin can be as little as1 mm for basal cell cancer using CCPDMA or Mohs surgery, to several centimeters foraggressive cancers. The effectiveness of chemotherapy is often limited by toxicity to othertissues in the body. Radiation can also cause damage to normal tissue.Because cancer is a class of diseases, it is unlikely that there will ever be a single "cure forcancer" any more than there will be a single treatment for all infectious diseases.Angiogenesis inhibitors were once thought to have potential as a "silver bullet" treatmentapplicable to many types of cancer, but this has not been the case in practice.Experimental cancer treatments are treatments that are being studied to see whether theywork. Typically, these are studied in clinical trials to compare the proposed treatment to thebest existing treatment. They may be entirely new treatments, or they may be treatments thathave been used successfully in one type of cancer, and are now being tested to see whetherthey are effective in another type.Alternative cancer treatments are treatments used by alternative medicine practitioners. Theseinclude mind–body interventions, herbal preparations, massage, electrical devices, and strictdietary regimens. Alternative cancer treatments are ineffective at killing cancer cells. Someare dangerous, but more are harmless or provide the patient with a degree of physical oremotional comfort. Alternative cancer treatment has also been a fertile field for hoaxes aimedat stripping desperate patients of their money. PrognosisCancer has a reputation as a deadly disease. Taken as a whole, about half of patientsreceiving treatment for invasive cancer (excluding carcinoma in situ and non-melanoma skincancers) die from cancer or its treatment. However, the survival rates vary dramatically bytype of cancer, with the range running from basically all patients surviving to almost nopatients surviving.Patients who receive a long-term remission or permanent cure may have physical andemotional complications from the disease and its treatment. Surgery mayhave amputated body parts or removed internal organs, or the cancer may have damageddelicate structures, like the part of the ear that is responsible for the sense of balance; in some
cases, this requires extensive physical rehabilitation or occupational therapy so that thepatient can walk or engage in other activities of daily living. Chemo brain is a usually short-term cognitive impairmentassociated with some treatments. Cancer-related fatigue usuallyresolves shortly after the end of treatment, but may be lifelong. Cancer-related pain mayrequire ongoing treatment. Younger patients may be unable to have children. Some patientsmay be anxious or psychologically traumatized as a result of their experience of the diagnosisor treatment.Survivors generally need to have regular medical screenings to ensure that thecancer has not returned, to manage any ongoing cancer-related conditions, and to screen fornew cancers. Cancer survivors, even when permanently cured of the first cancer, haveapproximately double the normal risk of developing another primary cancer. Some advocateshave promoted "survivor care plans"—written documents detailing the diagnosis, all previoustreatment, and all recommended cancer screening and other care requirements for the future—as a way of organizing the extensive medical information that survivors and their futurehealthcare providers need.Progressive and disseminated malignant disease harms the cancer patients quality of life, andsome cancer treatments, including common forms of chemotherapy, have severe side effects.In the advanced stages of cancer, many patients need extensive care, affecting familymembers and friends. Palliative care aims to improve the patients immediate quality of life,regardless of whether further treatment is undertaken. Hospice programs assist patientssimilarly, especially when a terminally ill patient has rejected further treatment aimed atcuring the cancer. Both styles of service offer home health nursing and respite care.Predicting either short-term or long-term survival is difficult and depends on many factors.The most important factors are the particular kind of cancer and the patients age and overallhealth. Medically frail patients with many comorbidities have lower survival rates thanotherwise healthy patients. A centenarian is unlikely to survive for five years even if thetreatment is successful. Patients who report a higher quality of life tend to survivelonger. People with lower quality of life may be affected by major depressive disorder andother complications from cancer treatment and/or disease progression that both impairs theirquality of life and reduces their quantity of life. Additionally, patients with worse prognosesmay be depressed or report a lower quality of life directly because they correctly perceivethat their condition is likely to be fatal.
Despite strong social pressure to maintain an upbeat, optimistic attitude or act like adetermined "fighter" to "win the battle", personality traits have no connection to survival. EpidemiologyMain article: Epidemiology of cancerDeath rate from malignant cancer per 100,000 inhabitants in 2004. no data ≤ 55 55-80 80-105 105-130 130-155 155-180 180-205 205-230 230-255 255-280 280-305 ≥ 305In 2008 approximately 12.7 million cancers were diagnosed (excluding non-melanoma skincancers and other non-invasive cancers) and 7.6 million people died of cancerworldwide. Cancers as a group account for approximately 13% of all deaths each year withthe most common being: lung cancer (1.3 million deaths), stomach cancer (803,000deaths), colorectal cancer (639,000 deaths), liver cancer (610,000 deaths), and breastcancer (519,000 deaths). This makes invasive cancer the leading cause of death in
the developed world and the second leading cause of death in the developing world. Overhalf of cases occur in the developing world.Global cancer rates have been increasing primarily due to an aging population and lifestylechanges in the developing world. The most significant risk factor for developing cancer is oldage. Although it is possible for cancer to strike at any age, most people who are diagnosedwith invasive cancer are over the age of 65. According to cancer researcher Robert A.Weinberg, "If we lived long enough, sooner or later we all would get cancer." Some of theassociation between aging and cancer is attributed to immunosenescence errors accumulatedin DNA over a lifetime, and age-related changes in the endocrine system.Some slow-growing cancers are particularly common. Autopsy studies in Europe and Asiahave shown that up to 36% of people have undiagnosed and apparently harmless thyroidcancer at the time of their deaths, and that 80% of men develop prostate cancer by age 80. Asthese cancers, often very small, did not cause the persons death, identifying them would haverepresented overdiagnosis rather than useful medical care.The three most common childhood cancers are leukemia (34%), brain tumors (23%),and lymphomas (12%). Rates of childhood cancer have increased between 0.6% per yearbetween 1975 to 2002 in the United States and by 1.1% per year between 1978 and 1997 inEurope. In the developed world, one in three people will be diagnosed with invasive cancerduring their lifetimes. If all people with cancer survived and cancer occurred randomly, thelifetime odds of developing a second primary cancer would be one in nine. However, cancersurvivors have an increased risk of developing a second primary cancer, and the odds areabout two in nine. About half of these second primaries can be attributed to the normal one-in-nine risk associated with random chance. The increased risk is believed to be primarily dueto the same risk factors that produced the first cancer (such as the persons genetic profile,alcohol and tobacco use, obesity, and environmental exposures), and partly due to thetreatment for the first cancer, which typically includes mutagenic chemotherapeutic drugs orradiation. Cancer survivors may also be more likely to comply with recommended screening,and thus may be more likely than average to detect cancers.
