The document provides guidelines from the American Cancer Society and US Preventive Services Task Force for cancer screening in average-risk asymptomatic individuals. It discusses screening recommendations for breast, colorectal, cervical, lung and prostate cancer. For each cancer, it summarizes the guidelines from both organizations, noting areas of agreement and differences in their recommendations for when to begin screening, screening intervals, and when to stop screening.
Colorectal Cancer Detection: Fact vs FictionJarrod Lee
Colorectal cancer is the most common cancer in Singapore. It can be prevented by timely screening. Yet there are many misconceptions about colorectal cancer screening. This talk addresses some of the common perceptions about colorectal cancer screening. This talk was first presented to the public at Feel Fab Fest 2018.
breast cancer
cancer
epidemiology
community medicine
awareness of breast cancer
سرطان الثدي
وبائيات سرطان الثدي
epidemiology of breast cancer
prevention of breast cancer
risk factors of breast cancer
epidemiology of breast cancer in iraq
sign and symptoms of breast cancer
location of breast cancer
Screening for Prostate cancer has had many different opinions and much research has been conducted in the last 20 years. In this presentation we will discuss the current guidelines for proper screening and gain more insight into men’s health.
Colorectal Cancer Detection: Fact vs FictionJarrod Lee
Colorectal cancer is the most common cancer in Singapore. It can be prevented by timely screening. Yet there are many misconceptions about colorectal cancer screening. This talk addresses some of the common perceptions about colorectal cancer screening. This talk was first presented to the public at Feel Fab Fest 2018.
breast cancer
cancer
epidemiology
community medicine
awareness of breast cancer
سرطان الثدي
وبائيات سرطان الثدي
epidemiology of breast cancer
prevention of breast cancer
risk factors of breast cancer
epidemiology of breast cancer in iraq
sign and symptoms of breast cancer
location of breast cancer
Screening for Prostate cancer has had many different opinions and much research has been conducted in the last 20 years. In this presentation we will discuss the current guidelines for proper screening and gain more insight into men’s health.
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In this webinar:
Dr. Paula Gordon will share information on when individuals should start screening for breast cancer, and how often to screen - in order for cancer to be found as early as possible, and to allow the least aggressive options for treatment. Dr. Gordon will also discuss how to screen for recurrence in women who’ve had cancer, explain why these methods are not always offered, and suggest what you can do to improve access to optimal screening.
View the video: https://youtu.be/7uFksz6_4Zk
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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.
About this Webinar: This talk will explore breast screening for women 40-49. The benefits and harms for screening will be discussed, as well as what is unique about breast cancer in women in their 40s. In order to understand the controversy around current guidelines recommending against screening women 40-49, we will review the evidence upon which these guidelines are based, and their impact on breast cancer outcomes for these women.
Aflibercept in combination with fluorouracil, leucovorin, and irinotecan in t...Mary Ondinee Manalo Igot
Folfiri aflibercept poster for apcc 2015
Aflibercept in combination with fluorouracil, leucovorin, and irinotecan in the treatment of Asian patients with metastatic colorectal cancer
Primary mediastinal liposarcoma of the superior, middle, and anterior mediast...Mary Ondinee Manalo Igot
Primary mediastinal liposarcoma of the superior, middle, and anterior mediastinum
https://www.actamedicaphilippina.org/issue/1102
A case of chronic diarrhea secondary to Capillaria philippinensis in Occidental, Mindoro Philippines: a newly-diagnosed endemic area?
https://www.actamedicaphilippina.org/article/7208-a-case-of-chronic-diarrhea-secondary-to-capillaria-philippinensis-in-occidental-mindoro-possibly-a-newly-described-endemic-area
Correlation between Demographic, Socio-economic, and Cancer-Specific Factors with Quality of Life Scores among Newly-Diagnosed Cancer Patients of the Medical Oncology Clinics of the Philippine General Hospital Cancer Institute
https://www.actamedicaphilippina.org/issue/1102
Safety and efficacy of aflibercept in combination with fluorouracil, leucovor...Mary Ondinee Manalo Igot
Safety and efficacy of aflibercept in combination with fluorouracil, leucovorin and irinotecan in the treatment of Asian patients with metastatic colorectal cancer
This presentation talks about the nonconventional ways to look for cancer. It discusses next generation sequencing for multilane panels for cancer predisposition syndromes, whole genome sequencing, circulating tumor cells, circulating tumor DNA, and CancerSEEK. It also discusses the traditional cancer screening guidelines by the American Cancer Society and the USPSTF.
