Cancer Screening and Prevention

Screening Principles & Levels - Spotting Trouble Early

• Screening: Identifies apparently healthy individuals at ↑ risk of a disease. Early detection, not diagnostic.
• WHO Criteria (Key):
  • Important health problem.
  • Recognizable early stage.
  • Suitable, acceptable, valid test.
  • Effective treatment available.
  • Cost-effective; benefits > harm.
• Levels of Prevention:
  • Primordial: Prevent risk factor emergence (e.g., policies).
  • Primary: Prevent disease (e.g., HPV vaccine).
  • Secondary: Early detection via SCREENING (e.g., mammography).
  • Tertiary: Reduce complications (e.g., rehab).
  • Quaternary: Avoid overmedicalization.

⭐ Screening is Secondary Prevention, aiming to reduce mortality/morbidity by early detection.

Breast & Cervical Cancer - Guarding the Guardians

• Breast Cancer Screening:
  • SBE: Monthly >20 yrs.
  • CBE: Ages 25-39 (q1-3 yrs), ≥40 yrs (annually). (India: 30-65 yrs, q5 yrs).
  • Mammography: Annually 50-75 yrs; earlier if high-risk/CBE+.
• Cervical Cancer Screening:
  • Pap Smear: Ages 21-29 (q3 yrs).
  • Ages 30-65: Pap (q3 yrs) / HPV DNA (q5 yrs) / Co-test (q5 yrs).
    • (India: VIA 30-65 yrs, q5 yrs; Pap if VIA+).
• Key Prevention:
  • Cervical: HPV Vaccination (9-14 yrs ideal).
  • Breast: Healthy lifestyle, breastfeeding.

⭐ HPV types 16 & 18 are responsible for ~70% of cervical cancers and are targeted by vaccines.

Colorectal & Prostate Cancer - Gut & Gents Checks

Colorectal Cancer (CRC):

• Screening: Age 45-75 yrs (average risk). 📌 "Get your REAR in GEAR!"
• Tests:
  • FIT/gFOBT: Annually.
  • sDNA-FIT: q1-3 yrs.
  • Colonoscopy: q10 yrs (Gold Standard).
  • CT Colonography/Flex Sig: q5 yrs.
• High Risk (FAP, Lynch, IBD, Strong Fam Hx): Earlier, frequent. FAP: Sigmoidoscopy age 10-12. Lynch: Colonoscopy age 20-25.

Prostate Cancer:

• Screening: Shared decision. Discuss age 50+ (avg risk); 45+ (African American, +ve FamHx <65); 40+ (multiple 1st degree relatives).
• Tests: PSA +/- DRE.
• PSA > 4 ng/mL: Suspicious.

  ⭐ PSA is organ-specific, not cancer-specific; elevated in BPH, prostatitis.

Lung & Oral Cancer - Breath & Bite Patrol

• Prevention: Tobacco cessation is paramount for both.
• Lung Cancer Screening (LDCT):
  • Criteria: Age 50-80 yrs, ≥20 pack-year smoking history, current smoker or quit <15 yrs.
  • Schedule: Annual. Significantly reduces lung cancer mortality.
• Oral Cancer Screening (Visual Exam & Palpation):
  • Key Risks: Tobacco (all forms), heavy alcohol, betel quid, HPV.
  • Premalignant: Leukoplakia (white), Erythroplakia (red), Oral Submucous Fibrosis. Biopsy suspicious lesions.

⭐ Erythroplakia has a substantially higher malignant transformation rate (up to 50%) than leukoplakia.

General Prevention Strategies - Prevention Power-Ups

• Vaccination Power:
  • HPV vaccine: Prevents cervical, anal, oropharyngeal cancers.
  • HBV vaccine: Prevents hepatocellular carcinoma.
• Chemoprevention Shield:
  • Tamoxifen/Raloxifene: ↓ breast cancer risk in high-risk women.
  • Aspirin: ↓ colorectal cancer (CRC) risk in specific high-risk groups.
• Lifestyle Fortification:
  • Tobacco cessation: Crucial for multiple cancers.
  • Limit alcohol consumption.
  • Healthy diet: ↑ fruits, vegetables; ↓ processed/red meat.
  • Regular exercise & weight control.
  • Sun protection (UV exposure reduction).

⭐ Daily low-dose Aspirin is recommended for CRC prevention in individuals with Lynch syndrome (HNPCC) aged 40-70 years, typically 81-325 mg based on guidelines.

High‑Yield Points - ⚡ Biggest Takeaways

• Cervical Cancer: Screen women 30-65 yrs (Pap q3yr, HPV q5yr, or VIA/VILI per national guidelines).
• Breast Cancer: Mammography q2yrs for women 50-74 yrs; SBE/CBE awareness.
• Oral Cancer: Visual inspection for high-risk (tobacco users) vital in India.
• Colorectal Cancer: Screen from age 45-50 yrs (FOBT/FIT, colonoscopy).
• Lung Cancer: LDCT for high-risk smokers (age 50-80, >20 pack-years).
• Prevention: Tobacco cessation is paramount. HPV & HBV vaccination are crucial.