HistoryHippocrates (ca. 460 BC – ca. 370 BC) described several kinds of cancers, referring to themwith the Greek word carcinos (crab or crayfish), among others. This name comes from theappearance of the cut surface of a solid malignant tumour, with "the veins stretched on allsides as the animal the crab has its feet, whence it derives its name". Since it was againstGreek tradition to open the body, Hippocrates only described and made drawings ofoutwardly visible tumors on the skin, nose, and breasts. Treatment was based on the humortheory of four bodily fluids (black and yellow bile, blood, and phlegm). According to thepatients humor, treatment consisted of diet, blood-letting, and/or laxatives. Through thecenturies it was discovered that cancer could occur anywhere in the body, but humor-theorybased treatment remained popular until the 19th century with the discovery of cells.Engraving with two views of a Dutch woman who had a tumor removed from her neckin 1689.Celsus (ca. 25 BC - 50 AD) translated carcinos into the Latin cancer, also meaningcrab. Galen (2nd century AD) called benign tumoursoncos, Greek for swelling, reservingHippocrates carcinos for malignant tumours. He later added the suffix -oma, Greek forswelling, giving the name carcinoma.The oldest known description and surgical treatment of cancer was discovered in Egypt anddates back to approximately 1600 BC. ThePapyrus describes 8 cases of ulcers of the breastthat were treated by cauterization, with a tool called "the fire drill." The writing says aboutthe disease, "There is no treatment."Another very early surgical treatment for cancer was described in the 1020s by Avicenna (IbnSina) in The Canon of Medicine. He stated that the excision should be radical and that alldiseased tissue should be removed, which included the use of amputation or the removalof veinsrunning in the direction of the tumor. He also recommended the useof cauterization for the area treated if necessary.
In the 16th and 17th centuries, it became more acceptable for doctors to dissect bodies todiscover the cause of death. The German professor Wilhelm Fabry believed that breast cancerwas caused by a milk clot in a mammary duct. The Dutch professor Francois de la BoeSylvius, a follower of Descartes, believed that all disease was the outcome of chemicalprocesses, and that acidic lymph fluid was the cause of cancer. His contemporary NicolaesTulp believed that cancer was a poison that slowly spreads, and concluded that itwas contagious.The first cause of cancer was identified by British surgeon Percivall Pott, who discovered in1775 that cancer of the scrotum was a common disease among chimney sweeps. The work ofother individual physicians led to various insights, but when physicians started workingtogether they could make firmer conclusions.With the widespread use of the microscope in the 18th century, it was discovered that thecancer poison spread from the primary tumor through the lymph nodes to other sites("metastasis"). This view of the disease was first formulated by the Englishsurgeon Campbell De Morgan between 1871 and 1874. The use of surgery to treat cancer hadpoor results due to problems with hygiene. The renowned Scottish surgeon AlexanderMonro saw only 2 breast tumor patients out of 60 surviving surgery for two years. In the 19thcentury, asepsisimproved surgical hygiene and as the survival statistics went up, surgicalremoval of the tumor became the primary treatment for cancer. With the exceptionof William Coley who in the late 19th century felt that the rate of cure after surgery had beenhigher before asepsis (and who injected bacteria into tumors with mixed results), cancertreatment became dependent on the individual art of the surgeon at removing a tumor. Duringthe same period, the idea that the body was made up of various tissues, that in turn were madeup of millions of cells, laid rest the humor-theories about chemical imbalances in the body.The age of cellular pathology was born.The genetic basis of cancer was recognised in 1902 by the German zoologist Theodor Boveri,professor of zoology at Munich and later in Würzburg. He discovered a method to generatecells with multiple copies of the centrosome, a structure he discovered and named. Hepostulated that chromosomes were distinct and transmitted different inheritance factors. Hesuggested that mutations of the chromosomes could generate a cell with unlimited growthpotential which could be passed onto its descendants. He proposed the existence of cell cyclecheck points, tumour suppressor genes and oncogenes. He speculated that cancers might be
caused or promoted by radiation, physical or chemical insults or by pathogenicmicroorganisms.1938 poster identifying surgery, x-rays and radium as the proper treatments for cancer.When Marie Curie and Pierre Curie discovered radiation at the end of the 19th century, theystumbled upon the first effective non-surgical cancer treatment. With radiation also came thefirst signs of multi-disciplinary approaches to cancer treatment. The surgeon was no longeroperating in isolation, but worked together with hospital radiologists to help patients. Thecomplications in communication this brought, along with the necessity of the patientstreatment in a hospital facility rather than at home, also created a parallel process ofcompiling patient data into hospital files, which in turn led to the first statistical patientstudies.A founding paper of cancer epidemiology was the work of Janet Lane-Claypon, whopublished a comparative study in 1926 of 500 breast cancer cases and 500 control patients ofthe same background and lifestyle for the British Ministry of Health. Her ground-breakingwork on cancer epidemiology was carried on by Richard Doll and Austin Bradford Hill, whopublished "Lung Cancer and Other Causes of Death In Relation toSmoking. A Second Reporton the Mortality of British Doctors" followed in 1956 (otherwise known as the Britishdoctors study). Richard Doll left the London Medical Research Center (MRC), to startthe Oxford unit for Cancer epidemiology in 1968. With the use of computers, the unit was thefirst to compile large amounts of cancer data. Modern epidemiological methods are closelylinked to current concepts of disease andpublic health policy. Over the past 50 years, great