Electrochemotherapy for the palliative treatment of skin metastases and malig...Mary Ondinee Manalo Igot
Primary Author: Dr Claire Habito (Onco-Dermatologist)
This study observational study was done to evaluate the efficacy, safety, and clinical outcome of four-electrode electrochemotherapy device for the treatment of cutaneous metastases and malignant wounds.
Will detail on the historical chemotherapy, latest chemotherapy and a proposed chemotherapy for burst lymphoma. Will also detail on the pathophysiology of burnt lymphoma
“Cancer Anorexia Cachexia (originally Cancer Cachexia) is a multifactorial syndrome defined by:
Ongoing loss of skeletal muscle mass (with or without loss of fat mass)
Cannot be fully reversed by conventional nutritional support
Leads to progressive functional impairment”.
Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface MalignanciesMary Ondinee Manalo Igot
The prognosis of most peritoneal surface malignancies were previously dismal. However, with the incorporation of HIPEC to standard of care, we have been seeing doubling of survival for select malignancies. Appropriate patient selection is crucial.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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1. TITLE
Speaker
CANCER SCREENING in the
NORMAL RISK
ASYMPTOMATIC FILIPINO
Mary Ondinee Manalo-Igot, MD, MSCM, FPCP, FPSO, FPSMO
Medical Oncologist / Neuro-Oncologist
DLSUMC – Department of Internal Medicine
Acacia Hotel Manila / September 20, 2018
2. OUTLINE
• Cancer Situation in the Philippines
• Principles of Cancer Screening
• 2018 Screening Guidelines from ACS and
USPSTF
• Screening in a Resource Limited-Setting
• DOH Cancer Control Program
• Summary
3. CLINICAL SCENARIO in the clinic:
• 69/M, office executive
• good functional capacity
• healthy lifestyle
• no comorbids
• no vices
• no personal or family history of cancer
5. Cancer Situation in the Philippines
• Cancer is an epidemic.
• Cancer is the third leading cause of morbidity
and mortality in the country.
• 189 of every 100,000 Filipinos are afflicted
with cancer while four Filipinos die of cancer
every hour or 96 cancer patients every day.
Department of Health web portal:
https://portal2.doh.gov.ph/philippine-cancer-control-program
Philippine Health Statistics, 2009
6. Estimated Leading New Cancer Cases,
Both Sexes, 2015
CANCER
SITES
NUMBER %
Breast 20267 19
Lung 13679 13
Colon/Rect
um
9625 9
Liver 8649 8
Cervix 7289 7
Prostate 5526 5
Leukemia 4270 4
Thyroid 3288 3
Stomach 2715 3
Ovary 2657 2
2015 Philippine Cancer Society Facts and Estimates (Manila Cancer
Registry and Rizal Cancer Registry)
7. Estimated Leading New Cancer Cases in
the Philippines, Both Sexes, 2015
CANCER
SITES
NUMBER %
Breast 20267 19
Lung 13679 13
Colon/Rec
tum
9625 9
Liver 8649 8
Cervix 7289 7
Prostate 5526 5
Leukemia 4270 4
Thyroid 3288 3
Stomach 2715 3
Ovary 2657 2
2015 Philippine Cancer Society Facts and Estimates (Manila Cancer
Registry and Rizal Cancer Registry)
9. CANCER SCREENING
• Refers to a test or examination performed on
an asymptomatic individual.
