Professional Documents
Culture Documents
Primary prevention: Finding and removing adenoma thus reducing Colorectal cancer
burden
Goal:
To reduce mortality and/or severity of the disease through early
detection and treatment.
Principles of screening
● Disease should be important health problem in terms of frequency
and/or severity.
Biases in screening
Lead time bias: (DPCP- Frequency of screening less than DPCP)
● Over diagnosis:
Diagnosis of a condition that would not have become clinically
significant had it not been detected by screening.
A. Breast Cancer
B. Cervical Cancer
C. Colorectal Cancer
D. Lung Cancer
E. Prostate Cancer
F. Genetic Screening
G. Indian Scenario
NCCN
BREAST CANCER
SCREENING
Women at Average Risk
Age 20-40 yrs:
CBE every 1-3 yrs.
Age ≥ 40 yrs:
Annual CBE + Annual screening mammography.
Ultrasound
BI-RADS 4-5
Age<30
Age≥30
BI-RADS 1-3
Mammogram
BI-RADS 4-5
NCCN
CERVICAL CANCER
SCREENING
● Cervical cytology alone is more
effective at detecting squamous cell
carcinoma.
● Women previously treated for CIN 2, CIN 3 should CONTINUE to have routine
screening for at least 20 yrs after treatment, because they remain at risk for
persistent or recurrent disease.
● Screening may be discontinued for women with an intact cervix who are older
than 65 yrs with negative previous results and with no history of abnormal
cervical cytology tests.
LSIL/HSIL/ASC-H Colposcopy
AIS
Colposcopy + Endometrial Biopsy
AGC
Management according to
Colposcopic Biopsy finding
Colposcopy
Lesion seen Lesion not seen
&Biopsy positive & Biopsy Negative
- Guaiac-based screening
- Immunochemical based testing annually
- Stool DNA test with high sensitivity ( interval for screening is
uncertain)
COLONOSCOPY
● A 10 yr interval is appropriate for average risk patients who had an
optimal procedure.
● Shorter intervals may be indicated based on the quality and
completeness of the colonoscopy.
● Colonoscopy has limitations and cannot detect all cancers and
polyps.
FLEXIBLE SIGMOIDOSCOPY
● May be performed alone or in combination with stool based
screening.
● Requires no sedation unlike colonoscopy and less bowel
preparation, but is limited to examination of the lower half of the
colon tract.
● Patients with lesions larger than 1cm should directly be referred for
colonoscopy since they are almost always adenomatous polyps.
COMPUTED TOMOGRAPHIC COLONOGRAPHY
● Also known as Virtual colonoscopy or CTC.
● Advantage of being noninvasive and not requiring sedation.
However,a positive finding requires colonoscopy and extra
colonic findings.
● Overall data suggests that CTC may be useful for the detection of
larger polyps however, it is still an evolving technology.
1. Age 55-74 yrs : 30 or more pack year history and if former smoker,
have quit within 15 yrs.
Annual screening recommended every 2 yrs.
2. Age < 50 yrs : 20 or more pack year history and additional risk
factors.
● DRE and PSA are the two components used in Prostate Screening.
● TRUS has been associated with a high false positive rate, making it
unsuitable as a screening tool.
● In 2010, ACS recommended that men make an informed decision about
whether to be screened for prostate cancer.
● If screening is done, it should begin at age 50 in men at average risk who
have a life expectancy of at least 10 yrs.
GENETIC SCREENING
ASCO GENETIC TESTING GUIDELINES 2010
Prostate I
Testis D
Cancer burden: India (GLOBOCAN 2012)
Current state of Cancer screening: India
Out of 809 women eligible for screening only 6.9% underwent screening
● Finding the cancer may or may not improve the person’s health
or help the person live longer.