1. Fortis Hospital, Shalimar Bagh
CANCER SCREENING AND PREVENTION
Dr. Ajay Mehta
MBBS, MD, DTCD, DPMR
Sr. Consultant & HOD
Department of Medical Oncology
FORTIS HEALTHCARE
Fortis Hospital, Shalimar Bagh

3. CANCER SCREENING AND PREVENTION
HEADINGS
CANCER FACTS
CANCER GLOBAL BURDEN
CAUSES OF CANCER
7 DANGER SIGNALS
SCREENING DEFINITION
SCREENING BASICS
PRINCIPLES OF SCREENING
COMMONLY SCREENED DIAGNOSIS

4. CANCER SCREENING AND PREVENTION
CANCER PREVENTION DEFINITION
LEVELS OF PREVENTION
PRIMARY PREVENTION
SECONDARY PREVENTION
TERTIARY PREVENTION
FUTURE TRENDS

5. CANCER FACTS

6. FACTS ABOUT CANCER
70 – 80 % CANCER CASES ARE DETECTED AT LATE STAGE WHEN TREATMENT IS NOT POSSIBLE
EARLY DETECTION OF CANCER HELPS IN COMPLETE CURE OF SOME CANCER
PREVENTION BY TAKING SOME PRECAUTIONARY MEASURES IS THE BEST WAY TO PREVENT CANCER

7. CANCER GLOBAL BURDEN

8. 66 % of all cancers will be in the developing world !
By 2015,
66 % of all cancers will be in
the developing world !

9. GLOBAL SCENARIO
FEMALES
MALES

10. INDIA: SCENARIO
Males
Females
Globocan database

11. DELHI: SCENARIO

12. CANCER DEFINITION

13. What Is Cancer?
Cancer is a large group of diseases (over 200) characterized by uncontrolled growth and spread of abnormal cells.*
We use the term “cancer” to refer to a group of almost 200 different diseases. Our bodies are made up of about 30 trillion cells. The cells group together to form tissues and organs. Cancer can arise in any of those cells.
For example, stomach cancer is a different disease than breast cancer. It has different treatments, etc. There are even different types of breast cancer and skin cancer, etc.
*American Cancer Society, Cancer Facts and Figures 2005

14. Normal cell vs cancer cell

15. NORMAL CELL CHARACTERISTICS:
Metabolism. Strictly controlled & predictable
Maturation & Specialisation. Occurrs before dividing. Strictly controlled.
Reproduction = Cell death
Contact Inhibition. Mechanism for switching off division when in contact with different cells
Recognition. Like cells stay together.

16. Cancer Cell Characteristics:
Unchecked & Uncontrolled Growth
Loss of contact inhibition
Loss of capacity to differentiate
Increased growth fraction
Chromosomal Instability
Capacity to metastasise
Altered biochemical properties

17. Normal Cells Vs. Cancer Cells
Lose control over growth and multiplication
Do not self-destruct when they become worn out or damaged
Crowd out healthy cells

18. GROWTH OF CANCER CELLS Cancer cells reproduce every 2-6 weeks.
If cancer cells divide every month, it would be 2 1/2 years before one cancer cell grows into a small grape-sized tumor.
A person has usually had cancer for several years before it is detected and/or causes side effects.
Cancer cells reproduce every 2-6 weeks.
2-6 weeks
Size of cancer cells:
One million cancer cells = head of a pin
One billion cancer cells = a small grape
230 = 1,073,741, = 1 billion cells
2-6 weeks
2-6 weeks

19. CAUSES OF CANCER

20. CAUSES - TOBACCO CIGARETTE SMOKING IS A MAJOR CAUSE OF CANCER
SMOKING MAY BE – ACTIVE OR PASSIVE – BOTH ARE HARMFUL
CONSUMPTION OF TOBACCO IN FORM OF KHAINI, ZARDA AND GHUTKA ALSO CAUSES CANCER
TOBACCO NOT ONLY CAUSES CANCER BUT ALSO OTHER DISEASES

21. CAUSES – BETELNUT BETELNUT CONTAINS CARCINOGENS
THE NUTS KEPT BURRIED IN THE GROUND FOR LOND PERIOD LEADS TO THE GROWTH OF FUNGUS WHICH IS CARCINOGENIC
PEOPLE CONSUMING BETELNUT ALSO HAVE THE HABIT OF CONSUMING TOBACCO

22. CAUSES - ALCOHOL
ALCOHOL CONSUMPTION LEADS TO CANCER OF ORAL CAVITY, PHARYNX, LARYNX, ESOPHAGUS, STOMACH, LIVER
PEOPLE WHO DRINK ALSO SMOKES FURTHER INCREASING THE RISK OF DEVELOPING CANCER

