1. Cancer Prevention Eyad Alsaeed, MD,FRCPC Consultant Radiation Oncology PSHOC KFMC

2. PRIMARY PREVENTION Primary prevention avoids the development of a disease. Most population-based health promotion activities are primary preventivehealth promotion measures

3. SECONDARY PREVENTION  Secondary prevention activities are aimed at early disease detection, thereby increasing opportunities for interventions to prevent progression of the disease and emergence of symptoms. symptoms

4. Example :  Primary : Education  ENT : smoking, alcohol  Lung : smoking  Breast : obesity, Exercise,Alcohol, HRT  Colorectal :high fat, low fiber, high phos,low ca  Bladder :smoking,Dye worker,Schistosoma  Cervical : HPV, early Age of sexual activity, multiple sexual partner, smoking  Endometrial :obesity, Late menopause, null parity

5. Secondary prevention  Screen  The process by which unrecognized disease are identified by test that applied rapidly on a large scale.

6. Criteria considered important for a screening program to be valid  The disease is causing public health problem  Natural history well-known  The disease can be detected in precancerous stage or early stage  The treatment available for the early stage with less cost and morbidity.  High sensitivity test available  High specificity test available  Acceptable by the patient population and not morbid  Cheap 6

7. Types of screening  Mass screening: whole population  Multiple screening: use variety of screening test in the same occasion  Targeted screening: to a group of specific exposure  Case finding: patient who consult health practitioner for some other purpose 7

8. Disadvantage of screening  Cost  false +ve  False –ve  treating clinically occult disease  no available treatment  over treating of borderline  long period of morbidity  screening test hazard 8

9. Essential feature for screening program  TEST sensitive specific acceptable by the Pt. &Dr. safe cheap  Disease - high incidence - significant mortality &morbidity - well known natural history - detection in early stage and treatment alter the natural history - effective treatment available 9

10. GUILINES  Breast Cancer  Colorectal  Cervical  Prostate

11. Canadian Breast Cancer Screening Recommendations  Age 40-49  Breast Exam By Health Professionals q 2 years  Regular self Exam. And check up  Age 50-69 (20y)  Breast Mammogram q 2 years  Exam By Health Professional q 2 years  Regular self Exam. And check up  Age > 70  Breast Exam By Health Professional q 2 years  Regular self Exam. And check up 11

12. Saudi Arabia  - baseline mammogram and Breast Examination at age 40  - or 5 years less than first relative in family  - no signs or symptoms  US if age less than 35

13. Colorectal  Average risk per sons (age ~ 50 yrs,  a symptomatic, no FH):  colonoscopy q lOyr (preferred) or FOBT q 1yr + flexible sigmoidoscopy q 5yr or double- contrast barium enema q 5 yr

14. CONT.. Inflammatory bowel disease: colonoscopy q 1-2yrs, initiate 8 yr s after symptom onset if pancolitis or 15 yr s after symptom onset if L-sided colitis Family Hx (non-FAP/HNPCC): colonoscopy q 1-5yrs, initiate at age 40yrs or lOyrs prior to earliest cancer diagnosis in family

15. Cont..  Familial adenosis polyposis (lifetime cancer risk -100% by age 50): APC gene testing, early screening, colectomy or proctocolectomy after onset of polyposis  Hereditary nonpolyposis colorectal cancer: colonoscopy q 1-2 yr s, initiate at age 20-25 or 10 yrs younger than earliest cancer diagnosis in family

16. Cervical Cancer  Screening with Pap smear decreases mortality by 70%.  ACS recommends screening for all women who are sexually active or who are >18 yrs old . After 3 normal annual exams, screening may be performed less frequently

17. Prostatic cancer  Screening recommendations from the ACS include annual PSA & DRE beginning at age 50 if life expectancy is > 10 yr.  Men with a +FR & African Americans may begin screening at 40-45 yrs

18.  THANK YOU