efforts have been spent on gathering data across medical practise, hospital, provincial, state,and even country boundaries to study the interdependence of environmental and culturalfactors on cancer incidence.Cancer patient treatment and studies were restricted to individual physicians practicesuntil World War II, when medical research centers discovered that there were largeinternational differences in disease incidence. This insight drove national public health bodiesto make it possible to compile health data across practises and hospitals, a process that manycountries do today. The Japanese medical community observed that the bone marrow ofvictims of the atomic bombings of Hiroshima and Nagasaki was completely destroyed. Theyconcluded that diseased bone marrow could also be destroyed with radiation, and this led tothe discovery of bone marrow transplants for leukemia. Since World War II, trends in cancertreatment are to improve on a micro-level the existing treatment methods, standardize them,and globalize them to find cures through epidemiology and international partnerships. Society and cultureWhile many diseases (such as heart failure) may have a worse prognosis than most cases ofcancer, it is the subject of widespread fear and taboos. Euphemisms, once "a long illness",and now informally as "the big C", provide distance and soothe superstitions. This deep beliefthat cancer is necessarily a difficult and usually deadly disease is reflected in the systemschosen by society to compile cancer statistics: the most common form of cancer—non-melanoma skin cancers, accounting for about one-third of all cancer cases worldwide, butvery few deaths are excluded from cancer statistics specifically because they are easilytreated and almost always cured, often in a single, short, outpatient procedure.Cancer is regarded as a disease that must be "fought" to end the "civil insurrection"; a War onCancer has been declared. Military metaphors are particularly common in descriptions ofcancers human effects, and they emphasize both the parlous state of the affected individualshealth and the need for the individual to take immediate, decisive actions himself, rather thanto delay, to ignore, or to rely entirely on others caring for him. The military metaphors alsohelp rationalize radical, destructive treatments.In the 1970s, a relatively popular alternative cancer treatment was a specialized form of talktherapy, based on the idea that cancer was caused by a bad attitude. People with a "cancer
personality"—depressed, repressed, self-loathing, and afraid to express their emotions—werebelieved to have manifested cancer through subconscious desire. Some psychotherapists saidthat treatment to change the patients outlook on life would cure the cancer. Among othereffects, this belief allows society to blame the victim for having caused the cancer (by"wanting" it) or having metaphysically prevented its cure (by not becoming a sufficientlyhappy, fearless, and loving person). It also increases patients anxiety, as they incorrectlybelieve that natural emotions of sadness, anger or fear shorten their lives. The idea wasexcoriated by the notoriously outspoken Susan Sontag, who published Illness asMetaphor while recovering from treatment for breast cancer in 1978.Although the original idea is now generally regarded as nonsense, the idea partly persists in areduced form with a widespread, but incorrect, belief that deliberately cultivating a habit ofpositive thinking will increase survival. This notion is particularly strong in breast cancerculture. ResearchCancer research is the intense scientific effort to understand disease processes and discoverpossible therapies.Research about cancer causes focusses on the following issues: Agents (e.g. viruses) and events (e.g. mutations) which cause or facilitate genetic changes in cells destined to become cancer. The precise nature of the genetic damage, and the genes which are affected by it. The consequences of those genetic changes on the biology of the cell, both in generating the defining properties of a cancer cell, and in facilitating additional genetic events which lead to further progression of the cancer.The improved understanding of molecular biology and cellular biology due to cancer researchhas led to a number of new, effective treatments for cancer since President Nixon declared"War on Cancer" in 1971. Since 1971 the United States has invested over $200 billion oncancer research; that total includes money invested by public and private sectors andfoundations. Despite this substantial investment, the country has seen a five percent decreasein the cancer death rate (adjusting for size and age of the population) between 1950 and 2005.
Leading cancer research organizations and projects include the American Association forCancer Research, the American Cancer Society (ACS), the American Society of ClinicalOncology, the European Organisation for Research and Treatment of Cancer, the NationalCancer Institute, the National Comprehensive Cancer Network, and The Cancer GenomeAtlasproject at the NCI. Environmental Factors and Cancer Deaths Exposure Issues • Home environment • Current events • Workplace • School • Government Decisions
• Global and local environment What causes cancer ? • Organic chemicals • Inorganic chemicals • Fiber • Hormonal Carcinogenesis The Effects of Cancer on Social Behavior Cancer takes a physical toll, but it also takes a social toll. Because of feelings that occur before, during and after treatment, you may find your relationships uncomfortable or even strained. Fortunately, there is help. Cancer arises largely as a result of lifestyle, and is thus a consequence of the conditions in which individuals live and work. For some cancers, specific causal relationships to chemicals are well established; leukaemia as a result of exposure to benzene used in tyre manufacture is one example. Lifestyle influences are relevant for most cancers. The changes in incidence of different forms of cancer among migrants who have moved from one part of the world to another probably reflects major lifestyle changes resulting from acculturation to the way of life in the host country. Types• Both internal and external factors affect a cancer patients social behavior. For example, the fatigue from cancer treatment often leads to withdrawal, and the pressure from piling medical bills often leads to worry and negativity. Time Frame• Every cancer patient is different: some patients beat cancer in a matter of months while others battle it for years. The National Cancer Institute (2009) stresses that regardless of how long your cancer lasts, you must focus on living.
