The presentation describes various facts about breast and cervical cancer including burden of disease, survival outcomes, need for early diagnosis and screening recommendations.

1. Breast and Cervical Cancer
Awareness
Dr Alok Gupta
MD, DM,
Consultant Medical Oncologist
Max Super Speciality Hospital, Saket
Ex-Asst. Professor, AIIMS, New Delhi

2. What is cancer?

3. World Cancer Epidemiology
 14.1 million new cases every year.
 8.2 million deaths every year (2nd MC).
 5 MC in India are breast, cervix, oral cavity, lung and
colorectal (large intestine).

5. Estimates for India

6. Problem Statement

7. Multifaceted Aspects of Cancer Management
1. Pathogenesis/cancer development
2. Cancer prevention/Risk factor modification
3. Cancer screening/early detection
4. Diagnosis and Treatment
5. Surveillance and Cancer Survivorship

8. Multifaceted Aspects of Cancer Management
1. Pathogenesis/cancer development
2. Cancer prevention/Risk factor modification
3. Cancer screening/earlydetection
4. Diagnosis and Treatment
5. Surveillance and Cancer Survivorship

9. What is Screening?
Test and exam used to find a disease (like a pre-
cancer or cancer) in people who do not have
any symptoms. Examples..
Not a DIAGNOSTIC test
Aim: Reduction of morbidity and mortality

10. Breast Cancer
 In India, 1 out of every 2 women diagnosed with
breast cancer dies of this disease, mainly
because the tumor is diagnosed too late.

13. Epidemiology

14. Problem Statement

15. Is screening feasible in breast cancer?

16. Survival in Breast Cancer

17. Benefits of screening for breast cancer
Important public health problem/outcome vary
with stage
Early detection/stage migration
30% reduction in mortality

18. Methods of screening for breast cancer
Breast-self examination
Ultrasound
Mammography
MRI
Clinical breast examination

19. Breast Self-Examination (BSE)
Potential Benefits
Simple and non-invasive test
Women gain a sense of control over their health
Some breast cancer has been detected with BSE

20. Clinical Breast Examination (CBE)

21. Mammography
Screening
(asymptomatic)
Diagnostic
(symptomatic)
Mammography

23. Mammography


24. Ultrasonography
Useful adjunct to mammography
Assist in suspicious lesion detected on
mammography or physical examination
Useful in the guidance of biopsies and
therapeutic procedures.
Originally, used as method of
differentiating cystic from solid breast
masses
Limitations as screening test:
Failure to detect microcalcifications
Poor specificity (34%)
Useful in detecting occult breast
cancer in dense breasts.
Highly operator-dependent

25. Magnetic Resonance Imaging (MRI)
Explored in women at high risk and in younger women
MRI found to be highly sensitive (99% when combined with
mammography and CBE)
An important adjunct screening tool for women
BRCA1 or BRCA2 mutations, identifying cancers at earlier stages.
MRI has limited use as a screening tool:
Cost. 10-fold higher cost than mammography
Poor specificity (26%)  false-positive reads

27. Screening Recommendations for Average Risk
 Between 40–75 years – Annual CBE + Annual
Mammography.
 Breast self-examination(BSE), start at 20 yrs,
monthly.
 Clinical Breast Examination (CBE) 3 yearly, 20-
40 years.

28. Screening Recommendations for High Risk (>20%)
 CBE 6 monthly, start at 25 years.
 MRI annually, start at 25 years.
 Mammography annually, start at 30 years. (6
monthly interval from MRI)

29. Cancer Cervix
What is cervix?
The cervix is the lower part of the
womb also known as uterine
cervix. The cervix connects the body
of the uterus to the vagina(birth
canal).

34. Epidemiology

35. Problem Statement

39. 90%
10%
90%
1% 0.1%
Is it feasible to screen for Cancer Cervix?

40. Method - PAP (Cervical) Smear Test
A cervical smear test is a
simple procedure which involves
gently scraping some cells from the
surface of the cervix and putting them
on a slide. The cells are then
examined under a microscope in the
laboratory to see if they are normal.

41. Timing of PAP Test

42. Benefit of screening in cervical cancer
 70% reduction in cervical cancer deaths.
 Now ranks 14th for cancer deaths in developed
world.
 5-year survival rate is approximately 92%.

43. Screening Recommendations
 <21 years: No screening
 21-30 years: PAP smear every 3 years
 30-65 years: PAP smear every 3 years or PAP
smear + HPV testing every 5 years
 >65 years: No screening

44. Summary
 Breast cancer followed by cervical cancer are the two
most common cancers among women in India.
 If detected in early stage, >90% patients can be
completely cured.
 Mammography can help in detecting breast cancer at an
early stage/pre-cancerous stage.
 PAP test can help in detecting cervical cancer at an early
stage/pre-cancerous stage.

45. THANK YOU