PREVENTATIVE MEASURES FOR CANCER Flashcards
EXAMPLES OF NON-MODIFIABLE, ENVIRONMENTAL AND LIFESTYLE FACTORS ATTRIBUTING TO CANCER
NON MODIFIABLE: AGE, SEX, GENETICS………………..
ENVIRONMENT: POLLUTION, SECOND-HAND SMOKE, INFECTION, CHEMICAL EXPOSURE, RADIATION EXPOSURE……………..
LIFESTYLE: TOBACCO, DIET, OBESITY, OCCUPATION, UV EXPOSURE, ALCOHOL……………
EXAMPLES OF PREVENTATIVE MEASURES FOR CANCER
- GENETIC SCREENING
- SCREEINING FOR PRE-CANCEROUS CONDITIONS
- IMMUNISATIONS
- LIFESTYLE MODIFICATIONS
- ENVIRONMENTAL INTEREVENTIONS
HOW CAN THE GENETIC RISK OF CANCER BE EVALUATED? WHAT MAKES ONE MORE LIKELY TO BE GENETICALLY PREDISPOSED TO CANCER?
FAMILY HISTORY: 3+ RELATIVES, SAME SIDE OF THE FAMILY, SIMILAR CANCERS
FAMILY HISTORY OF EARLY CANCER: 2+ RELATIVES WITH EARLY CANCER DIAGNOSIS
MULTIPLE CANCER: 1 RELTIVE HAS 2+ TYPES OF CANCER
RARE CANCER: 1 RELATIVE WITH RARE CANCER
FAMILY FEATURES/INDICATIONS OF POSSIBLE BRCA GENE MUTATIONS?
- RELATIVE WITH MALE BREAST CANCER
- 2+ RELATIVES WITH BREAST CANCER < 50 Y.O.
- A RELATIVE WITH BILATERAL BREAST CANCER
% OF MALE BREAST CANCER CASES?
CCA 1%
RISK OF CANCER WITH BRCA MUTATIONS?
> 50% RISK OF BREAST CANCER BY 70 Y.O. (IN GEN POPULATION, 1/9 WOMEN WILL DEVELOP BREAST CANCER)
MANAGEMENT STRATEGIES WHEN BRCA MUTATION IS IDENTIFIED?
- PROPHYLACTIC BILATERAL MASTECTOMY
- OOPHORECTOMY
- ANTI-ESTROGEN DRUGS (E.G. TAMOXIFEN)
ISSUES WITH GENETIC SCREEING FOR CANCER?
- FAMILY TENSIONS, WHO DO YOU TELL?
- ANXIETY, UNCERTAINTY, WILL THE CANCER EVER ACTUALLY DEVELOP?
- FALSE SECURITY IF THERE IS NO MUTATION
- UNCLEAR RESULTS, WHAT DOES IT MEAN?
- DISCRIMINATION, DO I NEED TO TELL LIFE INSURANCE? EMPLOYMENT? (legally not required to tell insurance)
- VERY EXPENSIVE
DESCRIBE SCREENING FOR PREMALIGNANT DISEASE?
- IDENTIFY PEOPLE AT RISK (USUALLY BASED ON NON MODIFIABLE FACTORS)
- GOAL IS TO IDENTIFY EARLY CANCER OR PRE-CANCER
- CONDUCT NON INVASIVE RELATIVELY CHEAP TEST TO START WITH, IF SOMEONE INDICATIVE OF HAVING PREMALIGNANT CHANGE, IDEAL/DEFINITIVE TEST SHOULD BE PERFORED AND TREATMENT SHOULD FOLLOW
EXAMPLE OF PREMALIGNANT DISESE SCREENING - CERVICAL SCREENING?
