February 4 is World
Cancer Day. Be aware and learn some facts about screening for Cancer.
SCREENING
– WHY, WHEN AND WHOM
Want
to stave off cancer? Just a few simple life-style changes would do, a research
has claimed. In fact, the research,
published in the ‘British Journal of Cancer’, found smoking is the biggest
lifestyle contributor to one’s risk of developing cancer. Apart from lung cancer, it has also been
linked to causing bladder, kidney, pancreatic and cervical cancer.
One
in 25 cancers is linked to a person’s job, such as being exposed to chemicals
or asbestos, while one in 33 is linked to infections, such as the human
papillomavirus (HPV), which causes most cases of cervical cancer.
In
men, 6.1% of cancer cases were linked to a lack of fruit and vegetables, 4.9%
to occupation, 4.6% to alcohol, 4.1% to overweight and obesity and 3.5% to
excessive sun exposure and sunbeds.
In
women, 6.9% were linked to overweight and obesity, 3.7% to infections such as
HPV, 3.6% to excessive sun exposure and sunbeds, 3.4% to lack of fruit and
vegetables and 3.3% to alcohol.
The
full list of 14 risk factors are – tobacco, lack of fruit and vegetables, being
overweight or obese, alcohol, excessive sun exposure and sunbeds, occupation,
infections, radiation, lack of physical exercise, lack of breast feeding,
hormones, red meat, lack of fibre and too much salt. Drinking alcohol is linked to a range of
cancers, including breast cancer, liver cancer and cancer of the oesophagus.
“Many
people believe cancer is down to fate or ‘in the genes’ and that it is the luck
of the draw whether they get it. Looking
at all the evidence, it’s clear that around 40% of all cancers are caused by
things we mostly have the power to change”.
Awareness
and Early Cancer Detection
All
too often, when the doctor utters the word ‘cancer’, what the patient hears is
“you are dying”. The fact is it need not
be so. Cancer is a dreaded disease, but
the fear often arises out of ignorance and misconceptions, rather than any
reality. One of the main problems in
India, in the control of cancer was lack of knowledge about lifestyles and
societal practices that caused 70 percent of its occurrence. With the highest incidence of cancers in the
head and neck regions for men and cervix and breast for women, many of these
cancers were preventable and curable had they been caught at an early stage.
According
to the World Health Organisation (WHO), most cases of cancer are detected only
in the advanced stages, when they are untreatable. This is especially true in developing
countries. The fact is that in the case
of Head and Neck cancers, Cervical cancer and Breast cancer, i.e., the most
common cancers in India, there are proven screening methods to catch the
disease at an early stage when it is curable.
The problem is that the patient at this stage is totally asymptomatic
and will not, in the normal course of affairs, consult a doctor. The need is for a patient-friendly,
non-invasive screening mechanism that would be effective enough to detect
cancer early, yet be non-intimidating so that people would be willing to come
in and be tested.
Oral
cancers show up in the form of white patches (leucoplakia), black patches
(melanoplakia), red patches (erythroplakia), submucous fibrosis 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.
What
is Cancer Screening?
Some
types of cancer can be found before they cause symptoms. Checking for cancer (or for conditions that
may lead to cancer) in people who have no symptoms is called screening. Screening can help doctors find and treat
some types of cancer early. Generally,
cancer treatment is more effective when the disease is found early. However, not all types of cancer have
screening tests and some tests are only for people with specific genetic risks.
When
breast cancer starts, it is too small to feel and does not cause signs and
symptoms. Mammograms help doctors look
for early signs of breast cancer. If
breast cancer is found early, it may be possible to treat it before it spreads.
Women
may have questions about when to start getting regular mammograms and about the
benefits and potential harms. Physicians
and other health care providers may also want to better understand the
scientific evidence about the use of screening mammograms.
Women
age 40 and older should have mammograms every 1 to 2 years. Women who are at higher than average risk of
developing breast cancer should talk with their health care providers about
whether to have mammograms before age 40 and how often to have them.
What is a mammogram?
A mammogram is an X-ray picture of the
breast.
Mammograms can
be used to check for breast cancer in women who have no signs or symptoms of
the disease. This type of mammogram is
called a screening mammogram. Screening
mammograms usually involve two x-ray pictures, or images, of each breast. The X-ray images make it possible to detect tumors
that cannot be felt. Screening
mammograms can also find microcalcifications (tiny deposits of calcium) that
sometimes indicate the presence of breast cancer.
Mammograms can also be used to check
for breast cancer after a lump or other sign or symptom of the disease has been
found. This type of mammogram is called
a diagnostic mammogram. Signs of breast
cancer may include pain, skin thickening, nipple discharge, or a change in
breast size or shape; however, these signs may also be indicators of benign conditions.
What
are the benefits of screening mammograms?
Early
detection of breast cancer with screening mammography means that treatment can
be started earlier in the course of disease, possibly before it has spread.
What
factors increase a women’s risk of breast cancer?
The
strongest risk factor for breast cancer is age.
A women’s risk of developing this disease increases as she gets
older. The risk of cancer, however, is
not the same for all women in a given age group.
Personal
history of breast cancer – Women who have had breast cancer
are more likely to develop a second breast cancer.
Family
history – A woman’s chance of developing breast cancer
increases if her mother, sister, and/or daughter have been diagnosed with the
disease, especially if they were diagnosed before age 50. Having a close male blood relative with
breast cancer also increases a woman’s risk of developing the disease.
