SHORT DESCRIPTION ABOUT CANCER BY DR. ANAND SINGH BHADORIYA (MBBS)

1. Cancer
Prevention &
Screening
Dr Anand Singh Bhadoriya
MBBS
(GRMC, GWALIOR)

2. World Cancer Burden (2002)
 Of the 10 million new cancer cases seen each year
worldwide, 4.7 million are in the more developed
countries and nearly 5.5 million are in the less
developed countries.
 In developed countries, cancer is the second most
common cause of death, and epidemiological
evidence points to the emergence of a similar
trend in developing countries.
 In approximately 20 years time, the number of
cancer deaths annually will increase from about 6
million to 10 million.

3. Cancer Burden in India (2002)
 Cancer prevalence is approximately 2.5 million
 An estimated 850,000 New Cancer Cases are
diagnosed each year
 An estimated 580,000 deaths due to cancer occur
each year

4. The common sites for cancer in India
 Oral cavity, lungs, oesophagus and stomach in
males and
 Cervix, breast and oral cavity among females.

5.  Tobacco Related Cancers (oral cavity, pharynx,
larynx and lungs) account for 200,000 new cases and
140,000 deaths annually
 Cervix Cancer accounts for 132,000 new cases and
74,000 deaths annually
 Breast Cancer accounts for 83,000 new cases and
45,000 deaths each year
Cancer Burden in India (2002)

6.  Over 70% of the cases report for diagnostic and
treatment services in advanced stages of the
disease, resulting in poor survival and high
mortality rates.
 The disease is associated with a lot of fear and
stigma in the country.

7. Main Thrust Areas
IEC Programs
For risk prevention, life style modification and improving
health seeking behavior
Clinic and Community-based Screening
Programmes for Common Cancers
Health Manpower Development
For supporting the cancer control programmes of the Central
and State Governments
Advocacy, NGO-Training and Networking
Research
For developing newer methods and strategies for the
prevention and early detection of common cancers in India

8. IEC - Special Focus programs
• 8th March - International Women’s Day – Dedicated to
Cervix Cancer
• 31st May – World No Tobacco day
• 9th October – Breast Cancer day

9. IEC materials

16. Breast Self Examination Clinic

17. OBJECTIVES
1. Test the Efficacy of simple and low cost
techniques, performed by primary health
workers, in the early detection of Breast and
Cervix Cancers among low socioeconomic
women in the 35-64 years age group, thereby
reducing the incidence of and deaths due to
these cancers
2. Study the cost effectiveness and logistic
feasibility of such a program
3. Explore the feasibility of horizontal integration
of the program into the existing health care
services

18. 1,50,000 (35-64 age)
Intervention - 75000 Control - 75000
Health Education Programme,
Clinical Breast Examination
and VIA by trained PHWs at
24 months interval
Health Education Programme
Referral of screen +ves to TMC
Active Surveillance to collect
information on Breast & cervical
cancer incidence & mortality,
24 months intervals
Treatment, Follow up & monitoring
of incidence and mortality. Evaluation of down staging,
mortality reduction & cost
effectiveness
METHODOLOGY

20. Order within Chaos

21. Health Education Program

22. Simple arrangements for Community-based Screening

23. Visual Inspection Of Cervix After Application Of 4% Acetic Acid
(Photograph was taken with the woman’s consent)

24. VIA Chart used by the health workers
(developed by the IARC group)

25. CBE by Trained Primary Health Worker
(Photograph was taken with the woman’s consent)

26. Data Recording,
Storage, Entry and
Analysis

27. Crossectional Studies using a common protocol
11 in India and 5 in Africa (n = 56,939)
Test Positivity% Sensitivity%
(95% CI)
Specificity%
(95% CI)
PPV% NPV%
VIA 16.1 76.8
(74.2 – 79.4)
85.5
(85.2 – 85.8)
9.4 99.5
VILI 16.4 91.7
(89.7 – 93.4)
85.4
(85.1 – 85.7)
10.9 99.8

28. Results of Cross-Sectional Studies
Accuracy Of Screening Tests
Int J Cancer 2004; 110-907-13;
J Med Screening 2004; 11:77-84;
Int J Cancer 2004; 112: 341-7
Cancer Detect Prev 2004 (in press)
Screening
Test
Participants
(Sites)
Sensitivity %
(range)
Specificity %
(range)
Cytology 22633(05) 58(29-77) 95(89-99)
HPV 18065(04) 67(46-81) 94(92-95)
VIA 54981(11) 77(58-94) 86(75-94)
VIAM 16900(03) 64(61-71) 87(83-90)
VILI 49080(10) 92(76-97) 85(73-91)
VIA(+) or VILI (+) 49080(10) 94 81
VIA(+) and VILI(+) 49080(10) 79 89

