What Is Cancer?
Cancer is a disease that affects our body as well as our soul, it can arise anywhere in the body with differential and unpredictable behavior. Cancer in the head and neck region behaves very differently from the ones occurring in the breast. No two cancers follow the same pattern, further adding to the list of challenges in managing this disease. This leads to the validation of the age-old fundamental concept of prevention is better than cure.
As discussed previously, certain factors are modifiable, and if we improve our habits, we can certainly reduce the risk of developing cancer. Whenever we talk about cancer prevention, two common terms we come across are screening and early detection. Screening is merely testing apparently normal individuals who are at high risk of developing cancer. Early detection implies identifying cancer when it is still curable. Screening and early detection are of use if it detects cancer that is curable thereby improving survival. Currently, screening guidelines exist for breast cancer, cervical cancer, lung cancer, and colorectal cancer. To simplify, if these cancers are detected very early, one can be optimistic about the cure and life span like healthy individuals.
What Are the Ways to Screen and Prevent Breast Cancers?
It is the most common cancer in the world and our country. The lifetime risk of developing breast cancer in any female is 12.4 %. Nearly 90 % of breast cancer patients go beyond 5 years. As per the latest data, 62 % of breast cancers are identified when they are still limited to the breast. Also, the death rates have been reducing by 1.8 % per year. This is possible only because of increased awareness among females, advances in treatment modalities, and a reduction in treatment-related side effects.
Nowadays, many females themselves report to their doctor with a small lump in the breast. On most occasions, such a lump is benign (a growth that is not cancer). However, it is worth evaluating to identify cancer. Following are the factors which are associated with an increased risk of developing breast cancer:
- Prior history of breast cancer.
- Prior history of radiation to the chest.
- Family history (mother/sister/grandmother) of breast cancer.
- Certain benign breast diseases which have a higher chance of becoming cancerous in the future.
There are risk assessment models available online, which gives an estimate of developing breast cancer in the next 5 years. A score of less than 1.7 % is considered as high risk. For females above 35 years of age, who are at high risk, there are certain screening test recommended, which help in detecting this cancer early and prevent the wrath of advanced cancer.
Screening Methods:
- Bilateral Mammography – These are a special type of X-rays of the breast, done to identify abnormalities. Usually should not be advised for young individuals and is preferred in women above 40 years.
- Breast Self-examination – All women are advised to have a breast self-examination at least once. This is a safe method and if found anything suspicious it is always advisable to see your doctor, preferably an oncologist (cancer specialist).
- Clinical Examination – This examination is done by a doctor preferably who has experience in treating breast diseases, advisable in females above 40 years every 6 to12 months.
- Magnetic Resonance Imaging (MRI) – Commonly known as MRI, brother of CT scan, this imaging modality is not routinely recommended. It is usually advised for young females who are at a high risk of developing breast cancer. Whether a female should be doing this expensive scan should be at the discretion of a qualified expert.
What Are the Ways to Screen and Prevent Cervical Cancers?
Uterus (womb) is a female organ in which the child lives during pregnancy. This uterus opens into the vagina, the part which extends into the vagina is called the cervix. This cervix is located approximately 6-7 cm from the vaginal opening. Cancers arising in the cervix are prevalent, especially in developing countries like ours. As per the latest statistics, it is the 3rd most common cancer overall and 2nd most common cancer in females. The lifetime risk of developing cervical cancer in any female is 0.6 %. A female diagnosed with cervical cancer has approximately a 65 % chance of survival beyond 5 years. However, this number goes beyond 90 %, if the cancer is limited to the cervix. Thus justifying the need for early detection.
The most significant association of cancer is with human papillomavirus (HPV). Higher the presence of this virus, the higher the risk of developing this cancer. There is an approximate 20 % chance that any female has this virus in her genital tract. Factors that can lead to increased risk of harboring HPV are early age are:
- Having sexual intercourse at a young age.
- Multiple sexual partners.
- Giving birth to many children.
- Weakened immune system (HIV infection).
- Smoking.
- Poor genital hygiene.
There is a very high probability that the females are associated with at least one of the risk factors mentioned. Thus it becomes important that all females should get themselves screened and help the community in fighting and winning against this cancer.
Screening Recommendations:
- Age < 21 years - No test recommended, irrespective of associated risk factors. However, one can discuss the option of HPV vaccination in sexually inactive adolescent girls, though not a routine practice in our country. You can consult a cancer specialist doctor regarding the risks and benefits of the same. Also, girls should be educated about safe sexual practices, the ill effects of smoking, contraception, and maintaining personal hygiene.
