ROJoson PEP Talk: Two Early Detection Programs for Cancers

1. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
September 23, 2023
1400H - 1500H
Via Zoom
Empowerment
objective - for
laypeople to have an
essential
understanding of
TWO EARLY
DETECTION
PROGRAMS FOR
CANCERS in their
health management.

2. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
September 23, 2023
1400H - 1500H
Via Zoom
Empowerment
objective - for
laypeople to have an
essential
understanding of
TWO EARLY
DETECTION
PROGRAMS FOR
CANCERS in their
health management.
Welcome all!
MUTE yourself but always
show your video picture.
Sign in your name, FB
account, or email address in
the Chat Box! Include names
of companions attending.
Use the Chat Box to ask
questions and make
comments while the PEP TALK
is on.
There will be group pictures
at start and end of PEP TALK –
show your face in video.

3. Reminder after the PEP
Talk:
Take the Online Learning
cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.
Link is in Chat Box.

4. Reminder:
50 OLETE Certificates = 1
Voucher for ROJoson
Telemedical Consultation

5. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Empowerment
objective - for
laypeople to have an
essential
understanding of
TWO EARLY
DETECTION
PROGRAMS FOR
CANCERS in their
health management.
ROJOSON’S REQUEST:
FEEDBACK TO THIS
PEP TALK!
Pls. type in your
feedback in the chat
box during the open
forum and before we
adjourn!
Thank you!

6. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Empowerment
objective - for
laypeople to have an
essential
understanding of
TWO EARLY
DETECTION
PROGRAMS FOR
CANCERS in their
health management.
LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
START PEP TALK
PROPER IN 2
MINUTES!
Pls. turn on your
video!
Show your face!

7. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Empowerment
objective - for
laypeople to have an
essential
understanding of
TWO EARLY
DETECTION
PROGRAMS FOR
CANCERS in their
health management.
ROJoson PEP Talk
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.

8. I started the PEP Talk
on May 15, 2021.
There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.

9. From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer depending on
our enthusiasm,
discipline and
perseverance.

10. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Empowerment
objective - for
laypeople to have an
essential
understanding of
TWO EARLY
DETECTION
PROGRAMS FOR
CANCERS in their
health management.
My PEP TALK today is
entitled:
TWO EARLY
DETECTION
PROGRAMS FOR
CANCERS

11. Contents
• What is the rationale for early detection
programs for cancers?
• What are the two early detection programs for
cancers?
• What is the early clinical diagnosis program for
cancers?
• What is the screening program for cancers?
• What is ROJoson’s advice on the more cost-
effective program for early detection of
cancers?
Disclaimer:
ROJoson PEP Talk
contains ROJoson’s
Thoughts,
Perceptions,
Opinions and
Recommendations
(TPORs) culled from
experiences of other
professionals and
ROJoson.
TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS

12. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is the rationale for early detection program
for cancers?

13. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is the rationale for early detection program
for cancers?
Early detection for cancer programs are strategies
and activities done to catch cancers in their early
or earlier stages of the disease with the objective
of avoiding complicated treatment and
promoting long-term remission and hopefully,
cure.

14. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What are the two early detection programs for
cancers?

15. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What are the two early detection programs for
cancers?
• Early clinical diagnosis program
• Screening program

16. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is the early clinical diagnosis program for
cancers?

17. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is the early clinical diagnosis program for
cancers? (as will be operationally defined by me)
Diagnosis in the medical context is the process of
assessing a human being and ending with a
judgment or conclusion whether a medical
condition or disease is present or not and if
present, what type.
In the context of cancer, conclusion will be
whether cancer is present or not and if present,
what type and what stage.

18. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is the early clinical diagnosis program for cancers?
Clinical diagnosis in the medical context is the process of
assessing a human being using symptoms (what a patient feels
and senses in himself/herself) and signs (what a physician sees
during a physical examination) as bases.
Clinical diagnosis is different from laboratory or procedure
diagnosis which is based on the results from laboratory tests or
procedures.
Note: The other type of early detection program for cancer called
screening program utilizes laboratory tests or procedures.

19. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is the early clinical diagnosis program for cancers?
The word “early” in early clinical diagnosis program implies
that the diagnostic process should be done as “early” as
possible.
Patients or laypeople should be taught how to do self-
examination and self-monitoring of their bodies at an early
age as possible and know the alert symptoms of cancers and
then seek medical consultation as soon as possible once they
have unusual or alert symptoms. This is the first step in the
early clinical diagnosis program in the early detection of
cancers.

20. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is the early clinical diagnosis program for
cancers?
Related to this first step in early clinical diagnosis
program is when patients or laypeople have
symptoms that are suspicious for cancer, they
should seek medical consultation as soon as
possible.

21. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is the early clinical diagnosis program for cancers?
The second step in the “early” clinical diagnosis program consists of
regular cancer specialist’s clinical examination (interview for
symptoms and physical examination for signs) for those with high
risk for cancers (particularly those with a strong history of the same
or related cancers in the family).
“Regular” means at least once a year.
After the clinical examination, the cancer specialists may do
laboratory or procedural tests as indicated (if an unusual finding is
detected). The laboratory or procedural tests are still part of the
early clinical diagnosis program and NOT part of screening program.

22. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is the screening program for cancers?

23. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is the screening program for cancers? (as
will be operationally defined by me)
Screening program for cancers consists of
laboratory tests and procedures on asymptomatic
patients or laypeople to catch cancers.
Examples are mammography for breast cancers;
FIT (fecal immunochemical test) and colonoscopy
for colon cancers; PSA (Prostatic Surface Antigen)
for prostate cancers; chest x-ray for lung cancers;
PAP smears for cervical cancers; and tumor
markers.

24. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is the screening program for cancers? (as
will be operationally defined by me)
Screening laboratory tests and procedures are
usually recommended for asymptomatic patients
or laypeople who are at a relatively high risk
compared to the general population because of
age; positive family history of cancers; and
exposure to environment cancer-risk factors.
They are usually recommended to be done at
planned intervals (every so often depending on
the type of cancers being monitored).

25. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-
effective program for early detection of cancers?

26. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-
effective program for early detection of cancers?
My advice: early clinical diagnosis program with
selective screening program for patients or
laypeople with high risk for cancer.
I don’t use age per se as a high-risk factor.
I use family history of cancer as a high-risk factor.

27. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-
effective program for early detection of cancers?
My advice: early clinical diagnosis program with
selective screening program for patients or
laypeople with high risk for cancer.
WHY?

28. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-
effective program for early detection of cancers?
Why not the usual screening program being
promoted in the country?
There are different guidelines on
• what screening tests to use
• at what age or when to start using (40, 45, 50)
• at what age or when to stop using (70, 75, 80)
• intervals of usage (annual or biannual)

29. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-
effective program for early detection of cancers?
Why not the usual screening program being
promoted in the country?
There are a lot of false positive results (because
of tendency to over-reading, - interpretation, -
diagnosis) which cause undue anxiety and which
lead to more tests and unnecessary treatment in
the end.
Note: they may have false negatives also.

30. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-
effective program for early detection of cancers?
Why not the usual screening program being
promoted in the country?
Screening diagnostic tests and procedures are not
FREE. They entail expenses, if not state-financed
and if not institution- or company-financed. They
may not be affordable.

31. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-
effective program for early detection of cancers?
Why not the usual screening program being
promoted in the country?
Screening diagnostic tests and procedures may
not always be available.

32. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-
effective program for early detection of cancers?
Why not the usual screening program being
promoted in the country?
Screening program guidelines for cancers are in
vogue for so many years now. A great majority of
the country’s population including health
professionals are NOT compliant with the
guidelines (possible causes: complacency;
inconvenience; economics; etc.)

33. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-effective program for early
detection of cancers?
Why early clinical diagnosis program instead of screening program?
Properly taught, patients or laypeople can do self-examination and self-
monitoring starting at an early age (say 18) and continuing up to near-
end of life.
It can detect cancer at any age even before and after the age being
recommended by screening guidelines (when to start and when to
end). Cancer can occur anytime. It can occur before and after the
recommended ages for screening.

34. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-effective program for early
detection of cancers?
Why early clinical diagnosis program instead of screening program?
Properly taught, patients or laypeople can detect early cancer as early as
Stage 1 through regular (monthly) self-examination and self-monitoring of
their bodies.
If a cancer is missed at one examination time, subsequent examinations
because of regular monitoring will be able to eventually discover it in the
soonest time possible (in terms of months) compared to screening
laboratory tests or procedures which are usually done at annual intervals
or even longer.

35. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-
effective program for early detection of cancers?
Why early clinical diagnosis program instead of
screening program?
The regular self-examination and self-monitoring
cost nothing to the patients and laypeople.
They are convenient also in that they can be done
any time and any place (in privacy).

36. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-effective program for early
detection of cancers?
Why early clinical diagnosis program instead of screening program?
The regular visit to a cancer specialist for history and physical
examination will reinforce the self-examination of the patients or
laypeople.
The cancer specialist can validate the findings of the patients or
laypeople – NO clinical cancer found; suspicious cancer found; or cancer
found. Diagnostic tests will be done as indicated if suspicious cancer or
a cancer is found or validated by the cancer specialist.

37. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-effective program for early
detection of cancers?
Why early clinical diagnosis program instead of screening program?
If the cancer specialist found nothing to suspect cancer, there is no need
for screening laboratory tests or procedures.
The costs of regular visit (say annually) to the cancer specialist are or
should be lower compared to those of screening laboratory tests and
procedures for cancer.

38. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-
effective program for early detection of cancers?
THUS, the more cost-effective is early clinical
diagnosis program with selective screening
program for patients or laypeople with high risk
for cancer.
Note: the patients / laypeople should be properly
educated and empowered to adopt this program.
Educating and empowering them will be less
costly than the screening laboratory tests and
procedures.

39. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more
cost-effective program for early
detection of cancers?
Patient education and empowerment
program on early clinical diagnosis for
cancers:
1. Must be told to do regular (monthly)
self-examination and self-
monitoring for possible cancer
development anytime and must do
religiously. Must be taught also on
how to.
Do monthly inspection and
palpation of the entire naked
body.
• Choose a date every month
to do this for reminder
purpose.
• Use a mirror as needed to
assist in inspection.
• Look for anything unusual.
• Palpate for anything
unusual or dominant mass.

40. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on
the more cost-effective
program for early detection
of cancers?
Patient education and
empowerment program on
early clinical diagnosis for
cancers:
2. Must know the common
alert or warning
symptoms for cancer.
Alert or warning symptoms of cancer:
• Change in bowel or bladder habits
• A sore that does not heal
• Unusual bleeding or discharge
• Thickening or lump in the breast or
elsewhere
• Indigestion or difficulty in swallowing
• Obvious change in a wart or mole
• Nagging cough or hoarseness
There are other warning symptoms but the
above are the more common ones.

41. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-
effective program for early detection of cancers?
Patient education and empowerment program on
early clinical diagnosis for cancers:
3. Must consult a cancer specialist as early as
possible if there are unusual findings on self-
examination, particularly if there are alert or
warning symptoms of cancer.

42. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-
effective program for early detection of cancers?
Patient education and empowerment program on
early clinical diagnosis for cancers:
4. If a patient is considered as a high-risk for
cancer (such as strong family history of
cancer), must have a regular consultation and
clinical examination with a cancer specialist
(usually annual or biannual – every 6
months).

43. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-
effective program for early detection of cancers?
Patient education and empowerment program on
early clinical diagnosis for cancers:
5. If a patient is considered as a low-risk or
average-risk for cancer, must have a regular
consultation and clinical examination with a
cancer specialist (the specialist will advise on
the planned interval – usually annual or every
2 years).

44. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What are the specific issues and experiences of others
to support ROJoson’s advice on “early” clinical
diagnosis program? (Focus: breast cancer and
mammogram)
Will cite
• a survey on compliance on mammography
• issues on different guidelines on screening
mammography
• Radiologists’ readings on mammography
• Switzerland experience on mammography
• Ukraine experience on early breast cancer detection
• other issues

45. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Issue of compliance on screening
mammography
Screening program guidelines for mammography
are in vogue for so many years now. A great
majority of the country’s population including
health professionals are NOT compliant with the
guidelines (possible causes: complacency;
inconvenience; economics; etc.)

46. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Survey (USA)
Seventy-six percent of women are concerned
about breast health, but about 64% of women
over 40 don’t follow the recommended guidelines
of getting a yearly mammogram, according to a
recent survey done on behalf of MedStar Health.
https://wtop.com/health-fitness/2022/10/64-of-women-dont-
follow-recommended-guidelines-for-yearly-
mammograms/#:~:text=Seventy%2Dsix%20percent%20of%20wo
men,on%20behalf%20of%20MedStar%20Health.
Issue on screening
mammography
Screening program
guidelines on
mammography are in
vogue for so many years
now. A great majority of
the country’s population
including health
professionals are NOT
compliant with the
guidelines (possible
causes: complacency;
inconvenience;
economics; etc.)

47. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Survey (USA)
Of the 510 women over 40 surveyed, 19% have
never had a mammogram; and the 45% who have
gotten mammograms aren’t doing it yearly, even
though 76% of the survey said breast health is
important to them and preventive screenings to
catch cancer early when it’s most treatable could
save their lives.
https://wtop.com/health-fitness/2022/10/64-of-women-dont-
follow-recommended-guidelines-for-yearly-
mammograms/#:~:text=Seventy%2Dsix%20percent%20of%20wo
men,on%20behalf%20of%20MedStar%20Health.

48. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Survey (USA)
The most common reasons women over 40 give
for skipping mammograms, according to the
survey:
•“Haven’t gotten around to it” — 22%
•“I’ve had normal mammograms in the past” —
22%
•“Breast cancer doesn’t run in my family” — 11%
•“Mammograms are painful” — 9%
•“I’m afraid. What if they find something? — 9%
https://wtop.com/health-
fitness/2022/10/64-of-
women-dont-follow-
recommended-guidelines-
for-yearly-
mammograms/#:~:text=Seve
nty%2Dsix%20percent%20of
%20women,on%20behalf%2
0of%20MedStar%20Health.

49. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Different guidelines on age to start and to stop screening
mammography
There is no universal consensus yet on when to start and to stop
screening mammography.
Some start at 40. Some at 45. Some at 50.
Some end at 70. Some at 75. Some at 80.
Some say: don’t do screening if the life expectancy is less than 10 years

50. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Majority of screening mammographies
have a BIRADS 0 reporting.
BIRADS 0 – means need additional tests
Mammography cannot stand-alone as a screening
procedure but it is being advocated.
With BIRADS 0 (needs additional tests),
ultrasound is usually concomitantly done.

51. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Switzerland’s Experience with Screening Mammography
In 2014, Switzerland stopped compulsory systematic screening
mammography for the entire country.
It gave 2 options: systematic screening and opportunistic screening (with
option not to do – leaving to the discretion of patients and physicians).
Doubts were raised whether screening mammography really saved lives.
There were issues of false positives, undue anxiety, unnecessary further
procedure and treatment.

52. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Majority of Filipino patients have breast
cancers discovered by themselves on
palpation and not through screening
mammographies.
For those who consult early, majority are
still in the early stage of breast cancers
and majority of these patients have long
period of remission up to 30 years or more
after treatment.

53. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Ukraine’s Experience with Early Diagnosis Program for Breast
Cancer
Circa 2021 – 2022, because of financial constraints, Ukraine’s breast cancer
program has now 2 options:
• early diagnosis, only for patients with symptoms
• systematic screening: applied to the entire healthy population
At present, they are doing EARLY DIAGNOSIS APPROACH.
“Better than screening: with WHO’s help Ukraine chose a cost-efficient
policy to prevent breast cancer” WHO publication
https://www.who.int/europe/news/item/08-03-2021-better-than-
screening-with-who-s-help-ukraine-chose-a-cost-efficient-policy-to-
prevent-breast-cancer

54. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Ukraine’s Experience with Early Diagnosis Program for Breast
Cancer

55. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS Ukraine concluded
that an early
diagnosis programme
would offer the best
chance of rapidly
reducing mortality
from breast cancer.

56. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Majority of Filipino patients have breast
cancers discovered by themselves on
palpation and not through screening
mammographies.
For those who consult early, majority are
still in the early stage of breast cancers
and majority of these patients have long
period of remission up to 30 years or more
after treatment.

57. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
ROJoson’s Advice on Early Detection of Breast Cancer Program
Early Clinical Diagnosis Program for Breast Cancer with selective screening
program for high-risk.
• Have knowledge on how to do breast self-examination and the alert
signs of breast cancer.
• Do monthly breast self-examination as early as 18 years old with or
without family history of breast cancer and for the rest of lifespan.
• Consult a breast specialist right away once with unusual findings on
breast self-examination or with symptoms suspicious for cancer.
• Have a regular breast clinical examination by a breast specialist
preferably once a year.
• Let the breast specialist advice on the type of screening procedures and
intervals in people with a high-risk for breast cancer.

58. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
What is ROJoson’s advice on the more cost-
effective program for early detection of cancers?
OVERALL:
My advice: early clinical diagnosis
program with selective screening program
for patients or laypeople with high risk for
cancer.

59. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Summary
Take Away
Contents
• What is the rationale for early detection
programs for cancers?
• What are the two early detection programs for
cancers?
• What is the early clinical diagnosis program for
cancers?
• What is the screening program for cancers?
• What is ROJoson’s advice on the more cost-
effective program for early detection of
cancers?

60. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Take Away in
relation to
Patient
Empowerment
Be always in touch with reliable medical
information on the EARLY DETECTION
PROGRAMS FOR CANCERS.
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions /
make better decisions on EARLY
DETECTION PROGRAMS FOR CANCERS in
your health management.

61. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Empowerment
objective - for
laypeople to have an
essential
understanding of
TWO EARLY
DETECTION
PROGRAMS FOR
CANCERS in their
health management.

62. Reminder after the PEP
Talk:
Take the Online Learning
cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.
Link is in Chat Box.

63. Reminder:
50 OLETE Certificates = 1
Voucher for ROJoson
Telemedical Consultation

64. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Empowerment
objective - for
laypeople to have an
essential
understanding of
TWO EARLY
DETECTION
PROGRAMS FOR
CANCERS in their
health management.
ROJOSON’S REQUEST:
FEEDBACK TO THIS
PEP TALK!
Pls. type in your
feedback in the chat
box during the open
forum and before we
adjourn!
Thank you!

65. TWO EARLY
DETECTION
PROGRAMS
FOR CANCERS
Empowerment
objective - for
laypeople to have an
essential
understanding of
TWO EARLY
DETECTION
PROGRAMS FOR
CANCERS in their
health management.
LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
START Q&A AND
INTERACTIONS!
Pls. turn on your
video!
Show your face!