This document discusses cancer screening and provides information on several common cancer screening tests. It begins with some key statistics on cancer in Singapore and discusses the importance and principles of cancer screening. It then provides details on specific screening tests for breast cancer, colon cancer, and cervical cancer. For each cancer, it discusses the rationale for screening, how the screening is performed, benefits and limitations of the different screening tests, and current screening guidelines. The overall message is that effective cancer screening is available for common cancers and can contribute to early detection and prevention of cancer if people comply with screening recommendations.
Endoscopic Mucosal Resection May Not Be Appropriate For All T1a Gastric CancersAudrey Choi, MD
Endoscopic resection of T1a gastric cancers in a large US population: a SEER study. This data was presented at Digestive Diseases Week 2015 under the ASGE schedule.
Dr. Murphy presents slides discussing general screening trends in the US, including how the US compares to other countries, different screening modalities, and differences in screening by:
-Age
-Gender
-Geography
-Race/Ethnicity
Endoscopic Mucosal Resection May Not Be Appropriate For All T1a Gastric CancersAudrey Choi, MD
Endoscopic resection of T1a gastric cancers in a large US population: a SEER study. This data was presented at Digestive Diseases Week 2015 under the ASGE schedule.
Dr. Murphy presents slides discussing general screening trends in the US, including how the US compares to other countries, different screening modalities, and differences in screening by:
-Age
-Gender
-Geography
-Race/Ethnicity
Colorectal Cancer Screening - What does the evidence really say?Jarrod Lee
Colorectal cancer is one of the most common cancers around the world. Screening has been proven to detect cancers in early curable stages, and to even prevent them. Yet, few topics are as controversial as colorectal cancer screening in medicine today. We take an evidence based approach to examine what the science truly says about the different modalities of cancer screening.
March 2019 - Polyps and Prevention: The Importance of Screening for Colorecta...Fight Colorectal Cancer
Did you know that colon polyps can lead to cancer? Did you know that colorectal cancer can be prevented through regular screening? It is important to stay up to date on CRC screening and guidelines, and it is also important to know about polyps and the role that they play in the development of colorectal cancer.
The Early Age Onset (EAO) Colorectal Cancer (CRC) Summit was a novel meeting designed for Early Age Onset (EAO) colorectal cancer (CRC) survivors, affected families as well as physicians and scientists who were interested in advancing their understanding of the rapidly increasing incidence of rectal and colon cancer among young adults under 50 years of age.
Co-hosted by the Colon Cancer Challenge Foundation and the CME office of Memorial Sloan Kettering Cancer Center the program provided an opportunity to hear leading clinicians and scientists on the epidemiology, pathogenesis, genomics and lifestyle challenges of EAO-CRC.
The course also included lectures as well as workshops and panel discussions designed to facilitate multidisciplinary consensus regarding the priorities of EAO-CRC prevention, clinical care and research moving forward.
Cancer screening may discover many dormant, regressing, or slowly progressing tumors that would not have affected the screened individuals. Such findings with there therapies are obviously harmful. This lecture is highly based on the book "over diagnosed" by H. Gilbert Welch and was presented in 2013 to KFSH-Dammam physicians
Colorectal Cancer Screening for Family Physicians - What's NewJarrod Lee
Colorectal cancer is the the most common cancer in Singapore and in many developed countries. The past decade has seen many countries implement colorectal cancer screening programs to decrease its mortality. Established cancer programs utilize tests such as fecal occult blood and colonoscopy to detect colorectal cancer in its early stages or even in its precancerous adenoma stage. Studies in recent years reinforce the benefit, accuracy and risks of these screening modalities. Nonetheless, screening rates remain suboptimal. The past 5 years have seen many new advances in colorectal cancer screening, including new screening modalities. Of these, 3 new modalities have already been approved by the US FDA and in various parts of the world. There are: stool DNA test, blood septin 9 test, and capsule colonoscopy. We discuss about these new developments in colorectal cancer screening and how they may impact our practice in the near future.
