3. Cancer Control
Cancer control consist of a series of
measures based on present medical
knowledge in the fields of prevention,
detection,diagnosis,treatment ,after care
and rehabilitation aimed at reducing
significantly the number of new cases,
increasing the cures and reducing the
invalidism due to cancer.
4. The basic approach to the control of cancer is through
Primary prevention
Secondary prevention
5. Primary prevention
Cancer prevention until recently was mainly concerned
with early diagnosis of the disease, preferably at a
precancerous stage.
control of tobacco and alcohol consumption
personal hygiene
radiation
occupational exposure
immunization
Foods drugs and cosmetics
treatment of precancerous lesions
Legislations
cancer education
6. Secondary prevention
i. Cancer registration :
hospital based registries
population based registries
ii. Early detection of cases
ii. Treatment
7. Cancer Screening
It can be defined as “search for unrecognized
malignancy by means of rapidly applied test’’
Cancer screening is possible in
Malignant disease preceded by premalignant lesion ,
removal of this prevents subsequent development.
Early stage of cancer detection has high rate of cure
75% of all cancer occur in body sites that are
accessible.
8. Method of Cancer Screening
a) Mass screening by comprehensive cancer detection
examination :
rapid clinical examination & examination of one or
more body sites by the physician is more important
b) Mass screening at single site:
comprises examination of single sites such as
uterine cervix ,breast or lung.
c) Selective screening:
refers to examination of people at special risk.
9. Risk factors of Breast Cancer
Age : 35 – 50 yrs
Family history: positive family history ,especially if a mother or
sister develop breast cancer when premenopausal
Parity:
Age at menarche & menopause:
Hormonal factors: elevated levels of both estrogen as well as
progesterone
Prior breast biopsy: biopsy for benign disease
Diet : high fat diet & obesity
Socioeconomic status: higher socio economic groups
Others: radiation ,oral contraceptives.
10. Screening of Breast Cancer
The basic techniques for early detection of
breast cancer are
a) Breast self examination
b) Palpation by physician
c) Thermography
d) mammography
11. All women should be encouraged to perform breast
self examination
Breast cancer are more frequently found by women
themselves than by a physician.
Palpation is unreliable for large fatty breast
Thermography- it has advantage that patient is not
exposed to radiation
It is not a sensitive tool
12. Mammography
Most sensitive and specific in detecting small tumors
Draw backs:
o Exposure to radiation , dose of 500 milliroentgen
o It requires technical equipment of high standard and
radiologist
o Biopsy from a suspicious lesion may end up in false
positive in as many as 5 to 10 cases for each case of
cancer detection.
Women under 35 yrs of age should not be exposed to
X rays unless they are symptomatic or family history
of early onset of breast cancer.
13. Prevention
Primary prevention
Elimination of risk factor & promotion of cancer
education
Average age at menarche can be increased
through reduction in childhood obesity
Frequency of ovulation decreased by an strenuous
physical activity.
14. Secondary Prevention
To detect recurrence as early as possible
To detect cancer in the opposite breast at an early
stage
Some cases progress rapidly even if diagnosed at an
apparently early stage others surviving for 20 yrs
even after metastatic spread
In general the removal of the tumor early is more
likely to be curative than removal at a later stage.
15. Risk factors of Cancer Cervix
Age : 25-45 yrs
Genital warts: past and / or present occurrence of
clinical genital warts
Marital status;
Early marriage
Oral contraceptive pills
Socio economic class: lower socio economic group
probably poor genital hygiene
16. Screening of Cancer Cervix
Prolonged early phase of cancer in situ can be
detected by Pap smear
All women should have a pap test at the beginning
of sexually activity & then every 3 yrs there after.
Pap test should be directed to women in poor socio
economic circumstances who are at the higher risk
of developing diseases.
visual inspection by acetic acid (VIA) & visual
inspection by lugol iodine (VILI) are done by trained
female health workers.
17.
18. Screening of Cancer cervix are related to the disease
& test.