• Goal of cancer screening is to prevent death
and suffering from the disease in question
through early intervention.
• Screening is a public health intervention.
• Opportunistic or programmatic
De Vita, Hellman, and Rosenberg’s Cancer: Principles & Practice of
Oncology, 10th edition.
10. Benefits and limitations of regular
cancer screening?
BENEFITS
• Getting screened reassures you if the
result is normal.
• Cancer screening may help prevent
cancer by finding changes in your
body that would become cancer if
left untreated.
• The earlier a cancer is detected, the
better your chance of survival.
LIMITATIONS
• Sometimes test results suggest
you have cancer even though
you don't (called a false
positive).
• The test may not detect cancer
even though it is present (called
a false negative).
• Some cancers would not
necessarily lead to death or
decreased quality of life
(overdiagnosis).
• Having screening tests may lead
to more tests and procedures
that may be harmful.
http://www.cancer.ca/en/prevention-and-screening
11. Principles of Cancer Screening
• Disease should have a high incidence
• Biological behavior and natural history of the disease
should be known
• Test should have high sensitivity, specificity, and
positive predictive value
• Test should be rapid, inexpensive, non-invasive, and
acceptable to patients
• An acceptable and efficacious method of treatment
must exist for patients diagnosed with disease
• Screening should lower the disease-specific morbidity
and increase survival
De Vita, Hellman, and Rosenberg’s Cancer: Principles & Practice of
Oncology, 10th edition.
16. 5-YEAR SURVIVAL RATE FOR BREAST
CANCER BY STAGE
Stage 5-Year Survival, %
0 99
I 92
IIA 82
IIB 65
IIIA 47
IIIB 44
IV 14
Modified from data of the National Cancer Institute:
Surveillance, Epidemiology and End Results (SEER).
17. Not the average risk
• Have a known BRCA1 or BRCA2 mutation
• Have a first-degree relative with breast cancer,
and have not had genetic testing themselves
• Had radiation therapy to the chest when they
were between the ages of 10 and 30 years
• Have Li-Fraumeni syndrome, Cowden
syndrome, or Bannayan-Riley-Ruvalcaba
syndrome, or have first-degree relatives with
one of these syndromes
• Have a lifetime risk of breast cancer of about
20% to 25% or greater, according to risk
assessment tools that are based mainly on
family history
Li-Fraumeni Syndrome: caused
by mutation in TP53. Cancers
include soft tissue & bone
sarcomas, breast cancer, brain
cancer, adrenocortical adenoCA,
& leukemia.
Cowden syndrome: caused by a
PTEN mutation characterized by
multiple hamartomas & an
increased risk of developing
cancers of the breast, thyroid,
endometrium, CRC, kidney and
melanoma.
Bannayan-Riley-Ruvalcaba
syndrome: caused by a PTEN
mutation characterized by
macrocephaly, multiple
hamartomas and dark freckles
on the penis of males. More
than half will have
developmental delays,
hypotonia, hyperextensibility,
scoliosis and pectus excavatum.
18. Breast Cancer Risk Assessment Tool
(Gail Model)
• It uses 7 key risk factors for breast cancer.
– Age
– Age at first period
– Age at the time of the birth of a first child (or has not given
birth)
– Family history of breast cancer (mother, sister or
daughter)
– Number of past breast biopsies
– Number of breast biopsies showing atypical hyperplasia
– Race/ethnicity
• Women with a 5-year risk of 1.67 percent or higher are
classified as "high-risk."
https://bcrisktool.cancer.gov/calculator.html
20. Previous Screening Recommendations for Breast Cancer
Test or Procedure American Cancer Society U.S. Preventive Services Task Force
Breast self
examination
Women ≥ 20 years: Breast
self-exam is an option
“D” = AGAINST
Clinical examination Women 20–39 years:
Perform every 3 years
Women ≥40 years: Perform
annually
Women ≥40 years: “I” =
INSUFFICIENT EVIDENCE
Mammography Women ≥40 years: Screen
annually for as long as the
woman is in good health
Women 50–74 years: Every 2 years
(“B”)
Women ≥75 years: “I”
“A”: The USPSTF recommends the service, because there is high certainty that the net benefit is
substantial.