Misconceptions• Misconceptions about cancer will weigh on your social energy. Contrary to popular belief, depression is not the norm, and not everyone diagnosed with cancer will endure prolonged suffering or a painful death. Upsides• Although negative emotions such as guilt, anger and depression can alienate those around you, cancer can also sweeten your social relationships. Cancer patients commonly report feelings of hope and gratitude, and the people in your social support system will help you maintain a positive outlook. Prevention• Talk about how you feel with your family members, friends and, if appropriate, clergy. Also, seek help from your care center, where doctors and nurses will help you cope with cancers social effects. Male Cancer Death Rates
Female Cancer Death Rate (Rate per 10,000)100 80 60 40 20 0 0 5 0 5 0 5 0 5 0 5 0 5 0 5 0 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 9 9 9 9 9 9 9 9 9 9 9 9 9 9 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 Managing national cancer control programmes With careful planning and appropriate priorities, within the scope of prevention, early detection, treatment and palliation, the establishment of national cancer control programmes offers the most rational means of achieving a substantial degree of cancer control, even where resources are severely limited. It is for this reason that the establishment of a national cancer control programme is recommended wherever the burden of the disease is significant, there is a rising trend of cancer risk factors and there is a need to make the most efficient use of limited resources. Effective and efficient cancer control programmes need competent management to identify priorities and resources (planning), and to organize and coordinate those resources to guarantee sustained progress to meet the planned objectives (implementation, monitoring and evaluation).
Good management is essential to maintain momentum and introduce any necessarymodifications. A quality management approach is essential to improving the performance ofthe programme.The four principal approaches to cancer control are: Prevention Prevention means eliminating or minimizing exposure to the causes of cancer, and includes reducing individual susceptibility to the effect of such causes. This approach offers the greatest public health potential and the most cost-effective long-term method of cancer control. Tobacco is the leading single cause of cancer worldwide and in the fight against cancer every country should give highest priority to tobacco control. Early detection Increasing awareness of the signs and symptoms of cancer contributes to early detection of the disease. Where tests for cancer of specific sites are available, and facilities are appropriate, screening of apparently healthy individuals can disclose cancer in early or precursor stages, when treatment may be most effective. Early detection is only successful when linked to effective treatment. Diagnosis and treatment Cancer diagnosis calls for a combination of careful clinical assessment and diagnostic investigations. Once a diagnosis is confirmed, it is necessary to ascertain cancer staging to evaluate the extension of the disease and be able to provide treatment accordingly. Cancer treatment aims at curing, prolonging useful life and improving quality of life. Treatment services should give priority to early detectable tumours and potentially curable cancers. In addition, treatment approaches should include psychosocial support, rehabilitation and close coordination with palliative care to ensure the best possible quality of life for cancer patients. Palliative care In most of the world, the majority of the cancer patients present with advanced disease. For them, the only realistic treatment option is pain relief and palliative care. Effective approaches to palliative care are available to improve the quality of life for cancer patients.Cancer prevention should be a key element in all national cancer control programmes.Prevention not only focuses on the risks associated with a particular illness or problem butalso on protective factors. Among prevention activities, emphasis should be placed on:
– tobacco control;– healthy diet;– physical activities and avoidance of obesity;– reducing alcohol use;– reducing carcinogenic occupational and environmental exposures;– immunization against hepatitis B virus;– combating schistosomiasis;– avoidance of prolonged exposure to the sun;– health education, relating to sexual and reproductive factors associated with cancer.Action on tobacco use is universally needed, but the priorities accorded to other componentsof the programme will depend on the results of a situation analysis of the country concerned,covering the actual and forecast burden of cancer cases in the country, and the estimatedproportion of potentially preventable cases.Cancer rates in India are considerably lower than those in more developed countries such asthe United States…data from population based cancer registries in India show that the mostfrequently reported cancer sites in males are lung, oesophagus, stomach, and larynx. Infemales, cancers of the cervix, breast, ovary, and oesophagus are the most commonlyencountered…In India, the incidence of breast cancer is increasing, with an estimated 80,000 new casesdiagnosed annually. The incidence of breast cancer increased by approximately 50%between 1965 and 1985. Much of this increase may be associated with greater urbanizationand improved life expectancy…
Cancer Control in IndiaIndia is one of the first few developing countries where a nation-wide cancer controlprograms were launched. Government of India took its first initiative in 1971. The NationalCancer Control Program for India was formulated in 1984 with four major goals 13: 1. Primary prevention of tobacco related cancer 2. Early detection of the cancers of easily accessible sites 3. Augmentation of treatment facilities 4. Establishment of equitable, pain control and palliative care network throughout the countryCancer PreventionAccording to Mayo Clinic, there are 7 steps to prevent cancer Avoid tobacco use: As already discussed, tobacco is the major risk factor for cancer. Hence, it is important to avoid tobacco in all forms, like both active and passive smoking and chewing tobacco. • Eat a variety of healthy foods: It is important to consume plant-based foods, rich in fruits and vegetables, reduce the intake of fat and alcohol. • Stay active and maintain a healthy weight: Regular exercise should be an integral part of one’s daily routine. • Protect yourself from the sun: Exposure to sun is the major cause of skin cancer. It is important to avoid the sun’s ultraviolet rays, especially from 10 am to 4 pm and applying adequate amounts of sunscreen lotion with a sun-protecting factor (SPF) of at least 15, especially before venturing outdoors during these hours • Get immunized: Vaccination against Hepatitis B should be regularly administered, as this infection could lead to liver cancer.
• Healthy practices: Sexually transmitted diseases like human papilloma virus infection, hepatitis B and HIV can lead to an increased incidence of various cancers. It is thus important to practice safe sex by using condoms, limit the number of sexual partners, or abstain from sex and never share needles. In case of drug addiction, it is important to seek help. • Get screened: Regular screening and self-examination for certain cancers helps in early detection of cancer and improves the prognosis.The Government of India launched the National Cancer Control Programme (NCCP) in1975–76 to tackle the increasing incidence of cancers in the country. This was later revised in1984–85 stressing on primary prevention and early detection of cancers. The primaryprevention focused on health education regarding hazards of tobacco consumption, genitalhygiene, and sexual and reproductive health. Secondary prevention aims at early diagnosis ofcancers of uterine cervix, breast and oro-pharyngeal cancers by screening methods. For thepurpose of detecting cancer of cervix at an early stage, early cancer detection centres indifferent medical colleges and postpartum smear testing units in medical colleges in thecountry have been established. A National Cancer Control Board was constituted at theCentre to operationalize the programme. Similar boards were suggested at the state levelscalled as State Cancer Control Board (SCCB) for the proper co-ordination of activities.Several states have formulated SCCB.During the period 1990–91, a demonstration project named district cancer control programme(DCCP) was initiated in selected districts of the country for early detection of cervical, oraland breast cancers at the doorsteps of rural community. The programme created awarenessamongst people regarding early symptoms of cancer, importance of observation of personalhygiene and healthy lifestyle, ill effects of tobacco consumption, etc. The project has fivecomponents, viz. health education, early detection, training of medical and para-medicalpersonnel, palliative treatment and pain relief and co-ordination and monitoring. The districtprojects are linked with Regional Cancer Centres (RCC), medical college hospitals havinginfrastructure for treatment of cancer and the appropriate institutions that supervise andmonitor the programme in collaboration with the concerned state governmentsThe DCCP scheme has been further reoriented on a pilot basis as Modified District CancerControl Programme.