Tailoring Colorectal Cancer Treatment: Sidedness, Biomarkers - August 2018 CR...Fight Colorectal Cancer
This month’s FightCRC webinar, Dr. Kanwal Raghav will spend the hour diving into the research behind two biomarkers related to colorectal cancer: HER2 and sidedness. This informative session will talk about the biomarkers that researchers are studying, as they may affect your treatment plan. Knowing your biomarkers will allow you to be your own best advocate.
Cancer screening - Evidence, Expected benefits, Methods and Current Recommend...Alok Gupta
The presentation discusses about Cancer screening - Evidence, Expected benefits, Methods and Current Recommendations.
The was presented in HEALTH CONNECT meeting at Max Hospital, Saket, new Delhi in 2016.
Epatocarcinoma: nulla di nuovo sotto il sole - Gastrolearning®Gastrolearning
Gastrolearning II modulo/13a lezione
Epatocarcinoma: nulla di nuovo sotto il sole
Relatore: Prof. Massimo Colombo (Milano)
Discussants: Prof. F. Farinati (Padova), Prof.ssa E. Villa (Modena), Prof. A. Grieco (Roma).
Colorectal Cancer Screening - What does the evidence really say?Jarrod Lee
Colorectal cancer is one of the most common cancers around the world. Screening has been proven to detect cancers in early curable stages, and to even prevent them. Yet, few topics are as controversial as colorectal cancer screening in medicine today. We take an evidence based approach to examine what the science truly says about the different modalities of cancer screening.
March 2019 - Polyps and Prevention: The Importance of Screening for Colorecta...Fight Colorectal Cancer
Did you know that colon polyps can lead to cancer? Did you know that colorectal cancer can be prevented through regular screening? It is important to stay up to date on CRC screening and guidelines, and it is also important to know about polyps and the role that they play in the development of colorectal cancer.
The Early Age Onset (EAO) Colorectal Cancer (CRC) Summit was a novel meeting designed for Early Age Onset (EAO) colorectal cancer (CRC) survivors, affected families as well as physicians and scientists who were interested in advancing their understanding of the rapidly increasing incidence of rectal and colon cancer among young adults under 50 years of age.
Co-hosted by the Colon Cancer Challenge Foundation and the CME office of Memorial Sloan Kettering Cancer Center the program provided an opportunity to hear leading clinicians and scientists on the epidemiology, pathogenesis, genomics and lifestyle challenges of EAO-CRC.
The course also included lectures as well as workshops and panel discussions designed to facilitate multidisciplinary consensus regarding the priorities of EAO-CRC prevention, clinical care and research moving forward.
Cancer screening may discover many dormant, regressing, or slowly progressing tumors that would not have affected the screened individuals. Such findings with there therapies are obviously harmful. This lecture is highly based on the book "over diagnosed" by H. Gilbert Welch and was presented in 2013 to KFSH-Dammam physicians
Colorectal Cancer Screening for Family Physicians - What's NewJarrod Lee
Colorectal cancer is the the most common cancer in Singapore and in many developed countries. The past decade has seen many countries implement colorectal cancer screening programs to decrease its mortality. Established cancer programs utilize tests such as fecal occult blood and colonoscopy to detect colorectal cancer in its early stages or even in its precancerous adenoma stage. Studies in recent years reinforce the benefit, accuracy and risks of these screening modalities. Nonetheless, screening rates remain suboptimal. The past 5 years have seen many new advances in colorectal cancer screening, including new screening modalities. Of these, 3 new modalities have already been approved by the US FDA and in various parts of the world. There are: stool DNA test, blood septin 9 test, and capsule colonoscopy. We discuss about these new developments in colorectal cancer screening and how they may impact our practice in the near future.
