Friday 3 February 2012



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.

      

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