Breast and cervical cancer awareness

The presentation describes various facts about breast and cervical cancer including burden of disease, survival outcomes, need for early diagnosis and screening recommendations.

1. Breast and Cervical Cancer Awareness Dr Alok Gupta MD, DM, Consultant Medical Oncologist Max Super Speciality Hospital, Saket Ex-Asst. Professor, AIIMS, New Delhi

2. What is cancer?

3. World Cancer Epidemiology 14.1 million new cases every year. 8.2 million deaths every year (2 nd MC). 5 MC in India are breast, cervix, oral cavity, lung and colorectal (large intestine). 

4. Estimates for India

5. Problem Statement

6. Multifaceted Aspects of Cancer Management Pathogenesis/cancer development Cancer prevention/Risk factor modification Cancer screening/early detection Diagnosis and Treatment Surveillance and Cancer Survivorship

7. Multifaceted Aspects of Cancer Management Pathogenesis/cancer development Cancer prevention/Risk factor modification Cancer screening/early detection Diagnosis and Treatment Surveillance and Cancer Survivorship

8. What is Screening? Test and exam used to find a disease (like a pre-cancer or cancer) in people who do not have any symptoms. Examples.. Not a DIAGNOSTIC test Aim: Reduction of morbidity and mortality

9. Breast Cancer In India, 1 out of every 2 women diagnosed with breast cancer dies of this disease, mainly because the tumor is diagnosed too late.

10. Epidemiology

11. Problem Statement

12. Is screening feasible in breast cancer?

13. Survival in Breast Cancer

14. Benefits of screening for breast cancer Important public health problem/outcome vary with stage Early detection/stage migration 30% reduction in mortality

15. Methods of screening for breast cancer Breast-self examination Ultrasound Mammography MRI Clinical breast examination

16. Breast Self-Examination (BSE ) Potential Benefits Simple and non-invasive test Women gain a sense of control over their health Some breast cancer has been detected with BSE

17. Clinical Breast Examination (CBE )

18. Mammography Screening (asymptomatic) Diagnostic (symptomatic) Mammography

19. Mammography

20. Ultrasonography Useful adjunct to mammography Assist in suspicious lesion detected on mammography or physical examination Useful in the guidance of biopsies and therapeutic procedures. Originally, used as method of differentiating cystic from solid breast masses Limitations as screening test: Failure to detect microcalcifications Poor specificity (34%) Useful in detecting occult breast cancer in dense breasts . Highly operator-dependent

21. Magnetic Resonance Imaging (MRI) Explored in women at high risk and in younger women MRI found to be highly sensitive (99% when combined with mammography and CBE) An important adjunct screening tool for women BRCA1  or  BRCA2  mutations , identifying cancers at earlier stages. MRI has limited use as a screening tool: Cost. 10-fold higher cost than mammography Poor specificity (26%)  false-positive reads

22. Screening Recommendations for Average Risk Between 40–75 years – Annual CBE + Annual Mammography. Breast self-examination(BSE), start at 20 yrs, monthly. Clinical Breast Examination (CBE) 3 yearly, 20-40 years.

23. Screening Recommendations for High Risk (>20%) CBE 6 monthly, start at 25 years. MRI annually, start at 25 years. Mammography annually, start at 30 years. (6 monthly interval from MRI)

24. Cancer Cervix What is cervix? The cervix is the lower part of the womb also known as uterine cervix. The cervix connects the body of the uterus to the vagina(birth canal).

25. Epidemiology

26. Problem Statement

27. 90% 10% 90% 1% 0.1% Is it feasible to screen for Cancer Cervix?

28. Method - PAP (Cervical) Smear Test A cervical smear test is a simple procedure which involves gently scraping some cells from the surface of the cervix and putting them on a slide. The cells are then examined under a microscope in the laboratory to see if they are normal.

29. Timing of PAP Test

30. Benefit of screening in cervical cancer 70% reduction in cervical cancer deaths. Now ranks 14th for cancer deaths in developed world . 5-year survival rate is approximately 92%.

31. Screening Recommendations <21 years: No screening 21-30 years: PAP smear every 3 years 30-65 years: PAP smear every 3 years or PAP smear + HPV testing every 5 years >65 years: No screening

32. Summary Breast cancer followed by cervical cancer are the two most common cancers among women in India. If detected in early stage, >90% patients can be completely cured. Mammography can help in detecting breast cancer at an early stage/pre-cancerous stage. PAP test can help in detecting cervical cancer at an early stage/pre-cancerous stage.

33. THANK YOU