The disease :
One of the criteria that must be fulfilled
before screening programme is initiated is that
natural history of disease and its development from
latent to declared disease should be understood.
The frequency with which carcinoma in situ
progresses to invasive carcinoma and the frequency
with which invasive ca is preceded by abnormal
smears.
19. The Test:
Two particular aspect deserve consideration i.e.
Response rate & Sensitivity of the test
Response rate
Its being the least in women thought to be most at risk
eg. Poorest and least educated women
Sensitivity test
o It detects neoplastic changes
o It has 20% of false negative rate
o The sensitivity will depend upon whether the cervical smear
is prepared from vaginal aspiration or direct cervical
scrapping
20. Prevention of Cancer Cervix
Primary prevention:
Until the causative factor are more clearly
understood there is no prospect of primary
prevention of the disease
It may be improved with personal hygiene and birth
control
Cancer of the cervix uteri will show the decline in
developing countries
Immunization
Gardasil & Cervarix
21. Secondary Prevention
This rest on early detection of cases through
screening & treatment by radical surgery and
radiotherapy
5 yr survival rate is virtually 100% for carcinoma in
situ , 79 % for local invasive disease & 45% for
regional invasive disease.
Carcinoma cervix is difficult to cure once symptoms
develop & is fatal if left untreated.
22. Screening of Lung Cancer
At present there are only 2 techniques for screening
for lung cancer
chest radiograph
sputum cytology
Mass radiography has been suggested for early
diagnosis at 6 monthly intervals. But the evidence in
support of this not convincing.
23. Primary Prevention
The most promising approach is to control the
“smoking epidemic” because 80-90% of all cases in
developed countries are due to smoking of cigarettes
WHO expert committees described method of
controlling the smoking epidemics. These are
I. Public information & education
II. Legislative & restrictive measures
III. Smoking cessation activities
IV. National & international co ordination
24. Secondary Prevention
At present there are only 2 procedures capable of
detecting presymptomatic , early stage lung cancer.
these are chest radiograph & sputum cytology
But screening for early stage lung cancer is less
attractive, more expensive & less potential
For untreated patients the median survival is 2 – 3
months compared to 10-14 months for patient
receiving combined chemotherapy
25. Prevention of Oral Cancer
Primary prevention :
If the tobacco habits are eliminated from the
community, it leads to reduction in the incidence of
oral cancer
This requires intensive public education &
motivation for changing life styles supported by
legislative measures like banning or restricting the
sale of tobacco
26. Secondary prevention
If cases detected early possibly at precancerous
stage, they can be treated or cured
The precancerous lesion can be detected for up to 15
yrs, prior to their change to an invasive carcinoma
Leucoplakias can be cured by cessation of tobacco
use. The main treatment modalities are surgery &
radiotherapy
The primary health care workers detect oral cancer
at an early stage during home visits.
They can prove to be a vital link & a key instrument
in the control of oral cancer in developing countries.
27. COTPA,2003-Tobacco Control Legislation
The important provisions of the act are
Prohibition of smoking in public places
Prohibition of advertisement of cigarettes & other
products
Prohibition of sale of cigarettes & other tobacco products
to a person below 18 yrs of age
Prohibition of sale of tobacco products near the
educational institutions
Mandatory depiction of statutory warnings on tobacco
packs
Mandatory depiction of tar & nicotine content
28. NATIONAL CANCER CONTROL PROGRAMME
Launched in 1975 -1976
Due to magnitude of the problem & gaps in the availability
of cancer treatment facilities , the programme was
revised in 1984-1985 & in dec 2004
OBJECTIVES OF THE PROGRAMME :
Primary prevention of cancer by health education
Secondary prevention i.e early detection & diagnosis of
common cancer by screening or self examination method
Tertiary prevention i.e strengthening of existing
institutions of comprehensive therapy including
palliative care
29. The schemes under revised programs are
Regional cancer centre scheme
Oncology wing development scheme
Decentralized NGO scheme
IEC activities at central level
Research and training
