Cancer and prevention - what we need to know

Screening and cancer prevention

1. Cancer and Cancer Prevention –
What you need to know?
Dr Sanjay M H
Rdaiation Oncologist
Senior Consultant – Sahyadri group
of hospitals
Pune, India

2. Cancer in IndiaCancer in India
•1 million 1 million new cases detected every yearnew cases detected every year
•3-3,50,000 die each year due to cancer3-3,50,000 die each year due to cancer
•500 % increase in cancer in India by 2025 500 % increase in cancer in India by 2025
(280% due to ageing & 220% due to (280% due to ageing & 220% due to
tobacco use)tobacco use)

3. What Is Cancer?

4. Loss of Normal Growth Control
Cancer
cell division
Fourth or
later mutation
Third
mutation
Second
mutation
First
mutation
Uncontrolled growth
Cell Suicide or Apoptosis
Cell damage—
no repair
Normal
cell division

5. Different Kinds of Cancer
Lung
Breast (women)
Colon
Bladder
Prostate (men)
Some common
sarcomas:
Fat
Bone
Muscle
Lymphomas:
Lymph nodes
Leukemias:
Bloodstream
Some common
carcinomas:

6. Malignant versus Benign Tumors
Malignant (cancer)
cells invade
neighboring tissues,
enter blood vessels,
and metastasize to
different sites
Time
Benign (not cancer)
tumor cells grow
only locally and cannot
spread by invasion or
metastasis

7. Why Cancer Is Potentially Dangerous
Melanoma
cells travel
through
bloodstream
Melanoma
(initial tumor)
Brain
Liver

8. What Causes Cancer?
Some viruses or bacteria
Heredity
Diet
Hormones
RadiationSome chemicals

9. Population-Based Studies
CANADA:
Leukemia
Regions of Highest Incidence
BRAZIL:
Cervical
cancer
U.S.:
Colon
cancer
AUSTRALIA:
Skin
cancer
CHINA:
Liver
cancer
U.K.:
Lung
cancer
JAPAN:
Stomach
cancer

10. Examples of Human Cancer Viruses
Some Viruses Associated with Human Cancers

11. Heredity and Cancer
Inherited factor(s)
All Breast Cancer Patients
Other factor(s)

12. 5 %
30 %
65 %
Economic spectrum in IndiaEconomic spectrum in India

13. Ratio of no. of qualified oncologists
to population in millions

14. 10 Most common Male Cancers10 Most common Male Cancers
TMH Registry, MumbaiTMH Registry, Mumbai
Lung: 696 (7.9)Lung: 696 (7.9)
Esophagus: 608(6.9)Esophagus: 608(6.9)
Leukemia: 598(6.8)Leukemia: 598(6.8)
B. mucosa: 598(6.8)B. mucosa: 598(6.8)
Pyriform: 505(5.7)Pyriform: 505(5.7)
Base tongue: 429(4.9)Base tongue: 429(4.9)
Lymphoma: 417(4.7)Lymphoma: 417(4.7)
Larynx: 373(4.2)Larynx: 373(4.2)
Stomach: 282(3.2)Stomach: 282(3.2)
Ant. tongue: 280(3.2)Ant. tongue: 280(3.2)
TOTAL: 8784TOTAL: 8784

15. 10 Most Common Cancers in Women10 Most Common Cancers in Women
TMH Registry, MumbaiTMH Registry, Mumbai
Breast: 1699(24.9)Breast: 1699(24.9)
Cervix: 1630(23.8)Cervix: 1630(23.8)
Ovary: 346(5.1)Ovary: 346(5.1)
Esophagus: 293(4.3)Esophagus: 293(4.3)
Leukemia: 269(3.9)Leukemia: 269(3.9)
B. mucosa: 217(3.2)B. mucosa: 217(3.2)
Lung: 152 (2.2)Lung: 152 (2.2)
Lymphoma: 140(2.0)Lymphoma: 140(2.0)
Thyroid: 137(2.0)Thyroid: 137(2.0)
Tongue: 132(1.9)Tongue: 132(1.9)
TOTAL: 6836TOTAL: 6836

16. Lung Cancer

17. Tobacco Use and Cancer
Some Cancer-Causing Chemicals in Tobacco Smoke

19. Lag Time
4000
3000
2000
1000
20-Year Lag Time Between
Smoking and Lung Cancer
Cigarettes
Smoked
per Person
per Year
Lung Cancer
Deaths (per
100,000 people)
Year
Lung
cancer
(men)
Cigarette
consumption
(men)
1900 1920 1940 1960 1980
150
100
50

21. Smoking Facts
•Tobacco use is the
leading cause of lung
cancer
•87% of lung cancers
are related to smoking
•Risk related to:
–age of smoking onset
–amount smoked
–gender
–product smoked
–depth of inhalation