29. Effective Treatment – Cryotherapy
(Osmanabad and Dindigul RCTs)
Lesion Cases Cure at 1
year
CIN 1 1137/1264 90%
CIN 2 & 3 184/234 79%

30. Effective Treatment – LEEP
(Osmanabad and Dindigul RCTs)
Lesion Cases Cure at 1
year
CIN 1 283/296 96%
CIN 2 & 3 288/336 86%

31.  Objective: Early Detection of Oral Cancer (Oral Exam)

32.  Objective: Early Detection of Cervix Cancer (VIA+VILI)

33. SCREENING GUIDELINES FOR TOBACCO SMOKERS
• There is no evidence that screening for lung cancer with
plain chest X-Ray or sputum cytology is effective.
• Strong evidence suggests that periodic screening with in
high-risk patients does not reduce mortality from lung
cancer.
• Besides radiography and sputum cytomorphologic
examination lack sufficient accuracy to be used in routine
screening of patients with a history of smoking.
• Plain X-Ray - Chest (Full Plate) may be advised in
symptomatic smokers. Spiral CT is experimental and may
be advised in certain cases. Clinical correlation of
radiological findings is extremely important in India due to
Pulmonary TB.
• Counseling against tobacco use should be given high
priority.

34. SCREENING GUIDELINES FOR ORAL TOBACCO/ PAN
MASALA/ ARECANUT USERS
• Although screening can lead to early detection, the two
most common methods of screening for oral cancer
(visual inspection and cytology) have not been shown to
reduce mortality from this disease.
• Mucosal erythroplakia, not leukoplakia, is the earliest sign
of oral cancer.
• Counseling against tobacco and alcohol use should be
given high priority.

35. Screening for Oral Cancer
 There are no international standards of methods or practices
for early detection of oral cancers, simply due to the fact that
these cancers are mostly found in developing countries,
particularly South Asian Countries.
 Simple oral examination with adequate light is a fairly good
screening method for the early detection of pre-cancerous
lesions of the oral cavity e.g. Leukoplakia, erythroplakia, non-
healing ulcers and oral sub-mucous fibrosis.
 Oral examination followed by indirect/ direct laryngoscopy if
needed is the standard procedure followed. Smokers are
also routinely investigated for pulmonary lesions by simple x-
ray of the chest.

36. SCREENING GUIDELINES FOR BREAST CANCER
• 30-65 years
• Breast Self Examination – Once a Month.
• Clinical Breast Examination – Once a Year.
• Mammography – Once a Year if available.
During BSE LOOK FOR
• Breast lumps (usually painless to begin with).
• Puckering/dimpling of skin over the breast.
• Nipple inversion/discharge.

37. SCREENING GUIDELINES FOR CERVIX CANCER
• 30-65 years – Once in 3-5 years
• Primary screening with VIA-VILI
• Test positives should receive Pap or HPV followed by
Colposcopy and treatment
Routinely Look For
• Post menopausal bleeding PV.
• Intermenstrual bleeding PV.
• Post-Coital bleeding PV.

38. SCREENING GUIDELINES FOR PROSTATE CANCER
DRE
• DRE has been one of the major screening methods for
the detection of prostate cancer, although its true value
as a screening tool has never been proven conclusively.
• The majority of studies on the use of DRE for prostate
cancer screening have been observational and have
yielded varying measures of sensitivity and survival.
None have shown that regular DRE screening reduces
mortality from prostate cancer.
• DRE should be done for all males above 50 years with
symptoms of prostate enlargement.

39. SCREENING GUIDELINES FOR PROSTATE CANCER
PSA
• Currently, use of the serum PSA as a screening tool for
prostate cancer is controversial.
• High false-positive (67 to 93%) leading to unnecessary
invasive diagnostic procedures.
• Data also suggest that PSA screening may very often
detect nonaggressive prostate cancer. The treatment of
such a cancer with RT or radical prostatectomy,
orchidectomy etc. may result in significant and
unnecessary morbidity.
• PSA should be done for all males above 50 years with
symptoms of prostate enlargement. The results should
be interpreted and discussed with the patients with
caution. Blood sample for PSA should always be
collected before DRE

40. SCREENING GUIDELINES FOR COLORECTAL CANCER
• High-risk patients are usually below 60 years with a
history of hereditary nonpolyposis colorectal cancer,
familial polyposis, ulcerative colitis, high-risk
adenomatous polyps or previous colorectal cancer.
Regular consumption of alcohol, tobacco and red meat
compound the risk.
• Fecal Occult Blood Test should be done for high risk
patients annually from the age 50.
• There is insufficient evidence to support screening with
the digital rectal examination (DRE), double contrast
barium enema or sigmoidoscopy/colonoscopy.
Colonoscopy can be be advised only after ruling out
amebiasis/ giardiasis/ shigellosis in India.

41. Thank You for Your Attention