23. CAUSES – FAT/FIBRE
HIGH INTAKE OF FAT (ANIMAL) INCREASES THE RISK OF DEVELOPING CANCER (BREAST AND COLON)
DIETARY FIBRE OF PLANT ORIGIN HAS A PROTECTIVE ROLE AGAINST CANCER

24. CAUSES – BARBEQUED FOOD
HIGH FAT AND HIGH PROTEIN FOOD WHEN GRILLED AT HIGH TEMPARATURE PRODUCES A CHEMICAL KNOWN TO BE HAVING CARCINOGENIC EFFECT
HIGHLY BROWN AND CHARRED FOOD HAS CANCER CAUSING COMPOUNDS

25. CAUSES - POLLUTION AIR POLLUTION – MAY ALSO CAUSE CANCER (ASBESTOS)
INDUSTRIAL WORKERS ARE EXPOSED TO VARIOUS CHEMICALS WHICH ARE KNOWN TO BE CARCINOGEN

26. CAUSES – WATER POLLUTION
WATER MAY CONTAIN A NUMBER OF CANCER CAUSING SUBSTANCE AS THE INDUSTRIES DUMP CHEMICAL DIRECTLY INTO WATER OR BURRY THEM IN THE GROUND

27. CAUSES – X-RAY X-RAYS MAY STIMULATE THE DEVELOPMENT OF CANCER
REPEATED X-RAYS SHOULD BE AVOIDED
X-RAY DONE ON PREGNANT WOMEN MAY INCREASE THE FREQUENCY OF CHILDHOOD CANCER

28. CAUSES - VIRUS CERTAIN VIRUSES MAY CAUSE CANCER
THESE VIRUSES ARE – HEPATITIS –B & C, EPSTEIN BARR VIRUS, HUMAN PAPILLOMA VIRUS, CMV. Etc.
THESE VIRUSES CAN BE TRANSMITTED BY BLOOD TRANSFUSION, USE OF CONTAMINATED NEEDLES, FROM MOTHER TO CHILD DURING PREGNANCY OR BREAST FEEDING AND THROUGH SEXUAL INTERCOURSE

29. CAUSES - HEREDITY
FEW CANCER LIKE RETINOBLASTOMA (EYE), COLON CANCER ARISING FROM GENETICALLY CAUSED POLYPS
EVEN BREAST CANCER AND ESOPHAGEAL CANCER

30. HOW TO DETECT DISEASE EARLY
SEVEN DANGER SIGNALS
CHANGE IN BLADDER & BOWEL HABITS
SORE THROAT NOT HEALING
UNUSUAL BLEEDING OR DISCHARGE
THICKENING OR LUMP IN BREAST OR ANYWHERE
INDIGESTION AND DIFFICULTY IN SWALLOWING
OBVIOUS CHANGE IN WART OR MOLE
NAGGING COUGH OR HOARSENESS OF VOICE

31. SCREENING DEFINITION

32. CANCER SCREENING
Screening is the process whereby Asymptomatic Individuals are Tested to Detect a disease that is YET to be Symptomatic.
CRITERIA laid down for
- Disease in question
- Screening test
- Screening problem .

33. CANCER SCREENING Disease natural history is well understood.
has a recognizable early stage .
Treatment at early stage is more successful than at late stage .
it is sufficiently common in target population to warrant screening.

34. CANCER SCREENING Test Sensitive and specific . Acceptable . Safe .
inexpensive.

35. CANCER SCREENING Programme
adequate facilities for diagnosis in those with a positive test .
high quality of Treatment for screen detected disease .
benefit outweighs physical and psychological harm .
benefit must justify financial cost.

36. SCREENING BASICS

37. SCREENING TESTS Universal screening Case finding
Screening all individuals of a certain category (e.g. PKU screening in kids)
Case finding
Screening a small group of individuals based on the presence of risk factors (e.g cancer clusters, family members diagnosed with hereditary disease)

38. Avoid bias by using Randomized Control Trials (RCTs)
SCREENING TESTS
Biases
Lead time bias
Length time bias
Selection bias
Overdiagnosis bias
Avoid bias by using Randomized Control Trials (RCTs)
Lead time bias: Diagnosing the disease earlier however having the same mortality as without screening
Length time bias: Slow growing tumors have the better prognoses than fast growing tumors, and screening tests more likely to detect these tumors that are more treatable anyway
Selection bias: -If patients with higher risk of disease are more likely to be screened, screening test results will look worse than they are
Overdiagnosis bias: Test may diagnose abnormalities that would never cause a problem in a person’s lifetime (i.e. prostate cancer)

39. THE PRINCIPLES OF SCREENING
The choice of disease for which to screen;
The nature of the screening test or tests to be used;
The availability of a treatment for those found to have the disease;
The relative costs of the screening