The project has been implemented in the states of Bihar, Tamil Nadu, Uttar Pradesh and WestBengal under the supervision of the state Regional Cancer Centres. Twenty/ten rural blocksfrom each of the above states have been selected. For each block, 20 female non-communicable workers have been appointed to advice women abouthealthy lifestyles, illeffects of tobacco and to detect the early symptoms of cancersDietary guidelines· It is essential to maintain appropriate weight for height,thus avoiding both under and over-nutrition.· Physical activity needs to be promoted to avoid obesity and accumulation of fat.· Intake of protective foods such as vegetables and fruits, preferably fresh, need to beincreased to avoid deficiency and protection against environmental insults.· Plant foods such as cereals, pulses, roots and tubers, green leafy and yellow vegetables,other vegetables/fruits and spices providing nutrients, as well as fibre and protectivephytochemicals, should be preferable items in the diet.· Animal foods (meat and fat) except fish should be curtailed. It is necessary to avoid salted,pickled, smoked and charred food substances.· Mouldy and damaged foods should be totally eliminated from the diet. GOVERNMENT POLICIESRadient Pharmaceuticals Corporation (RPC) and its exclusive India-based distributionpartner Jaiva Technologies, Inc. (JTI) and Jaiva’s Indian subsidiary Gaur Diagno, PvtLtd (GDL) announced the launch of a cancer education and screening program in India — akey international market where GDL is actively commercializing RPC’s Onko-Sure(R) invitro diagnostic (IVD) cancer test. The goal of the program is to drive public education; raisemarket awareness; and offer Onko-Sure(R) as a commercialized cancer screening test thatcan potentially help stem the rising cancer epidemic in India.According to the Cancer Foundation of India, cancer impacts up to 2.5 million people inIndia annually and the fight against cancer — in both the public and private healthcare
sectors — is largely restricted to improving diagnostic and treatment facilities throughout thecountry. Because of this, it has become increasingly vital to enhance activities and programsthat support cancer education and offer treatment options to potential and existing cancerpatients.With the launch of its cancer education and screening program on behalf of RPC, GDL istaking an aggressive leadership role in India with two distinct launch strategies. The firstcomprises a widespread deployment of GDL’s mobile cancer screening laboratory unitswhere Indian-based physicians and other medical staff travel to local towns to providecounseling and education, along with patient screening using RPC’s Onko-Sure(R) IVDcancer test. The second program is focused on Company collaboration with Indiangovernment agencies to establish GDL-sponsored cancer screening and testing facilitiesdirectly on-site in government hospitals. Physician-referred general cancer screening will alsobe conducted at these hospitals and it is anticipated that RPC’s Onko-Sure(R) IVD cancertests will be administered to patients contacted through the program. The goal of bothstrategies is to reduce the incidence of cancer in India, and through each program, patientswill be provided with registered health cards that will track a patient’s health records forfuture reference and statistical analysis.RPC’s projected Onko-Sure(R) IVD test kit purchase plan is focused primarily on the ramp-up of the government sponsored cancer testing program.The introduction of GDL’s new cancer education and screening program in India is the nextmost important and major milestone in the commercialization of Onko-Sure(R) in India.GDL is taking a leadership role in providing a market with 2.5 million cancer patients withnot only educational resources and support through this program, but also the potential ofearly disease detection and on-going monitoring though our USFDA approved Onko-Sure(R)IVD cancer test.This government screening program is a breakthrough project and we believe a continuousand aggressive approach is necessary if we are to reduce the incidence of cancer in India. Weanticipate this is just the beginning of additional large-scale screening programs we employ.GDL is committed to continuing all efforts to work with Indian government agencies with theultimate goal of reducing cancer rates in this country.
RPC’s Onko-Sure(R) IVD cancer test is a simple, non-invasive, patent-pending andregulatory-approved in vitro diagnostic (IVD) test used for the detection, screening, andmonitoring of various types of cancer. The test enables physicians and healthcareprofessionals to effectively monitor and/or detect certain types of cancers by measuring theaccumulation of Fibrin and Fibrinogen Degradation Products (FDP) in the blood. FDP levelsrise dramatically with the progression of cancer. Onko-Sure(R) is approved by the US FDAfor the monitoring of colorectal cancer and by Health Canada as a lung cancer detection andmonitoring test. Palliative care body to draw national policy in IndiaThe Indian Association of Palliative Care (IAPC) has named a committee to formulate anational policy for it. The committee will submit the drafted policy to the Centre and requestthat it be adopted across the country.The decision was taken by the Executive Council of the Association, which met on Saturdayat the Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, during its 10thAnnual Conference. “The committee was formed by the Executive Council, which met hereyesterday. The chairman of the committee is Dr Stanley Macaden, a palliative care specialistat Bangalore,” said Dr Anil Agarwal, Professor of Anesthesiology, SGPGI and ExecutiveCouncil Member of IAPC.The four-member committee is expected to submit its first draft within three months.“Palliative care is the treatment of pain caused by life limiting diseases like cancer,” said DrMR Rajagopal, one of the committee members. “Besides being a medical care, it is also aboutsocial and psychological assistance to patients and their families. Kerala is the only state thathas a palliative care policy and the need for a national policy was felt for long.”Founder of Pallium India, one of the charitable trusts rendering palliative care in Kerala,Rajagopal is a pioneer in the field here and was also a members of the committee thatformulated the policy in Kerala.“With palliative care being recognised as a human right, it is the obligation of the Unionhealth ministry to arrange for its provision at all government hospitals,” said Rajagopal.
