This document provides information about cancer screening and recommendations for different types of cancer. It discusses the major cancers in India like breast, cervical, colon, oral, lung and prostate cancer. For each cancer, it covers epidemiology, screening methods, benefits and recommendations. Screening can detect cancers early and reduce cancer deaths. Regular screening is recommended for certain populations based on risk factors like age, gender and family history. The key screening tests discussed are mammography, Pap smear, fecal occult blood test, colonoscopy, visual oral exam, low-dose CT scan and PSA testing. Screening can detect breast, cervical and colon cancers early and reduce deaths by 30%, 70% and 25% respectively.

1. Cancer Screening: When is the right
time?
Dr Alok Gupta
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. Can all cancers be detected early by screening?
 Rapidly growing tumors?
 Slow growing tumors?
 Tumors with pre-cancerous conditions?
 Breast
 Cervix
 Colon
 Oral cavity
 Prostate
 Lung

11. Cancer
 Burden of disease in India?
 Is screening useful?
 Methods available?
 When to start?
 What frequency?
 When to stop?

12. 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
Become comfortable with their own breasts
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).

30. Epidemiology

31. Problem Statement

32. 90%
10%
90%
1% 0.1%
Is it feasible to screen for Cancer Cervix?

33. 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.

34. 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%.

35. 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

36. Carcinoma Colon

37. Epidemiology

38. Problem Statement

39. Normal to Adenomato Carcinoma
Human colon carcinogenesis
progresses by the dysplasia/adenoma
to carcinoma pathway
(7-12 years)
Is it feasible to screen for Colon Cancer?

40. Benefits of Screening
 Cancer Prevention
 Removal of pre-cancerous polyps prevent cancer
(unique aspect of colon cancer screening)
 Improved survival
 Early detection markedly improves chances
of long term survival

41. Benefits of Screening
Survival Rates by Disease Stage*
89.8%
67.7%
10.3%
0
10
20
30
40
50
60
70
80
90
100
Local Regional Distant
Stage of Detection
5-yr
Survival
*1996 - 2003

42. Methods of Screening
 Fecal Occult Blood Testing (FOBT)
 Flexible Sigmoidoscopy (FSIG)
 FSIG + FOBT
 Colonoscopy
 Double Contrast Barium Enema (DCBE)

43. Screening Recommendations
 Average risk, Age ≥50 years:
 Colonoscopy every 10 years (Preferred)
 Annual FOB and sigmoidoscopy every 5 years
 High Risk:
 Colonoscopy- timing and frequency variable

44. Oral Cavity Cancer

45. Epidemiology

46. Problem Statement

47. Is it feasible to screen for Oral Cancer?
 Many cancers of the oral cavity have a long
early pre-cancer period.
 Easily accessible site.
 Screening method: Examination of mouth
carefully for any abnormal area and feel for any
lump or for any other lesion with a gloved finger.

48. Screening Recommendations
High Risk individuals to undergo yearly screening.

49. Lung Cancer

50. Epidemiology

51. Problem Statement

52. Is it feasible to screen for lung cancer?
DNA
damage to
cells
Abnormal
cell growth
Lesion
Pathological
Evidence
Metastasis Diagnosis Treatment Death
Damage accumulates with age and exposure to
agents e.g. tobacco (80%-90% cases).
Approximately 80% of diagnoses at a late stage
5 year survival 16.8%
Localized – 54%
Distant – 4%

53. Benefits of Screening
20% reduction in risk of
death from lung cancer in
high risk population
Stage T1AN0

54. Methods of Screening

55. Screening Recommendations
 Population
 50-74 years
 Current smokers or left within 15 years
 ≥20 pack years of smoking history
 Method: Low dose CT scan of chest
 Frequency: Annually (min of 3 years)

56. Prostate Cancer

57. Epidemiology

58. Problem Statement

59. Is it feasible to screen for prostate cancer?

60. Benefit of screening
 Upto 44% reduction in death from prostate
cancer

61. Methods of Screening
 Digital rectal examination
 Serum PSA (Prostate specific antigen): Blood
test

62. Screening Recommendations
 DRE and PSA every 2 years for men 50-70
years of age

63. Cancer Screening Summary
Cancer Preferred
Method
Population Age
group
Frequency Reduction
in cancer
related
death
Breast Mammography Avg Risk 40-75 Annual 30%
Cervix PAP smear Avg Risk 21-65 Once every
3 years
70%
Colon Fecal Occult
Blood/
Colonoscopy
Avg Risk >50 Annual/
Once every
10 years
25%
Oral Clinical
Examination
High Risk - Annual -
Lung LDCT scan High Risk 50-74 Annual 20%
Prostate DRE+PSA Avg Risk 50-70 Once every
2 years
44%

65. Thank You
Dr Alok Gupta
Phone No. 9167164364
Email:
alokgupta16@gmail.com
alok.gupta1@maxhealthcare.com

66. BREAST SELF EXAMINATION
Five Simple Steps

67. Step I
Begin by looking at your breasts in the
mirror with your shoulders straight and
your arms on your hips. Look for:
 breasts that are their usual size,
shape, and color.
 breasts that are evenly shaped without
visible distortion or swelling.
If you see any of the following changes,
bring them to your doctor's attention:
 dimpling, puckering, or bulging of the
skin.
 a nipple that has changed position or
an inverted nipple (pushed inward
instead of sticking out).
 redness, soreness, rash, or swelling.

68. Step 2 & 3
 Now, raise your arms and
look for the same changes.
 While you're at the mirror,
gently squeeze each nipple
between your finger and
thumb and check for nipple
discharge (this could be a
milky or yellow fluid or
blood).

69. Step 4
 Feel your breasts while lying
down, using right hand to feel
the left breast and then left
hand to feel the right breast.
Use a firm, smooth touch with
the first few fingers of your
hand, keeping the fingers flat
and together.
 Cover the entire breast from top
to bottom, side to side—from
your collarbone to the top of
your abdomen, and from your
armpit to your cleavage.

70. Step-4…..Contd…..
 Make sure to cover the whole
breast. Begin at the nipple,
moving in larger and larger
circles until you reach the outer
edge of the breast. Move your
fingers up and down vertically,
in rows, as if you were mowing
a lawn. Be sure to feel all the
breast tissue: just beneath your
skin with a soft touch and down
deeper with a firmer touch.
Begin examining each area with
a very soft touch, and then
increase pressure so that you
can feel the deeper tissue,
down to your ribcage.

71. Step 5
 Finally, feel your breasts
while you are standing or
sitting. Many women find
that the easiest way to feel
their breasts is when their
skin is wet and slippery, so
they like to do this step in
the shower. Cover your
entire breast, using the
same hand movements
described in Step 4.

72. CT Colonography (CTC)
CTC Image Optical Colonoscopy
Courtesyof BethMcFarland,MD

73. CT Colonography
Courtesyof BethMcFarland,MD
Poly
p
3-D view2-D view
Polyp

74. CT Colonography
Limitations
 Requires full bowel prep (which most patients find
to be the most distressing element of colonoscopy)
 Colonoscopy is required if abnormalities detected,
sometimes necessitating a second bowel prep
 Steep learning curve for radiologists
 Limited availability to high quality exams in many parts
of the country
 Most insurers do not currently cover CTC as
a screening modality

75. sDNA - Sample Collection