23. Various forms of smokeless tobacco

26. Premalignant Lesions of the Oral
Cavity
Homogenous leucoplakia : Buccal Mucosa

29. Cervical cancer

30. Where is the cervix?

32. Natural History of HPV Infection
Within 1 Year 1-5 Years
Up to Decades
Initial
HPV
Infection
Persistent
Infection
CIN
2/3
Cervical
Cancer
CIN 1
Cleared HPV Infection

33. 33
Preventing Cervical Cancer
•Screening for precancerous changes (and
treatment if problems found) – PAP smear
test
•Vaccination against HPV

34. Human Papillomavirus Vaccines
•HPV4 (Gardasil)
–contains types 16 and 18 (high risk) and
types 6 and 11 (low risk)
•HPV2 (Cervarix)
–contains types 16 and 18 (high risk)
•Both vaccines are supplied as a liquid in
a single dose vial or syringe
•Neither vaccine contains an antibiotic or
a preservative

35. HPV Vaccine Schedule and Intervals
•HPV4- 0, 2, 6 months
•HPV2- 0, 1, 6 months
•ACIP recommends- 0, 1 to 2, 6 months
•ACIP has not defined a maximum
interval between HPV vaccine doses
•If the interval between doses is longer
than recommended continue the series
where it was interrupted

36. Types of Breast Tumours
BENIGN
MALIGNANT
(CANCER)
- Fibroadenoma
- Papilloma
LESS THAN 3% OF ALL BREAST LUMPS ARE CANCEROUS!

37. What about Breast Cancer?

38. Noncancerous Conditions
•Fibrocystic changes: Lumpiness, thickening and
swelling, often associated with a woman’s period
•Cysts: Fluid-filled lumps can range from very tiny to
about the size of an egg
•Fibroadenomas: A solid, round, rubbery lump that
moves under skin when touched, occuring most in
young women
•Infections: The breast will likely be red, warm, tender
and lumpy
•Trauma: a blow to the breast or a bruise can cause a
lump

39. How can a BC present?How can a BC present?

Mass or painMass or pain
in the axillain the axilla

Palpable massPalpable mass

ThickeningThickening

PainPain

Nipple dischargeNipple discharge

Nipple retractionNipple retraction

Edema or erythemaEdema or erythema
of the skinof the skin

40. What are the known risk factors for
Breast cancer?

41. Breast Cancer - Risk Factors
•Age
•Length of reproductive life –
•Age of first child birth- <20 or >35 years
•Nulliparity
•Heredity - Family history (Genetic predisposition)
(BRCA1 or BRCA2 mutation)
•Breast disease
- High fat diet (saturated)
- High dose &/ or duration of HRT/Oral
contraceptives
- Obesity, alcohol & stress

42. •Opportunity for woman to
become familiar with her
breasts
•Monthly exam of the
breasts and underarm
area
•May discover any changes
early
•Begin at age 20, continue
monthly
What is Breast Self Exam?

43. Imaging
Normal Breast Dense Breast
Clemons, M and Goss, P. NEJM 344 (4): 276-85, 2001.
 Mammography

44. MALIGNANCY LEFT BREAST

45. Spread of Breast
Carcinoma:

46. Early Cancer May Not Have Any Symptoms

47. Females
•Clinical breast/ gynec
examination
• Mammography once in 2
years baseline at 40 45, then
after 50 once in 2 years
• PAP Smear once in 3 years
after age 22- 65
• Colposcopy when indicated
• Ultrasound of pelvis
•Oral examination
Males
•Oral examination
•Digital rectal
examination for
Prostate/ PSA
•Stool for Occult blood /
Colonoscopy after 50
and every 3 years
•Xray chest? For
smokers ? Low dose CT
chest
Mass Screening
effort

48. In general – what are the lifestyle
changes that prevent cancer?

49. Limit Alcohol and Tobacco
40x
30x
20x
10x
Alcoholic Drinks
Consumed per Day
Packs of Cigarettes
Consumed per Day
Combination of Alcohol and Cigarettes
Increases Risk for Cancer of the Esophagus
Risk
Increase
AND

50. Diet: Limit Fats and Calories
0
Number of Cases
(per 100,000
people)
Grams (per person per day)
Correlation Between Meat Consumption and
Colon Cancer Rates in Different Countries
40
30
20
10
30020010080

51. Diet: Consume Fruits and Vegetables

52. Exercise………..

53. Industrial Pollution
1930
Incidence of
Most Cancers
Year
199019701950

54. •In summary
•Cancer can be prevented by leading a
moderate lifestyle and taking care of
yourself
•Listen to any changes in your body
•Ask for a cancer screening package
next time you get your cardiac testing
done
•Remember cancer is better to prevent
than treat