A possible recommendation in the policy will be that all medical colleges should havepalliative care within two years and government hospitals within five years, said Rajagopal.The Medical Council of India has given approval for an MD course in Palliative Care Cancer Insurance Policy Indian Cancer Society and The New India Assurance Company Limited ( NIA) have pioneered cancer specific insurance policy to benefit large sections of people. The policy offered by New India Assurance is unique and extremely cheap compared to general health insurance policies. It can also be taken as an ‘Add on’ to top up your existing health policy. This insurance policy is open to any person upto 70 years provided they have had no cancer earlier. According to the agreement with NIA, anyone who wants to avail of this cover has to become a member of the Indian Cancer Society at a small cost of Rs.200. The policy comes into operation only after the one month of membership. Benefits of Cancer Insurance Policy • There is no medical test. Only Declaration of good health signed by a doctor is required. • The Cancer Insurance Policy offers adequate coverage towards the costs of diagnosis, biopsy, surgery, chemotherapy and/or radiotherapy, hospitalization and rehabilitation at an extremely low premium. • Reimbursement of claims is made every quarter for actual expenses incurred, until the entire sum insured is exhausted or the insured person is declared cured, whichever is earlier. • Free access to cancer related literature available with the Society. • At the Societys discretion, check-up facilities can be made available at its Cancer Detection Centre at Pedder Road, Mumbai. For Cancer Insurance policy holders, first time check up facility for cancer would be free of cost and for the second time onwards, the same facility would be available at 50%
of cost. • The entire administration of the policy is done by the society. As a result policy holder does not have to interact with NIA. Both premium payment and claim settlement are handled by society without any hassles for the policyholders. Amount Covered through Cancer Insurance Policy The Cancer Medical Expenses Insurance Policy offers two options of sum assured: • Coverage of Rs. 50,000 + 5% additional sum insured upto Rs. 75,000 for every claim free renewal. • Coverage of Rs. 200000 +5% additional sum insured upto Rs. 300,000 for every claim free renewal. The policy covers both the member and spouse regardless of whose name the membership is in. But once either of them contracts the disease the other would not be entitled for any benefits under the same policy. However, he/she can always take another policy.A non-governmental organization (NGO) is a legally constituted organizationcreated by natural or legal persons that operates independently from any government and aterm usually used by governments to refer to entities that have no government status. In thecases in which NGOs are funded totally or partially by governments, the NGO maintains itsnon-governmental status by excluding government representatives from membership in theorganization. The term is usually applied only to organizations that pursue somewider social aim that has political aspects, but that are not overtly political organizations suchas political parties. Unlike the term "intergovernmental organization", the term "non-governmental organization" has no generally agreed legal definition. In many jurisdictions,these types of organization are called "civil society organizations" or referred to by othernames.
Types of NGOsNGO type can be understood by orientation and level of co-operation.NGO type by orientation Charitable orientation; Service orientation; Participatory orientation; Empowering orientation;NGO type by level of co-operation Community- Based Organization; City Wide Organization; National NGOs; International NGOs; Steps in establishing NGOsThe first step in the establishment of the NGO is to identify the area of peculiar needs of thesociety, such as health, HIV/AIDS, Maternal Mortality, Polio, food, shelter,education, civilliberty and poverty alleviation among others.The second step is to identify people of similar minds; there must be a unity of purpose. Thethird step is to engage the services of a qualified legal practitioner for guidance for theRegistration process. Some NGOs can be registered with the regional or central governmentand that depends on the scope of the operations of the proposed NGO. The next importantstep also is to identify the internal or external partners with a clearly stated objectives andplan of actions.
SIDDHARTHA VASHISHTA CHARITABLE TRUSTVisionThe Jail system is like kidneys of society which filters out the toxins & re-introduces theclean fluid back into our system. This aspect is important and has to be understood thateverybody who is in jail will one day be re-introduced into the society. Therefore, we have totry & reform these people and not punish them, as punishment will only bring in ill-will &bitterness.Ours is the land of the Vedas, the Upanishads and of Gandhi where love & forgivenessconquers all. Therefore, this approach of punishment and hate has to transcend into one ofreform & change. It is the future of society that is at stake, therefore let it not be someoneelse’s problem. Make a difference. And you can do it by just changing your attitude ofnegativeness towards those in jail, to an open mind and to look at the positive side alsobecause everyone has a positive side.People who are in Jail are just like everyone else, they just happened to be at the wrong placeat the wrong time. Maybe there are a few rotten apples but they are just about 5% of thepeople in jail, the rest are in jail because of incidents & accidents, which can happen toanyone. So extend a hand and don’t shrug off your responsibilities towards the future of oursociety. This is a cause for the betterment of all. I understood it after spending more than 8years in jail & I feel it is my responsibility to let it be known to as many people as possible.Ongoing Activities: 1. Child Education program- provides education fees, books and uniform to the children of convicts. 2. Cancer Awareness & detection program- SVCT holds medical and cancer detection camps for the underprivileged: organizes film shows to demonstrate self
examination techniques, exhibition of educational posters on cancer prevention and hazards of tobacco consumption. 3. Rehabilitation of convicts- Facilitate their vocational training, help them in getting suitable jobs or setting up their own business enterprise. 4. Art exhibition- Promotion of creativity by supporting fine arts amongst inmates.Programs of the NGO: CATCH THE CANCER CANCER AWARENESS & DETECTION PROGRAM • Vision Cancer is the most rapidly growing disease in India and is now reaching epidemic proportions. The largest segment affected by cancer is Breast & Uterus Can-cer in Women and Mouth & Throat Cancer in Men. These happen to be amongst the most ignored symp-toms of illness as there is very little or no awareness about them in people & especially in the urban poor. We at SVCT feel that if detected in time, these can be easily treated. Our vision at SVCT is to help spread awareness and help detect these problems in as many people as possible. Objectives • To help create awareness about Breast, Uterus, Mouth & Throat Cancer in the urban poor. • To hold medical & cancer detection camps in underprivileged areas to diagnose & treat cancer patients. • To hold seminars & video conferences in the slums to teach them self-detection methods and spread awareness.