“B”: The USPSTF recommends the service, because there is high certainty that the net benefit is
moderate or moderate certainty that the net benefit is moderate to substantial.
“C”: The USPSTF recommends selectively offering this service to individual patients based on
professional judgment. There is at least moderate certainty that the net benefit is small.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty that the
service has no net benefit or that the harms outweigh the benefits.
“I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and
harms of the service.
21. 2018 Screening Recommendations for Breast Cancer
Test or Procedure American Cancer Society U.S. Preventive Services
Task Force
Breast self
examination
No recommendation “D”
Clinical examination No recommendation Women ≥40 years: “I”
INSUFFICIENT EVIDENCE
Mammography Women 40-44 years: Should
be able to start screening if they
want to
Women ≥45 years: Screen
annually for as long as the woman is
in good health and is expected to
live for 10 years or more
Women ≥55 years: Can
continue yearly or every 2 years
Women 40–49 years: The
decision should be an
individual one, and take
patient context/values into
account (“C”)
Women 50–74
years: Every 2 years (“B”)
Women ≥75 years: “I”
“B”: The USPSTF recommends the service, because there is high certainty that the net benefit is
moderate or moderate certainty that the net benefit is moderate to substantial.
“C”: The USPSTF recommends selectively offering this service to individual patients based on
professional judgment. There is at least moderate certainty that the net benefit is small.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty that the
service has no net benefit or that the harms outweigh the benefits.
“I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and
harms of the service.
22. American Society of Clinical Oncology (ASCO)
(counterpart of the Philippine Society of Medical Oncology)
• Recommends
annual
screening
starting age
40 years
• Greatest reduction
in breast cancer
deaths, with nearly
40% reduction in
breast cancer
related deaths
25. Stage 5-Year Survival, % Stage 5-Year Survival, %
I 92 I 88
IIA 90 IIA 83
IIB 87 IIB 81
IIIA 72 IIIA 72
IIIB 65 IIIB 58
IIIC 53 IIIC 50
IV 12 IV 13
Modified from data of the National Cancer Institute: Surveillance,
Epidemiology and End Results (SEER).
American Cancer Society. Colorectal Cancer Facts and Figures 2017-
2019. Atlanta, Ga: American Cancer Society; 2017.
5-YEAR SURVIVAL RATE
FOR COLON CANCER BY
STAGE
5-YEAR SURVIVAL RATE
FOR RECTAL CANCER
BY STAGE
26. AVERAGE RISK
• No personal history of:
– adenomatous polyps
– colorectal cancer
– inflammatory bowel disease
– confirmed or suspected hereditary colorectal
cancer syndrome (FAP or Lynch syndrome)
• No family history of colorectal cancer
27. 2008 Screening Recommendations for Colorectal Cancer
Test or
Procedure
American Cancer Society U.S. Preventive Services Task Force
Sigmoidoscopy Adults ≥50 years: Screen every 5 years
Note: For all CRC screening tests, stop
screening when benefits are unlikely
due to life-limiting comorbidity.
Adults 50–75 years: Every 5 years in
combination with high-sensitivity fecal
occult blood testing (FOBT) every 3
years (“A”)a
Adults 76–85 years: “C”
Adults ≥85 years: “D”
Fecal occult
blood testing
(FOBT)
Adults ≥50 years: Screen every year
with high sensitivity guaiac based FOBT
or fecal immunochemical test (FIT) only
Adults 50–75 years: Annually, for high-
sensitivity FOBT (“A”)
Adults 76–85 years: “C”
Adults ≥85 years: “D”
Colonoscopy Adults ≥50 years: Screen every 10 years Adults 50–75 years: every 10 years (“A”)
Adults 76–85 years: “C”
Adults ≥85 years: “D”
“A”: The USPSTF recommends the service, because there is high certainty that the net benefit is
substantial.