Tailoring Colorectal Cancer Treatment: Sidedness, Biomarkers - August 2018 CR...Fight Colorectal Cancer
This month’s FightCRC webinar, Dr. Kanwal Raghav will spend the hour diving into the research behind two biomarkers related to colorectal cancer: HER2 and sidedness. This informative session will talk about the biomarkers that researchers are studying, as they may affect your treatment plan. Knowing your biomarkers will allow you to be your own best advocate.
Cancer screening - Evidence, Expected benefits, Methods and Current Recommend...Alok Gupta
The presentation discusses about Cancer screening - Evidence, Expected benefits, Methods and Current Recommendations.
The was presented in HEALTH CONNECT meeting at Max Hospital, Saket, new Delhi in 2016.
Epatocarcinoma: nulla di nuovo sotto il sole - Gastrolearning®Gastrolearning
Gastrolearning II modulo/13a lezione
Epatocarcinoma: nulla di nuovo sotto il sole
Relatore: Prof. Massimo Colombo (Milano)
Discussants: Prof. F. Farinati (Padova), Prof.ssa E. Villa (Modena), Prof. A. Grieco (Roma).
This ground breaking program provided both survivors and health care professionals the opportunity to leverage each other's insights and an opportunity for all to hear "state-of-the-science" presentations on the epidemiology, pathogenesis, genomics and optimal multidisciplinary care of EAO-CRC.
The 2016 EAO CRC Summit featured keynote addresses from leading clinicians, epidemiologists and researchers from Europe, Africa, Australia and the nation's leading cancer centers and advocacy organizations.
diagnosis and outline of management of localized prostate cancer for non-urol...Dr Mayank Mohan Agarwal
a brief introduction of anatomy of prostate, screening of prostate cancer, measures to improve specificity of PSA screening, risk stratification of prostate cancer, treatment options - active surveillance, radical prostatectomy, radical radiotherapy
Professor Martin Wiseman presented on 'The Continuous Update Project - Breast cancer survivors and prostate cancer' on behalf of WCRF International at the SCPN conference 04/02/2015.
Scans and Ovarian Cancer: Everything You Want to Knowbkling
When you’re diagnosed with ovarian cancer, scans become an inevitable part of life. But what are the differences between the imaging tests? When should which scans be used? What about the pros and cons of each test? Join Dr. Kevin Holcomb, Vice-Chair of Gynecology and member of the Division of Gynecologic Oncology at Weill Cornell Medicine, and Dr. Elisabeth O’Dwyer, Instructor in Radiology at Weill Cornell Medicine and Assistant Attending Radiologist at NewYork-Presbyterian Hospital-Weill Cornell Campus, as they help make sense of it all.
Urinary bladder collects urine from the kidney which is then passed through the urethra. Cancer is abnormal growth of cells leading to tumour in urinary bladder. Bladder Cancer is diagnosed with cystoscopy and biopsy . Treatment of Bladder cancer is done as per stage. It includes Radical Cystectomy, Plevic Lymphadenectomy, Ileal conduit, Neobladder as surgical options.
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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1640 dr wong nan soon cancer screening and saving lives, healthcare costs
1. Cancer Screening
Saving Lives and Healthcare Costs
Dr Wong Nan Soon
Consultant Medical Oncologist
Oncocare Cancer Centre
Mt Elizabeth Medical Centre
Adjunct Associate Professor
Department of Clinical Sciences
Duke-NUS
3. Message
• Cancer is the commonest cause of death in
Singapore
• Cancer incidence increases with age
BUT
• Effective cancer screening is available for
common malignancies
• Cancer awareness and compliance with
screening recommendations can contribute to
healthy aging workforce
4. Scope
• Biology of cancer
• Cancer epidemiology in Singapore
• Principles behind screening
• Details of screening tests available
6. Stepwise Progression of Cancer
Dynamics of Cancer: Incidence, Inheritance, and Evolution. Frank SA.Princeton (NJ):
Princeton University Press; 2007.