CERVICAL SCREENING (SMEAR TEST)
- TARGET GROUP: PEOPLE WITH A CERVIX, AGED 25 TO 64
- FREQUENCY: EVERY 3 YEARS (25-49) OR EVERY 5 YEARS (50-64)
- INVITATION BY LETTER
- CERVICAL SAMPLE
- CHECK FOR HPV, CHECK FOR ABNORMAL CELLS
- FURTHER TRETMENT IF REQUIRED
EXAMPLE OF PREMALIGNANT DISESE SCREENING - BREAST CANCER
- TARGET: FEMALES AGED 50 TO 71
- EVERY 3 YEARS, LETTER INVITE
- EXAMINATION AND IMAGING (MAMMOGRAM OR ULTRASOUND)
- BIOPSY; CHECK FOR ABNORMAL CELLS
- FURTHER TREATMENT IF REQUIRED
EXAMPLE OF PREMALIGNANT DISESE SCREENING - BOWEL CANCER
- TARGET: ANYONE AGED 56, 60-74 Y.O. (OPTIONAL FOR 75+)
- EVERY 2 YEARS, POSTAL KIT SENT
- TEST STOOL SAMPLE, CHECK IF THERE IS BLOOD
- COLONOSCOPY IF NEEDED + TREATMENT IF REQUIRED
LIMITATIONS OF SCREEINING PROGRAMMES FOR PREMALIGNANT DISEASE?
- NOT EVERYONE ATTENDS SCREEINING
- SENSITIVITY VS SPECIFICITY, IMPERFECT TESTS
- CONSEQUENCES OF FALSE POSITIVES OR NEGATIVES (UNNECCESSARY TREATMENT, FALSE REASSURANCE)
- SPECIFIC CRITERIA NEED TO BE FULFILLED FOR A CONDITION TO QUALIFY FOR SCREENING (WILSON AND JUNGNER CRITERIA)
BASED ON WILSON AND JUNGNER CRITERIA, SHOULD THERE BE SCREEINING FOR PROSTATE CANCER? IS THERE PROSTATE SCREEING IN THE UK?
- NO PROSTATE SCREEINING IN THE UK
CRITERIA:
- IMPORTANT PROBLEM
- ACCEPTABLE TREATMENT
- FACILITIES FOR DIAGNOSIS AND TREATMENT
- EARLY STAGE DISEASE
- SUITABLE TEST
- ACCEPTABLE TEST
- CLEAR NATURAL HISTORY
- COST EFFECTIVE
THE ACEPTABLE TEST CRITERIA NOT SATISFIED: THE TEST (PSA TEST) FOR PROSTATE CANCER HAS A HIGH FALSE POSITIVE RATE (E.G. LEVELS OF PSA ARE RAISED IN SOMEONE WHO HAS RECENTLY HAD A UTI), AND THE NEXT STEP AFTER A POSITIVE TEST IS PROSTATE BIOPSY WHICH IS REALLY INVASIVE, PAINFUL AND COULD RESULT IN SEPSIS
THE CLEAR NATURAL HISTORY CRITERIA NOT SATISFIED: PROSTATE CANCER VERY SLOW GROWING AND IN MANY PATIENTS NEVER CAUSES PROBLEMS, MANY PATIENTS DIE WITH BUT NOT OF PROSTATE CANCER, NEVER REALISING THEY HAVE THE DISEASE (OVERTREATING, OVERDIAGNOSIS)
IMMUNISATIONS FOR CANCER PREVENTION?
SOME CANCERS ARE CAUSED BY CHRONIC INFECTIONS (MOSTLY VIRAL) (IMMUNISING AGAINST INFECTION CAN HELP PREVENT CANCER)
HPV –> CERVICAL CANCER
HEPATITIS B&C –> HEPATOCELLULAR CARCINOMA
EPSTEIN-BARR VIRUS –> NASOPHARYNGEAL CANCER, LYMPHOMA
HUMAN HERPESVIRUS 8 –> KAPOSI’S SARCOMA (IN IMMUNOSUPPRESSED INDIVIDUALS, USUALLY WITH HIV INFECTION)
BACTERIAL:
HELICOBACTER PYLORI –> GASTRIC CANCER
SCHISTOMA HAEMATOBILIUM –> BLADDER CANCER