“C”: The USPSTF recommends selectively offering this service to individual patients based on
professional judgment. There is at least moderate certainty that the net benefit is small.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty that the
service has no net benefit or that the harms outweigh the benefits.
“I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and
harms of the service.
28.
29. 2018 Screening Recommendations for Colorectal Cancer
Test or Procedure American Cancer Society U.S. Preventive Services Task Force
Stool-Based Tests
Fecal occult blood
testing (FOBT)
Adults ≥45 years: Screen
every year with high sensitivity
guaiac based FOBT or fecal
immunochemical test (FIT) only
Adults 50–75 years: Annually,
for high-sensitivity FOBT (“A”)
Adults 76–85 years: “C”
Adults ≥85 years: “D”
Fecal
immunochemical
testing (FIT)
Adults ≥45 years: Screen
every year
“I”
Fecal DNA testing Adults ≥45 years: Screen,
but interval uncertain
“I”
“A”: The USPSTF recommends the service, because there is high certainty that the net benefit is
substantial.
“C”: The USPSTF recommends selectively offering this service to individual patients based on
professional judgment. There is at least moderate certainty that the net benefit is small.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty that the
service has no net benefit or that the harms outweigh the benefits.
“I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and
harms of the service.
30. 2018 Screening Recommendations for Colorectal Cancer
Test or
Procedure
American Cancer Society U.S. Preventive Services Task Force
Direct Visualization Tests
Colonoscopy Adults ≥45 years:
Screen every 10 years
Adults 50–75 years: every 10 years
(“A”)
Adults 76–85 years: “C”
Adults ≥85 years: “D”
Sigmoidoscopy Adults ≥45 years: Screen
every 5 years
Adults 50–75 years: Every 5 years in
combination with high-sensitivity fecal occult
blood testing (FOBT) every 3 years (“A”)a
Adults 76–85 years: “C”
Adults ≥85 years: “D”
CT
colonography
Adults ≥45 years: Screen
every 5 years
“I”
“A”: The USPSTF recommends the service, because there is high certainty that the net benefit is
substantial.
“C”: The USPSTF recommends selectively offering this service to individual patients based on
professional judgment. There is at least moderate certainty that the net benefit is small.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty that the
service has no net benefit or that the harms outweigh the benefits.
“I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and
harms of the service.
31. Which test to choose for screening?
• “The ACS and USPSTF found no head-to-head studies
demonstrating that any of the screening strategies are
more effective than others, although the tests have
varying levels of evidence supporting their effectiveness,
as well as different strengths and limitations.”
• “Offering choice in colorectal cancer screening strategies
may increase the proportion of patients who will actually
do the screening.”
33. Stage 5-Year Survival, %
0 93
IA 93
IB 80
IIA 63
IIB 58
IIIA 35
IIIB 32
IVA 16
IVB 15
Modified from data of the National Cancer Institute: Surveillance,
Epidemiology and End Results (SEER).
American Cancer Society. Cancer Facts and Figures 2018. Atlanta, Ga:
American Cancer Society; 2018
5-YEAR SURVIVAL RATE FOR CERVICAL
CANCER BY STAGE
35. 2012-2018 Screening Recommendations for Cervical Cancer
Test or
Procedure
American Cancer Society (2012) U.S. Preventive Services Task Force
Pap test
(cytology)
Women <21 years: No screening
Women ages 21–29 years: Screen
every 3 years
Women 30–65 years: Acceptable approach to
screen with cytology every 3 years (see HPV test)
Women >65 years: No screening following
adequate negative prior screening
Women after total hysterectomy for
noncancerous causes: Do not screen
Women ages 21–65 years: Screen
every 3 years (“A”)
Women <21 years: “D”
Women >65 years, with adequate, normal
prior Pap screenings: “D”
Women after total hysterectomy for
noncancerous causes: “D”
HPV test Women <30 years: Do not use HPV testing
Women ages 30–65 years: Preferred approach
to screen with HPV and cytology cotesting every
5 years (see Pap test)
Women >65 years: No screening following
adequate negative prior screening
Women after total hysterectomy for
noncancerous causes: Do not screen
Women ages 30–65 years: Screen in
combination with cytology every 5 years if
woman desires to lengthen the screening
interval (see Pap test) (“A”)
Women <30 years: “D”
Women >65 years, with adequate, normal
prior Pap screenings: “D”
Women after total hysterectomy for
noncancerous causes: “D”
“A”: The USPSTF recommends the service, because there is high certainty that the net benefit is substantial.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty that the service has no net
benefit or that the harms outweigh the benefits.