- Age 21 to 29 years - Screening with cytology every 3 years is recommended for this age group. Cytology test is done by taking a Pap smear. In simple words, with the help of a brush or a spatula, cells from the cervix are collected and examined under a microscope for any abnormal-looking cells. A gynecologist (a doctor who specializes in diseases related to the female genital tract) usually performs this test.
- Age 30 to 65 years - There are two methods, cytology every 3 years or cytology and HPV testing every 5 years.
HPV vaccination is usually recommended for sexually inactive young girls aged 9 to 14 years, however for other age groups it can be considered. One should discuss with their doctor regarding feasibility and risk-benefit aspects. The major limitation of its widespread use is its cost.
What Are the Ways to Screen and Prevent Lung Cancers?
Lungs are sponge-like organs in our chest that are responsible for providing oxygen to the blood which is then transported to the entire body. This oxygen is essential for most of the functions carried out by the body. Smoking reduces the elasticity of the lungs and deposits various hazardous chemicals in the lungs. This deposition of chemicals irritates the lung to the extent that the cells become cancerous.
Lung cancer is the third most common cancer-related death in our country with a lifetime risk of 6.2 % chance of developing this illness. Smoking is the single most common associated risk factor with this cancer. Tobacco smoking accounts for 85 % of cancer-related deaths. Smoking is estimated to cause about 30 % of deaths due to cancer. The risk for lung cancer is 20 times higher for smokers compared to non-smokers.
Reduction in deaths from lung cancer can be achieved with timely screening. Overall chances of survival beyond 5 years are only around 20 %. However, if the cancer is limited to the lungs, the chances are around 50 %. Thus it is very important to identify your risk status and do a timely check-up so that this cancer is detected early and still curable. If you satisfy the following conditions, then it is important that you get yourself screened for lung cancer:
- Good physical condition and no specific chest complaints (cough or difficulty in breathing).
- Age between 50-75 years.
- More than 30 packs a year of smoking.
- Quit smoking for less than 15 years.
- Any additional risk factor like lung disease or history of radiation to the chest or exposure to chemicals or family history of lung cancer.
What Are the Ways to Screen and Prevent Colorectal Cancers?
The gastrointestinal tract is a long elastic tube that starts about 15 cm from the teeth and ends at the anus, the lowermost part between the buttocks. When we eat, the food passes through this tube and with the help of various chemicals called enzymes at different levels, the nutrients are extracted from that food whereas the remnant is passed as stools. The different parts of this tube are from the above esophagus (commonly called the food pipe), stomach, small intestine, large intestine (also called as the colon), rectum, and anal canal. There is a lot of similarity between the colon and rectum, hence often they are clubbed as colorectum.
Cancers in the colorectal region are common and usually related to the type of food we eat and family history. The basic principle lies in the fact, the longer the carcinogen (a substance that can result in cancer) is in contact with the colorectum, the higher the chances of cancer. Any food or activity that delays the motility and propelling activity of the colorectum is a harmful and potential cancer-causing agent. Important risk factors of colorectal cancers include:
- Red meat.
- Diabetes.
- Smoking.
- Sedentary lifestyle.
- A family history of colorectal cancer.
- Past history of inflammatory bowel disease (disease affecting the intestines which can turn cancerous with time).
- Polyps (swellings in the intestine that have the potential to become cancerous).
However, these polyps have variable behavior ranging from simple non-cancerous turning to dangerous ones which have a definite potential to become cancerous. The lifetime risk of developing this cancer is 4.2 %. The five-year chance of survival falls drastically from 90% for localized cancers to under 15 % for the ones which have spread to the entire body. It is recommended that individuals should be screened for this cancer because the early diagnosis has a significant impact on survival, tested patients have a 44 % lower risk of developing this cancer, and for every 1 % increase in colonoscopy rate, there is a 3 % decrease in deaths from colorectal cancer.
Different screening options are:
- Fecal Tests (Occult Blood / Immunochemical/ DNA based) - These tests are performed on stools and looked for blood and other known genetic mutations. To be done annually if negative.
- Flexible Sigmoidoscopy - It is a procedure in which the lower part of the large intestine is visualized using a camera. To be done every 5 years if negative.
- CT Colonography - It is a CT scan of the abdomen and pelvis with a special focus on the large intestine. To be done every 5 years if negative.
- Colonoscopy - It is a procedure in which the large intestine is visualized using a camera. To be done every 10 years if negative.
