Why Bother for Cancer Screening?

It is true that many people are not getting the recommended cancer screening tests! This is due to deficiency of adequate infrastructure and cancer support care as well as management of infectious and other non-communicable diseases (chronic respiratory, diabetes, and cardiovascular diseases).

Dr Mahesh Sultania says Cancer prevention strategies for the most common types of cancer like breast, stomach, lung, colorectal and prostate can control the cancer mortality and morbidity. Do you that the Indian government had published an operational framework for the first national cancer screening in 2016? It required mandatory screening of oral, breast, and cervical cancer in people who are above 30+. The cancers of the breast, uterine cervix and oral cavity have accounted for 34% of all cancers in India so the operational framework has declared prevention of these cancers as a public health priority.

What should be the Cancer Preventive and Awareness Strategies?

Making lectures, cancers screening camps and clinics, part of preventive strategy can reduce the incidence and prevalence of cancer.

Lectures: Holding lectures will make general population realise that most of the fear is due to lack of knowledge. People need to be told that cancer is preventable; can be detected at an early stage and cured. Lectures also cover general information about cancer, causes and risk factors, myths regarding the disease, changes in lifestyle and strategies of prevention of cancer.

Cancer Screening Camps: Most cancers are detected only in the advanced stages when they are untreatable. There are proven methods to detect most common cancer cases in India (Oral cancers, Cervical cancer and Breast cancer) at an early stage when it is curable. Major problem is that the patient at this stage is totally asymptomatic and will not, in the normal course of affairs, consult a doctor. Screening tests are patient-friendly, a non-invasive mechanism that would be effective enough to detect cancer early, yet be non-intimidating so that people would be willing to come in and get tested. The screening consists of examination by our panel of doctors including a surgeon, a physician, a gynaecologist and an ENT specialist. A blood sample may also be taken.

Cancer Screening Clinics: Oral cancers show up in the form of white patches (leucoplakia), black patches (melanoplakia), red patches (erythroplakia) and difficulty in fully opening the mouth. These can be easily detected during an oral examination. Cervical cancer can be detected through a Pap smear, a painless test, which involves scraping cells from the cervix during a pelvic examination. A microscopic examination of the smear can identify abnormal cells even in a pre-cancerous stage (dysplasia). A firm lump, small changes or discharge from the nipples are early signs of breast tumour.

Name some Screening Tests That Have Led to the Reduction in Cancer Deaths

• Mammography - This method to screen for breast cancer has been shown to reduce mortality from the disease among women ages 40 to 74, especially 50 or older.
• Pap test and human papillomavirus (HPV) testing - These tests reduce the incidence of cervical cancer because they allow abnormal cells to be identified and treated before they become cancer. They also reduce deaths from cervical cancer. Testing is generally recommended to begin at age 21 and to end at age 65, as long as recent results have been normal.
• Colonoscopy, sigmoidoscopy, and high-sensitivity fecal occult blood tests (FOBTs) - These tests have all been shown to reduce deaths from colorectal cancer. They can detect abnormal colon growths (polyps) that can be removed before they develop into cancer. Expert groups generally recommend that people who are at average risk for colorectal cancer have screening at ages 50 through 75.
• Low-dose helical computed tomography - This test to screen for lung cancer has been shown to reduce lung cancer deaths among heavy smokers ages 55 to 74.

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What are the Other Screening Tests for Cancer?

• Oral Examination – Oral examination for any white or red patch, reduced mouth opening and any ulcer can reduce cancers of buccal mucosa, tongue and other regions of an oral cavity.
• Alpha-fetoprotein blood test - This test is sometimes used, along with ultrasound of the liver, to try to detect liver cancer early in people at high risk of the disease.
• Breast MRI - This imaging test is often used for women who carry a harmful mutation in the BRCA1gene or the BRCA2 gene; such women have a high risk of breast cancer, as well as increased risk for other cancers.
• CA-125 test - This blood test, which is often done together with a transvaginal ultrasound, may be used to detect ovarian cancer early, especially in women with an increased risk of the disease. Although this test can help in diagnosing ovarian cancer in women who have symptoms and can be used to evaluate the recurrence of cancer in women previously diagnosed with the disease, it has not been shown to be an effective ovarian cancer screening test.
• Clinical breast examination and Self-breast examination - Routine examination of the breasts by health care providers or by women themselves has not been shown to reduce deaths from breast cancer. However, if a woman or her health care provider notices a lump or other unusual change in the breast, it is important to get it checked out
• PSA test - This blood test, which is often done along with a digital rectal exam, is able to detect prostate cancer at an early stage. However, expert groups no longer recommend routine PSA testing for most men because studies have shown that it has little or no effect on prostate cancer deaths and leads to overdiagnosis and overtreatment.
• Skin examination - Doctors often recommend that people who are at risk for skin cancer examine their skin regularly or have a health care provider do so. Such exams have not been shown to decrease the risk of dying from skin cancer, and they may lead to overtreatment. However, people should be aware of changes in their skin, such as a new mole or a change in an existing mole, and report these to their doctor promptly.
• Transvaginal ultrasound - This imaging test, which can create pictures of a woman’s ovaries and uterus, is sometimes used in women who are at increased risk of ovarian cancer or of endometrial cancer. But it has not been shown to reduce deaths from either cancer.