36. Simplified Cervical Cancer Screening
Woman’s Age How often should a woman have a
Pap Test?
<21 years old No testing needed
21-30 years old Pap test every 3 years
30-65 years old Pap test every 3 years, or
Pap test and HPV cotesting every 5
years
>65 years old No testing needed if no abnormal
results for the past 10 years
38. Stage 5-Year Survival, %
IA1 92
IA2 83
IA3 77
IB 68
IIA 60
IIIA 36
IIIB 26
IIIC 13
IVA 10
IVB <1
Modified from data of the National Cancer Institute: Surveillance, Epidemiology
and End Results (SEER).
Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project:
Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth)
Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2016;11(1):39-
51.
5-YEAR SURVIVAL RATE FOR NON
SMALL CELL CANCER BY STAGE
39. 2002 03 04 05 06 07 08 09 10
T0
NLST Design and Time Posts
• RCT
• 1:1 randomization to CT or
CXR
• Launched across ~ 33 sites
FinalAnalysis
CXR
CT
53,476
High-
Risk
Subjects
T2
T1
Follow up
Interim analyses
National Lung
Screening Trial
National Cancer
Institute
TSLN
40. NLST Summary
• CT scan detects more lung cancers than CXR by 2.3 folds
• 20% lung cancer mortality reduction CT vs CXR
− Absolute risk reduction = 0.4% (AR CT= 1.3% | CXR = 1.7%)
• Few major complications
• NNS (Number needed to screen) : 320
− NNS (Breast Cancer): US: 238, NZ: 781
• NCI_2012 and J med Screen, 2001;8(3):114-5
• Need for diagnostic algorithm to decrease false positives
41. SCREENING CRITERIA
•Currently smoke or have quit within the past 15
years, and
•Have at least a 30-pack-year smoking history, and
•Receive smoking cessation counseling if they are
current smokers, and
•Have been involved in informed/shared decision
making about the benefits, limitations, and harms
of screening with LDCT scans, and
•Have access to a high-volume, high quality lung
cancer screening and treatment center.
42.
43. 2018 Screening Recommendations for Lung Cancer
Test or Procedure American Cancer Society U.S. Preventive Services Task Force
Low dose helical CT
scan
Current or former smokers
aged 55-74 years in
good health: Screen every
year
Adults aged 55-80 years with a
history of smoking: Screen every
year, “B”
• Screening should be discontinued once:
• a person has not smoked for 15 years, or
• develops a health problem that substantially limits life expectancy
or the ability or willingness to have curative lung surgery
“A”: The USPSTF recommends the service, because there is high certainty that the net benefit is
substantial.
“B”: The USPSTF recommends the service, because there is high certainty that the net benefit is
moderate or moderate certainty that the net benefit is moderate to substantial.
“C”: The USPSTF recommends selectively offering this service to individual patients based on
professional judgment. There is at least moderate certainty that the net benefit is small.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty that the
service has no net benefit or that the harms outweigh the benefits.
“I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and
harms of the service.