Vogelstein et al.,New Engl J Med 1988
8. Cancer Burden
Singapore Cancer Registry Interim Report 2005-2009
9. Common Cancers by Gender
Singapore Cancer Registry Interim Report 2005-2009
10. Age Specific Cancer Incidence
Singapore Cancer Registry Interim Report 2005-2009
11. What is Prevention
• Primary prevention
– Prevents onset of disease
– Removes risk factors eg smoking cessation, avoiding
HRT
• Secondary
– Detects disease at early asymptomatic stage
– Stops disease progression
– Eg screening for breast cancer, colon cancer
• Tertiary
– Prevents disease deterioration and complications
– Eg lowering glucose in known diabetic
12. What is Screening
• Detection of unrecognized risk factor or
disease in well patients
• Can be part of primary or secondary
prevention
• Involves clinical examination, blood tests,
procedures such as mammography,
colonoscopy
13. Should We Screen Everyone for Every
Disease?
• Incidence of disease
• Morbidity and mortality of disease
• Is primary prevention possible
• Is early intervention effective/ curative
• Performance of screening test
– Specificity and sensitivity
– Safety, side effects, acceptability
– Cost
14. Evaluating Screening Test
Avoiding Bias
• Screen detected cancers
vs symptomatic cancers
– Lead time bias
– Length time bias
– Overdiagnosis bias
– Selection bias
15. Recommended Screening
Cancer Type Average Risk High Risk
Breast cancer Yes Yes
Colorectal cancer Yes Yes
Cervical cancer Yes Yes
Ovarian cancer No Yes (BRCA mutation)
Uterine cancer No Yes (Lynch syndrome)
Lung cancer No Yes (Heavy smokers)
Liver cancer No Yes (Hepatitis B carriers)
Prostate cancer No Yes (Strong family history)
NPC No Yes (Strong family history)
18. Screening Mammogram
Study Protocol Frequency Population Subgroup Invited Control F/U RR (95%CI)
HIP 2V MM, q12m x 4 40-64 40-49 14432 14701 18 0.77(0.53-1.11)
(1963-1969) CBE 50-64 16568 16299 18 0.80(0.59-1.08)
Edinburgh 1 or 2V q24m x4 45-64 45-49 11755 10641 14 0.83(0.54-1.27)
(1979-1988) MM, CBE 50-64 11245 12359 10 0.85(0.62-1.15)
Kopparberg 1V MM q24mx4 40-74 40-49 9650 5009 20 0.76(0.42-1.40)
(1977-1985) 50-74 28939 13551 20 0.52(0.39-0.70)
Ostergotland 1V MM q24mx4 40-74 40-49 10240 10411 20 1.06(0.65-1.76)
(1977-1985) 50-74 28229 26830 20 0.81(0.64-1.03)
Malmo 1 or 2V MM q18-24m x5 45-69 45-49 13528 12242 12.7 0.64(0.45-0.89)
(1976-1990) 50-69 17134 17165 9 0.86(0.64-1.16)
Stockholm 1V MM q28mx2 39-59 39-49 11724 12015 11.4 1.01(0.51-2.02)
(1981-1985) 50-59 9276 14217 7 0.65(0.4-1.08)
Gothenberg 2V MM q18mx5 39-59 39-49 11724 14217 12 0.56(0.32-0.98)
(1982-1988) 50-59 9276 16394 13 0.91(0.61-1.36)
CNBSS1 2V MM Q12m x5 40-49 40-49 25214 25216 11-16 1.07(0.75-1.52)
CNBSS2 CBE 50-59 50-59 19711 19694 13 1.02(0.78-1.33)
(1980-1987)
UK AGE 2V MM Q12m x 7 39-41 - 53914 107007 11 0.83 (0.66-1.04)
(1991-1997) year 1 then
1 V MM
Smith RA, Dorsi CJ. Screening for breast cancer in : Diseases of
the breast, Lippincott WW, Philadelphia USA, 2004
19. Benefits and Risks
Fletcher and Elmore, New Engl J Med 2003
Warner, New Engl J Med 2011
20. Impact at Population Level
Trends in female breast cancer mortality rates by ethnicity, USA 1975-2002
21. Screening Mammography Guidelines
Agency Frequency Age 40-49 Age 50-69 Age>69