Genetic
alterations (changes) – Inherited changes in certain genes
(for example, BRCA 1, BRCA 2, and others) increase the risk of breast
cancer. These changes are estimated to
account for no more than 10 percent of all breast cancers. However, women who carry certain changes in
these genes have a much higher risk of breast cancer than women who do not
carry these changes.
Breast
density – Women who have a high percentage of dense breast
tissue have a higher risk of breast cancer than women of similar age who have
little or no dense tissue in their breasts.
Women
who had their first full-term pregnancy after age 30 or who have never had a
full-term pregnancy are also at increased risk for breast cancer.
Long-term
use of menopausal hormone therapy – Women who use
combined estrogen and progestin menopausal hormone therapy for more than 5
years have an increased chance of developing breast cancer.
Radiation
therapy – Women who had radiation therapy to the chest
(including the breasts) before age 30 have an increased risk of developing
breast cancer throughout their lives.
This includes women treated for Hodgkin’s Lymphoma. Studies show that the younger a woman was
when she received treatment, the higher her risk of developing breast cancer
later in life.
Alcohol
– Studies indicate that the more alcohol a woman drinks, the greater her risk
of breast cancer.
Body
weight – Studies have found that the chance of getting
breast cancer after menopause is higher in women who are overweight or obese.
Physical
activity level – Women who are physically inactive
throughout life may have an increased risk of breast cancer. Being active may help reduce risk by
preventing weight gain and obesity.
What
is the best method of detecting breast cancer as early as possible?
Getting
a high-quality screening mammogram and having a clinical breast exam (an exam
done by a health care provider) on a regular basis are the most effective ways
to detect breast cancer early.
Checking
one’s own breasts for lumps or other unusual changes is called a breast
self-exam, or BSE. This type of exam
cannot replace regular screening mammograms or clinical breast exams.
Although
regular BSE is not specially recommended for breast cancer screening, many
women choose to examine their own breasts.
Women who do so should remember that breast changes can occur because of
pregnancy, aging, menopause, during menstrual cycles, or when taking birth
control pills or other hormones. It is
normal for breasts to feel a little lumpy and uneven. Also, it is common for breasts to be swollen
and tender right before or during a menstrual period. If a woman notices any unusual changes in her
breasts, she should contact her health care provider.
What
causes cervical cancer?
Almost
all cervical cancer is caused by an infection from a virus called HPV or human
papillomavirus.
HPV
infection is very common and is spread through sexual contact. Most people don’t know they have HPV because
they have no symptoms.
Most
HPV infections go away on their own, but some may not. If HPV does not go away, it can cause cell
changes. The Pap test can find these
changes before they become cervical cancer.
What
is a Pap Test?
The
pap test is a simple and routine way to find cell changes. During a Pap test the doctor or nurse will
collect a few cells from your cervix to send to a medical lab for testing. You can get the Pap test at your doctor’s
office, clinic, or community health centre.
Why
should I have a Pap test?
Sometimes
cells in a woman’s cervix begin to change and look abnormal. These abnormal cells may not be cancer
yet. But if you don’t have the cell
changes treated, the changes may become cancer.
Having Pap tests regularly gives you the best chance of finding cell
changes or cervical cancer early, when they are easy to treat.
The Pap test
checks for cell changes caused by HPV that could become cancer.
When
should I have a Pap test?
Have
your first Pap test about 3 years after the first time you have sex, or when
you reach age 21 (whichever comes first).
Keep
getting Pap tests every 1 to 3 years. If
you are 30 or older, an HPV test may be done along with the Pap test.
Talk
with your doctor or nurse about whether and when you should get a Pap test if
you are 65 or older.
A
note about HPV
HPV
is a virus that is spread through sexual contact. Condoms do not fully protect against HPV. You can be infected with HPV and not know it
because there are no symptoms. Most HPV
infections go away on their own, but some may not. The infections that do not go away can lead
to abnormal cell changes in the cervix.
Having Pap tests regularly can find these changes early and prevent cervical
cancer.
Did
you know that an HPV vaccine is available to girls and young women? This
vaccine had been shown to protect against some of the HPV types that cause
cervical cancer. Ask your doctor about
the HPV vaccine. Even if you get the
vaccine, you will still need to have Pap tests regularly.
When
can I stop getting a Pap test?
If
you are 65 or older, talk to your doctor about whether or not you should keep
having Pap tests. Your doctor will tell
you how often you should get one. This
will depend on the results of your previous tests, and whether you are sexually
active.
Screening
and Testing to Detect Colon and Rectal Cancer
Screening
methods to find colon or rectal changes, that may lead to cancer include
laboratory tests such as fecal occult blood tests (FOB) and imaging tests such
as sigmoidoscopy and colonoscopy.
Screening by the latter two tests can find precancerous polyps which can
be removed during the test and may find cancer early when it is most treatable.
Computerized
tomographic colonography, also known as virtual colonoscopy, is comparable to
standard colonoscopy, which uses a long, flexible tube with a camera to view
the lining of the colon, in its ability to accurately detect cancer and
precancerous polyps and could serve as an initial screening exam for colorectal
cancer.
Screening oneself
for cancer thus helps in earlier
detection of the disease thereby making treatments easier and also increasing
the chances for a complete cure.