45. Stage 5-Year Survival, %
I Local Stage 100
II 100
IIIA Nearly 100
IIIB Regional Stage Nearly 100
IVA Nearly 100
IVB Distant Stage 29
Howlader N, Noone AM, Krapcho M, et al (eds). SEER Cancer Statistics
Review, 1975-2014, National Cancer Institute. Bethesda, MD,
bhttps://seer.cancer.gov/csr/1975_2014/, based on November 2016
SEER data submission, posted to the SEER web site, April 2017.
5-YEAR SURVIVAL RATE FOR PROSTATE
CANCER BY STAGE
47. 2008-2016 Screening Recommendations for Prostate Cancer
Test or Procedure American Cancer Society U.S. Preventive Services Task
Force
Prostate Specific
Antigen (PSA)
Men ≥50 years: should talk to a doctor
about the pros and cons of testing so
they can decide if testing is the right
choice for them.
Men ≥45 years: should talk to a doctor
about the pros and cons of testing if
African American or have a father or
brother who had prostate cancer before
age 65.
How often they are tested will depend
on their PSA level.
Men 55-69 years: “D”
Men ≥70 years:
recommends against PSA
testing “D”
Digital rectal
examination
As for PSA; if men decide to be tested, they
should have the PSA blood test with or
without a rectal exam.
No individual recommendation
“C”: The USPSTF recommends selectively offering this service to individual patients based on
professional judgment. There is at least moderate certainty that the net benefit is small.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty
that the service has no net benefit or that the harms outweigh the benefits.
48.
49. 2018 Screening Recommendations for Prostate Cancer
Test or Procedure American Cancer Society U.S. Preventive Services Task
Force
Prostate Specific
Antigen (PSA)
Men ≥50 years: should talk to a
doctor about the pros and cons of testing
so they can decide if testing is the right
choice for them.
Men ≥45 years: should talk to a doctor
about the pros and cons of testing if
African American or have a father or
brother who had prostate cancer before
age 65.
How often they are tested will depend
on their PSA level.
Men 55-69 years:
make an individual
decision about whether to
be screened after a
conversation with their
clinician about potential
benefits and harm “C”
Men ≥70 years:
recommends against PSA
testing “D”
Digital rectal
examination
As for PSA; if men decide to be tested, they
should have the PSA blood test with or
without a rectal exam.
No individual recommendation
“C”: The USPSTF recommends selectively offering this service to individual patients based on
professional judgment. There is at least moderate certainty that the net benefit is small.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty
that the service has no net benefit or that the harms outweigh the benefits.
50. WHERE ARE WE RIGHT NOW IN
TERMS OF CANCER SCREENING?
51. CLINICAL SCENARIO at Service OPD:
• IM resident during Cancer Consciousness Week
• Giving a lecture to 30-50 people from low to no
income families on the benefits of cancer
screening
• What will you offer them?
52. Philippine Cancer Control Program
Administrative Order No. 89-A s. 1990, amending A.O. No. 188-A s. 1973
• National Cancer Prevention and Control Action Plan
(NCPCAP) 2015-2020:
1. POLICY AND STANDARDS DEVELOPMENT
– Development of “National Policy on the Integration of Palliative
and Hospice Care into the Philippine Health Care System”
– Development and Operationalization of National Cancer
Prevention and Control Website and Social Media Sites
– Development of “Comprehensive National Policy on Cancer
Prevention and Control”
– Establishment of National Cancer Center and Strategic Satellite
Cancer Centers
– Expansion of Philhealth Z Benefit Package Coverage to Other
Cancers
53. The reality is that more than 80% of Philippine families cannot
afford out-of- pocket expenses needed for basic medical care.
• Contrary to the continuing
misperception that most
Filipinos lack awareness that
certain common cancers are
curable when detected and
treated early, it could be that
due to socio-economic
realities, majority actually
have no choice.
54. Combined monthly income of those in the
poverty line : ≤ P9,000 / MONTH
• According to a controversial statement from
NEDA, a family of 5 would need around
P42,000 / month to live comfortably.