40. The disease must be an important health problem.
There should be a recognizable latent or early symptomatic stage.
The natural history of the disease, including latent to declared disease, should be adequately understood

41. SCREENING TESTS Universal screening Case finding
Screening all individuals of a certain category (e.g. PKU screening in kids)
Case finding
Screening a small group of individuals based on the presence of risk factors (e.g cancer clusters, family members diagnosed with hereditary disease

42. SCREENING TESTS Adverse effects
Stress and anxiety caused by false positive results
Unnecessary radiation/chemical exposure and test discomfort
Prolonged knowledge of a disease with no treatment
False sense of security over false negative results
Overuse of medical resources

43. ADVERSE EFFECTS

44. SCREENING TESTS Adverse effects
Stress and anxiety caused by false positive results
Unnecessary radiation/chemical exposure and test discomfort
Prolonged knowledge of a disease with no treatment
False sense of security over false negative results
Overuse of medical resources
Unnecessary secondary investigations for false positives

45. PITFALLS OR BIASES

46. Avoid bias by using Randomized Control Trials (RCTs)
SCREENING TESTS
Biases
Lead time bias
Length time bias
Selection bias
Overdiagnosis bias
Avoid bias by using Randomized Control Trials (RCTs)
Lead time bias: Diagnosing the disease earlier however having the same mortality as without screening
Length time bias: Slow growing tumors have the better prognoses than fast growing tumors, and screening tests more likely to detect these tumors that are more treatable anyway
Selection bias: -If patients with higher risk of disease are more likely to be screened, screening test results will look worse than they are
Overdiagnosis bias: Test may diagnose abnormalities that would never cause a problem in a person’s lifetime (i.e. prostate cancer)

47. COMMONLY SCREENED DIAGNOSIS

48. COMMONLY SCREENED DIAGNOSES
Cancer (Breast, lung, colorectal, prostate, pancreatic, cervical, ovarian, skin, testicular, thyroid)
Cardiovascular (AAA, Blood pressure, Lipid disorders, carotid artery stenosis, PAD)
Infectious disease (HIV, Hep B/C, STDs, Tuberculosis)
Injury and violence (domestic violence, Youth violence/gang activity, seatbelt use)
Mental health/substance abuse (Etoh, illicit drugs, tobacco, depression, suicide risk)
Endocrine/Metabolism (Diabetes, IDA, obesity, physical activity)
MSK –osteoporosis
OB/Gyn (Pre-eclampsia, Rh incompatibility, neural tube defects, asymptomatic bacteruria, Down’s syndrome)
Pediatrics (PKU, sickle cell disease, visual impairment, lead intoxication, hearing loss, dental caries)

49. CANCER PREVENTION DEFINITION

50. INTRODUCTION CANCER IS PREVENTABLE
80 – 90% CANCER ARE DUE TO OUR HABITS AND ACTIVITIES
CANCER INVOLVES ALMOST EVERY PARTS OF THE BODY
CANCER CELLS MULTIPLY IN AN UNCONTROLLABLE & HAPAZARD MANNER

51. SCENARIO CANCER IS THE CAUSE OF 12% OF ALL DEATHS
IN INDIA 1.5 – 2 MILLION ESTIMATED CANCER CASES AT ANY POINT OF TIME
EVERY YEAR 8 LAKHS NEW CASES ARE DETECTED IN INDIA
EVERY YEAR 5.5 LAKHS CANCER PATIENTS DIE IN OUR COUNTRY

52. LEVELS OF PREVENTION

53. CANCER PREVENTION
LEVELS OF PREVENTION 1 PRIMARY PREVENTION . 2 SECONDARY PREVENTION . 3 TERTIARY PREVENTION .

54. PRIMARY PREVENTION

55. CANCER PREVENTION PRIMARY PREVENTION Is when there is NO ABNORMALITY
OBJECTIVES
- Strengthening Healthy Lifestyle .
- Decreasing Weakness .
- Preventing and Minimizing Risk Factors of CARCINOGENESIS Exposure .

56. SECONDARY PREVENTION

57. CANCER PREVENTION
SECONDARY PREVENTION Is when Abnormality is found . OBJECTIVES - Early Diagnosis // Investigations for Abnormality . - Assessment of Risk Groups . - CANCER SCREENINGS . - Early Detection .

58. TERTIARY PREVENTION

59. CANCER PREVENTION
TERTIARY PREVENTION EXAMPLES : Use of Vit. A in prevention of Lung Ca/Leukemias , Tamoxifen in Breast Ca/Uterine Ca.

60. Visionary’s Dream

61. Our Values

62. Presentation Overview
Land Area acre
Built-Up Area Lac sq.ft.
No. of Floors 7 floors
ICUs 5

63. THANK YOU