CHANCE FOR CHANGE REHABILITATION OF CONVICTSVisionAll people who are convicted are not per say criminals. They are more often that not victimsof circum-stances. They too were normal citizens who made a mistake & ultimately they toowill join mainstream society and therefore they should be given a chance to change. We atSVCT strongly believe that human beings are not bad but circumstances fare differently fordifferent people. Therefore, SVCT is trying to help effect this change.Objectives Training in different fields (vocational training) with certification. Help in getting suitable jobs. To create awareness among youth & business enterprises to help them rehabilitate. Help them in becoming self-reliant, build self-worth & live a dignified life post release. To finance & support needy inmates after their release. HUMAN TOUCH CHILD EDUCATION PROGRAMVisionThe children of jail inmates suffer for want of education, books and medical attention asusually their earning parents are in jail and they also become stigmatic. Therefore, we at
SVCT feel that it is our moral duty to try and help out & support as many families aspossible. These children have done nothing wrong & deserve a chance to build their futurelike all other children. They should not pay for the mistakes of their parents. By helping thesechildren, we will help build a better society.ObjectivesThe objective of this program is To make Educational & Medical Aid available to all the families of poor & under- privileged jail inmates. To develop self worth in them. To help them face life with their heads held high. To give them a feeling that they are not outcast from the society. To ensure they do not get frustrated & take to wrong ways. To help build a secure society which has love & forgiveness & not condemnation? CAMPS organised by the NGOHEALTH CAMP ( 26-02-2011 )A Health Camp was organised on 26th february 2011 at Tilak Vihar, New Delhi by SVCT.120 O.P.Ds were conducted. people appriciated this camp.HEALTH CAMP ( 23-02-2011 )A Camp was organised on 23rd february 2011 at PeeraGarhi Jhuggi Camp ( The Slum Basti ).Here a street children meeting was organised for Non-Forma Education in PeeraGarhi ( SlumBasti). 30 students were participated in this camp. It was successful attempt by SVCT.HEALTH CAMP ( 19-02-2011 )
A Health Camp was organised on 19th february 2011 at PeeraGarhi Jhuggi. 220 O.P.Ds wereconducted. The camp was succesfully completed and people appreaciated the efforts done bythis camp.HEART CAMP ( 16-02-2011)A Heart Camp was organised on 16th february 2011 at Allahabad Bank. 102 O.P.Ds wereconducted . People were very happy due to SVCTs efforts.Participation in Mirenda House College (09 -02-11 to 11-02-11)HEALTH CAMP(05-02-2011)A camp was organised on 5th february 2011 at Shiv Mandir, Sangam Vihar Old KakrolaRoad, New Delhi from 11a.m. to 3p.m. with the help of Dr. U.P. Singh(Roshan Garden).245O.P.Ds were conducted. People appreciated the efforts done by SVCT.HEALTH CAMP(04-02-2011)A camp was organised on 1st february 2011 at MCD Primary School, Janakpuri C-4 Block,New Delhi from 10a.m. to 1p.m. with the help of Mata Chaudhary Heera DeviCharitableTrust.208 O.P.Ds were conducted. People appreciated this activity, done by SVCT.HEALTH CAMP(01-02-2011)A camp was organised on 1st february 2011 at MCD Primary School, Janakpuri C-4 Block,New Delhi from 10a.m. to 1p.m. 275 O.P.Ds were conducted. People appreciated thisactivity, done by SVCT.HEART CHECK UP CAMP(30-01-2011)
A free heart check up camp was organised on 30 january 2011 at Shree Sanatan DharamMandir sabha D-Block, Janakpuri, New Delhi from 11a.m. to 3p.m. in association with MetroHospital and Cancer Institute, Preet Vihar,Delhi. 89 O.P.Ds, 75 E.C.Gs, 75 R.B.S(SugarTest) and 26 Echo Test were conducted.HEALTH CAMP(29-01-2011)A general health camp was organised on 29th january 2011 at Ranaji Enclave, NajafgarhRoad, New Delhi from 11a.m. to 3p.m. with the help of Mr. Bhola Nath and Mrs. SumanTaneja. 22 O.P.Ds were conducted.Efforts of SVCT were appreciated by everyone.BREAST CANCER CAMP(24-01-2011)A camp was organised on 24th january 2011 at Gita Mandir Complex, C-2 Block, Janakpuri,New Delhi from 10a.m. to 3 p.m.with the help of ROKO Cancer. The camp was held to getpeople awared about the effects of breast cancer.46 O.P.Ds and 27 Memography wereconducted.Drawing Competition(23-01-2011):A drawing competion was organized for different age groups (i.e. 5-7 years,8-10 years and11-12 years) at Shree Ram Vatika Park, Mayur Vihar-2, Delhi with the help of ResidentWelfare Society(Regd) from 10a.m. to 1p.m.. Prizes were distributed by MLA Ch. AnilKumar and Counsellor Mr. Devendar Kumar to best two of each group. Mr. AnilGrover(Presint of Resident Welfare Society) thanked SVCT for this event.Health Camp(22-01-2011)
This camp was organised on 22nd january 2011 at Bharat Jodo Complex, 109 TaraNagar(Near Kakrola Dairy), New Delhi from 11p.m. to 3p.m. It was helped by Mr. SatnamSingh of Bharat Jodo to make it a success. 244 O.P.Ds were conducted.Health Camp(15-01-2011)This camp was organised on 15th january 2011 at Shiv Mandir, Shyam Vihar(Kakrola area)near Dwarka Sector-14, New Delhi from 11p.m. to 3p.m. It was helped by Mr. Nawab Singh,Mr. Rajinder Chopper and Mr. Ashwini Ranga to make it successful. 125 O.P.Ds wereconducted.General Camp(26-12-2010)A Camp was organised with the help of Aster Eye Care at Allahabad Bank premises in LajpatNagar from 11a.m. to 3p.m. In this camp 41 O.P.Ds were conducted. A small informaticexhibition on cancer and tobacco was also placed. Many people and bank staff appreciatedthe efforts done by SVCT.Health camp At Vikas Nagar(25-12-2010)A Camp was organised at Vikas Nagar on 25th December 2010 at F-1, Kernal Bhatia Road,Green Avenue, Vikas Marg, Hospital Road,New Delhi from 11a.m. to 3p.m. with the help ofBhagwan Dass Chauhan( President, Block- E, Vikas Nagar). In this camp, 203 O.P.Ds wereconducted. Patients were screened and dispensed the required medicine.Quiz Competition for Immunization & Nutrition at Uttam Nagar(15-12-2010):A Quiz competition was organized on nutrition and immunization on15th December 2010 atIdeal Radiant Public School in Shiv Vihar in Uttam Nagar from 11:30a.m to 2p.m.In this Quiz competition 50 Ladies participated and 25 question were asked. 1st prize goes toMrs.Sarita who scored 12/25, 2nd goes to Nilam Rai who scored 12/25. 3rd goes to Mirrawho scored 9/25 markes. Consolation Prize were distributed who have given more than 2Question.