55. I
ESTIMATED PRICES OF SCREENING TESTS
(as of September 2018, c/o front desk personnel)
SCREENING
TEST
Private Hospital in
Alabang
De La Salle – UMC DLS-UMC Charity Rate
(with Social Service Help)
BREAST CANCER
Mammogram P3,594.00 P1,393.00 P1,114.00
COLORECTAL CANCER
Colonoscopy P16,000.00 plus PF P9,000.00 plus PF P9,000.00
Sigmoidoscopy P13,000.00 plus PF P9,000.00 plus PF P9,000.00
CT colography P24,552.00 None None
FOBT P480.00 P220.00 P180.00
CERVICAL CANCER
Pap smear (conventional) P1,600.00 plus PF P400.00 plus PF P200.00
Pap smear (cytology) P2,800.00 plus PF None None
HPV test P7,000.00 None None
Pap smear with HPV cotesting P8,600.00 plus PF None None
LUNG CANCER
Low dose helical CT scan P9,277.00 P6,550.00 P6,550.00
PROSTATE CANCER
PSA P4,780.00 P1,820.00 P1,456.00
* Philhealth coverage still deductible where applicable.
56. Philippine Cancer Control Program
Administrative Order No. 89-A s. 1990, amending A.O. No. 188-A s. 1973
• National Cancer Prevention and Control Action Plan
(NCPCAP) 2015-2020:
2. ADVOCACY AND PROMOTIONS
• National Cancer Consciousness Week
• Colon and Rectal Cancer Awareness Month
• Cancer in Children Awareness Month
• Cervical Cancer Awareness Month
• Prostate Cancer Awareness Month
• Lung Cancer Awareness Month
• Liver Cancer Awareness Month
• Breast Cancer Awareness Month
• Cancer Pain Awareness Month
In the Philippines, in
spite of nearly two
decades of
“Awareness
Campaigns”
conducted by the
public and private
sectors, such as those
on breast, cervix and
colorectal cancers,
majority of these
cancers are still not
diagnosed and treated
at an earlier, more
curable stage.
57.
58.
59. Philippine Cancer Control Program
Administrative Order No. 89-A s. 1990, amending A.O. No. 188-A s. 1973
• National Cancer Prevention and Control Action
Plan (NCPCAP) 2015-2020:
3. SERVICE DELIVERY
• Availability of Free Cervical Cancer Screening in all trained
RHUs
• Availability of cryotherapy equipment in every province (81
provinces)
• Availability and accessibility of screenings for selected
cancers in all trained RHUs
• School-based HPV vaccination of 9-13 year old females
• Hepatitis B vaccination for all health workers nationwide
60. Philippine Cancer Control Program
Administrative Order No. 89-A s. 1990, amending A.O. No. 188-A s. 1973
• Availability of Free Cervical Cancer Sceening in all
trained RHUs via Visual Inspection with Acetic Acid
(VIA)
– VIA:
• Uses bright white light to visualize the cervix with unaided eye
• Clean cervix with dilute 3-5% acetic acid solution
• Wait at least 1 minute
• Abnormal tissue temporarily appears white (acetowhite)
• Get IMMEDIATE results
• Alternative to cytology in screening for cervical cancer in poorly-
resourced locations
• Can be done by nurses/midwives/BHW trained to deliver the
service
– SERVICE OPD of OB at the DE LA SALLE – UMC:
• Service is FREE
• Pay P50.00 for the speculum to be used
• Additional ≈P500 for biopsy if with abnormal findings
VIA NEGATIVE
VIA POSITIVE
61. IN SUMMARY
• HIGH – MODERATE
INCOME SETTING
– Screen patient if
average risk / falls
under the screening
criteria
– Discuss risks and
benefits of cancer
screening
– Use ACS or USPSTF
Guidelines
• RESOURCE LIMITED
– Take advantage of
AWARENESS WEEKS to
score some freebies
– Refer to Service OPD
CANCER TEST
Breast (October) Mammogram
Colorectal
(March)
FOBT
Cervical (May) VIA c/o service OPD or
RHU
Prostate (June) -
Lung (November) -