US Preventive Services 2 yrs Discuss Yes Yes
Task Force Q2 yrs
Canadian Task Force on 1-2 yrs Discuss Yes No
Preventive Health Care
ACS 1 yr Yes Yes Yes
NCI 1-2 yrs Yes Yes Yes
HPB Singapore/MOH 2 years Discuss Yes -
Q1 year
22. Other Modalities
– MRI
• Prospective data in familial breast cancer1,2
• Higher sensitivity, lower specificity
• Impact on mortality not determined
• Higher cost
– Digital mammography
• Recent randomised trial showed higher accuracy in women
age <503
1. Warner E et al. JAMA 292:1317, 2004
2. Kriege M et al. NEJM 351:427, 2004
3. Pisano ED et al. NEJM 353:1846, 2005
25. Symptoms and Signs of Colorectal
Cancer
• Blood in stools
• Change in stool calibre
• Change in bowel habits
• Sense of incomplete bowel emptying
• Abdominal distention
• Weight loss
• Anemia
26. Why is Screening Useful?
• There is a long period in the early stages
where there are no symptoms.
• Colorectal cancer develops from polyps or
adenomas. Removing polyps prevents
cancer.
27. How is Screening Performed?
• Faecal Tests
– Occult blood test
• Guaic based
• Immunohistochemical test
– Stool DNA
• Colonoscopy
• Virtual (CT) colonoscopy
• Flexible sigmoidoscopy
• Double contrast barium enema
28. Faecal Occult Blood Tests
• Detection of microscopic amounts of blood in the
stool
• Cancers may bleed an invisible amount during the
early stages
• Different types of test kits are available
– Guaic based
– Immunohistochemistry
31. Faecal Occult Blood Test
• If positive, colonoscopy required
• If negative, may be sampling error
32. Faecal Occult Blood Test
• False positive
– Diverticular disease
– Haemorrhoids
– Guaic based: red meat, raw turnips, broccoli,
cauliflower, radish
• False negative (guaic based tests)
– Non bleeding polyp/ tumour
– Medications: aspirin, NSAIDS, vitamin C >750 mg
per day
33. Benefits of FOBT
• Incidence of stage 4 reduced by 32-47%
• Incidence of colorectal cancer reduced by 20%
• Death from colorectal cancer reduced by
between 15% to 30%
– Absolute benefit 0.8-4.6 per 1000 patients
screened
– Numbers needed to screen 217-1250
Walsh et al. JAMA 2003
34. Colonoscopy
• Gold standard
• Enables screening and
intervention
• No randomized trials
• Based on cohort studies
– Reduces incidence of
colorectal cancer by 76%
– False negative rate 5-
12%
– Complication rate 0.03-
0.17%
39. Cervical Cancer
• Rationale for Screening
– No randomized trials
– Convincing evidence from observational
studies
• Introduction of screening programs
– Decreased incidence of cervical cancer
– Decreased cervical cancer deaths
– Calculations suggest 90% reduction in cervical
cancer mortality
40. Cervical Cancer Primary Prevention
• Bivalent
• Quadrivalent
• Best efficacy when given prior to HPV
exposure
• Does not alter need for screening
41. Ministry of Health Guidelines on Screening
• Cervix
– Women who have had sex before or are
sexually active should go for a Pap smear
once every 3 years
– Start at age 25
42. Conclusion
• Effective cancer screening is available for
common malignancies
• Cancer awareness and compliance with
screening recommendations can contribute to
healthy aging workforce
• Seek help from a medical professional to tailor
a suitable screening program
• Avoid overzealous screening