Health camp At Uttam Nagar(11-12-2010):A Camp was organized on 11th December 2010 at Shiv Vihar in Uttam Nagar from 10a.m to2p.m. Three doctors provide their services to 136 patients. This camp programme containsthe O.P.D was conducted to scrutnize the cancer patients for further detection. Cards wereissuied to the patients and medicines were distributed to them.People were very happy by this activity, done by SVCT.AIDS Awareness Camp At Uttam Nagar(09-12-2010):AIDS Awareness Camp was organized on 9th December 2010 in Shiv Vihar in Uttam Nagarfrom 10a.m to 2p.m. 18 Ladies ware participate In This camp. In this camp people know howto prevent from AIDS. This was the first activity in this area.People appreciated this activity,done by SVCT.Health camp At Dwarka(04-12-2010):A Camp was organized on 4th December 2010 in Dada Mainder in Dwarka from 10a.m to2p.m. Two doctors from E.S.I and CIVIL Hospital(Gurgaon)offered services as volunteers to110 patients. This camp programme contains the O.P.D was conducted to scrutnize the cancerpatients for further detection. Medicines were distributed to them.People appreciated this activity, done by SVCT.Cancer camp(28-11-2010):A camp was organized in collaboration with MKS ROKO Cancer Charitable Trust,with thehelp of CRPF Camp at Jhadhoda Kalan on 28th Nov. 2010 from 10.00am to 5.00 pm. A teamof Doctor’s, technicians, nursing staff has screened 36 suspected patients. A complete MobileCancer Van with in fitted Potable Mammography X-Ray machine brought by ROKO. inwhich 21 Mammography was done. Details Reports given at the camp side. Every person’s isnot affected by the Cancer. A doctor was engaged where 74 OPD patients were screened andall patients were given required medicines. On this occasion some posters was also displayedand leaflets regarding Tobacco and Breast Cancer were distributed amongst the patients and
general public. People were very happy and appreciated about this arrangement done bySVCT.Health camp At J.J.Colony,Dwarka(18-11-2010):A Camp was organized on 18 November 2010 in J.J. Colony (Sector- 7) in Dwarka from10a.m to 2p.m. Two doctors from E.S.I hospital offered services to 188 patients. Mr. BijenderSingh and Mr. Chiranjee Lal did the innaugration of camp and support alot in this task. Mr.Daya Prasad who is a MCD worker helped in this camp. This camp programme contains theO.P.D was conducted to scrutnize the cancer patients for further detection. Cards were issuiedto the patients and medicines were distributed to them.People were very happy by this activity, done by SVCT.We give God all the glory and honour for his grace and mercy towards all those who wereinvolved in the medical camp directly or indirectly, his grace was sufficient.Cancer camp At Udham Singh Park,Wazirpur(27-10-2010):A camp was organized in collaboration with MKS ROKO Cancer Charitable Trust, at UdamSingh Park, Wazirpur Industrial Area on 27th Oct. 2010 from 10.00am to 5.00 pm. A team ofDoctor’s, technicians, nursing staff has screened 66 suspected patients. A complete MobileCancer Van with in fitted Potable Mammography X-Ray machine brought by ROKO. inwhich 24 Mammography was done. Details Reports given at the camp side. Every person’s isnot affected by the Cancer. So similar OPD for general public was also arranged by SVCT, Adoctor (Dr. Naveen Tyagi) was engaged where 175 OPD patients were screened and allpatients were given required medicines. On this occasion some posters was also displayedand leaflets regarding Tobacco and Breast Cancer were distributed amongst the patients andgeneral public. People were very happy and appreciated about this arrangement done bySVCT. Mr.Ram Kumar Pradhan (Jhuggi cluster) gave special thanks for organizing theactivity.Cancer camp At Wazirpur(20-10-2010):A camp was organized in collaboration with Indian Cancer Society (Regd) at Udam SinghPark, Wazirpur Industrial Area on 20th Oct.2010 from 2.00pm to 6.00 pm. A team of
Doctor’s including 1 Male, 1 Female, technicians, nursing staff.They screened 41 patients bythe team of Doctors of Indian Cancer Society (Regd.) which includs Pep Test and collectedblood samples for Hemogram. Investigation Report in detail will be given to the patients after2 weeks. we arrange some medicines for genral O.P.D and required items from local marketand hold the camp. Dr (Mrs.) Vandana Mehta took initiate and screened 125 OPD (54 female,65 male & 6 children). A drive against Tobacco was also launched; hand bills and posterswere displayed and distributed amongst general public.