A brief description on screening of breast, cervical, and oral cancer and their various components including who to screen, when to screen, where to screen, who will screen, and what will be the consequences if comes screen positive

1. Breast, Oral, and
Cervical Screening and
Management

2. Epidemiology
• Cancer along with
1) Cardiovascular diseases,
2) Diabetes, and
3) Chronic respiratory diseases
and other illnesses like Injuries, genetic
diseases etc. are classified as Non-
communicable Diseases, popularly known as
NCDs.

3. 1. Source:- Operational Guidelines NPCDCS, Govt. of India, New Delhi

4. National Programme for Prevention and
Control of Cancer, Diabetes,
Cardiovascular Diseases and Stroke

5. Why Cancer or Particularly Breast,
Cervical and Oral Cancer
• Why cancers in general ?
It is predicted that the no. of cases of cancer
in India is projected to be 1.5 mn in the year
2035 and because the odds of having OOP
(Out of Pocket Expenditures) are very high as
compared to other disease conditions.

6. • The expenses that the patient or the family
pays directly to the health care provider,
without a third-party (insurer, or State) is
known as 'Out of Pocket Expenditure' (OOP).
• Catastrophic health expenditure(CHE)
is defined as OOP spending for health care
that exceeds a certain proportion of a
household's income (e.g., 30% of annual
household income known as CHE30) with the
consequence that households suffer the
burden of disease.

7. • Together these 3 cancers (breast, cervical, and
oral) accounts for 34% of all cancer related
morbidity and mortality.

8. Cervical Cancer
1. Target Population:-
2. Method:-
3. Who can do it:-
4. At what frequency it should be
done:-
5. What to do if comes positive:-

9. Target Population
• Any women aged 30 years and above and not
meeting the following criteria:-
Menstruation Pregnancy
Within 12 weeks of
delivery/abortion
Previous h/o
treatment for
Cancer Cervix
Exclusion
Criteria

10. Method
Explain the
procedure to the
women and take
consent
Make the women
lie down on her
back with her legs
folded.
Insert the
speculum gently
and expose the
cervix.
Note any abnormal
discharge, bleeding
or growth in the
cervix.
Apply 3-5% freshly prepared
Acetic acid with a cotton
swab on the mouth of
cervix and wait for 1 min.

12. • Interpretation:- Depends upon the color
changes observed on the cervix.
VIA Negative VIA Positive

14. Who can do it
• Any trained paramedical health worker and
not necessarily a doctor can perform this
procedure.

15. At what frequency it should be done
• Every 5 years if it comes negative till women is
65 years of age and if positive, the following
algorithm should be followed:-

16. What to do if comes positive

17. Breast Cancer
1. Target Population:-
2. Method:-
3. Who can do it:-
4. At what frequency it should be
done:-
5. What to do if comes positive:-

18. Target Population
• Any women aged 30 years and above .

19. Method-CBE (Clinical Breast
Examination)
Inspection
For any change In
symmetry, shape, size
and skin changes like
dimpling, retractions.
Palpation
For any discharge,
swelling, lumps, and
tenderness.
Interpretation

20. • Interpretation:-
1) Normal/Negative:- No abnormalities on
visual inspection and palpation.
2) High Risk:-
a) Target women with family h/o
Breast/Ovarian/Colon Cancer.
b) H/o Chronic Benign Breast Diseases.
c) Personal H/o breast cancer in the same or
the opposite breast.

21. 3) Abnormal:- Definite asymmetrical finding on
palpation or inspection which could be:-
Probably Malignant Probably Non-Malignant
Discrete hard lumps in the breast Other lumps in the breast
Recent nipple distortion or retraction Non bloody discharge in the breast
Skin dimpling or ulceration
Blood stained nipple discharge

22. Who can do it
• A trained Physician or a Staff Nurse/ Auxiliary
Nurse Midwife or a Health worker.

23. At what frequency it should be done
• American college of Obstetricians and
Gynaecologists(ACOG) recommends CBE at
intervals of 1-3 years for asymptomatic,
average-risk women aged25-39 years and
annually for asymptomatic, average-risk
women aged >=40 years.

24. What to do if comes positive

25. Oral Cancer
1. Target Population:-
2. Method:-
3. Who can do it:-
4. At what frequency it should be
done:-
5. What to do if comes positive:-

26. Target Population
• Any individual aged 30 years and above.

27. Method-Oral Visual Examination
• Any ulcer (painful or painless), mass, fissure,
patch, plaque seen in the oral cavity should be
seen in suspicion with keeping these Pre-
cancerous lesions in mind:-
I. Erythroplakia.
II. Leukoplakia.
III. Palatal changes.

28. Leukoplakia Erythroplakia
Whitish Patch that can’t be
characterized as any other disease.
Bright, velvety area sometimes
surrounded by faint plaques which can’t
be characterized by any other disease.
Risk of Malignancy is lower than
Erythroplakia.
Risk of Malignancy is Higher than
Leukoplakia.
Homogenous variety is having Low risk
of cancer but Ulcerated/Erosive,
Speckled/Nodular, Verrucous variety is
having high risk of cancer.
About 90% of these lesions show
cellular dysplasia or malignancy.

29. Who can do it
• ASHA/Health worker/NCD Nurse/ANMs will
collect responses from Self-administered
Questionnaire.
• Further Evaluation by Dentist/Surgeon/ENT
specialist/MO at PHC/CHC/DH.

30. At what frequency it should be done
• Biannualy as recommended by Centre for
Disease Control, USA.

31. What to do if comes positive