Screening for Breast, Cervical, Prostate and Lung Cancer

1. Screening for Breast, Cervical, Prostate and Lung Cancer Jo-Anna L. Rorie, PhD (c) Assistant Professor RHA Training Program Module 11

2. Definition of Cancer • What is cancer? • The body is made up of trillions of living cells. Normal body cells grow, divide, and die in an orderly way. During the early years of a person's life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out, damaged, or dying cells. • Cancer begins when cells in a part of the body start to grow out of control. There are many kinds of cancer, but they all start because of this out-of-control growth of abnormal cells. • http://www.cancer.org/Cancer/LungCancer-SmallCell/OverviewGuide/lung-cancer-small-cell-overview-what-is-cancer

3. Breast Cancer Screening

4. The Data • Not counting some kinds of skin cancer, breast cancer in the United States is: • The most common cancer in women, no matter your race or ethnicity. • The most common cause of death from cancer among Hispanic women. • The second most common cause of death from cancer among white, black, Asian/Pacific Islander, and American Indian/Alaska Native women. • http://www.breastcancer.org/symptoms/understand_bc/statistics.jsp

5. The Data 2011 estimates for US Women • 230,480 new cases of invasive breast cancer were expected to be diagnosed in 2011 • 57,650 new cases of carcinoma in situ (CIS) were expected to be found (CIS is non-invasive and is the earliest form of breast cancer). • About 39,520 deaths from breast cancer were expected in • http://www.breastcancer.org/symptoms/understand_bc/statistics.jsp

6. Who is at risk? • Research has found several risk factors that may increase your chances of getting breast cancer, including: • Getting older. • Being younger when you first had your menstrual period. • Starting menopause at a later age. • Being older at the birth of your first child. • Never giving birth. • Not breastfeeding • http://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm

7. Who is at risk? • Personal history of breast cancer or some non-cancerous breast diseases. • Family history of breast cancer (mother, sister, daughter). • Treatment with radiation therapy to the breast/chest. • Being overweight (increases risk for breast cancer after menopause). • Long-term use of hormone replacement therapy (estrogen and progesterone combined). • Drinking alcohol (more than one drink a day). • Not getting regular exercise • http://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm

8. Symptoms • Breast cancer symptoms vary widely — from lumps to swelling to skin changes — and many breast cancers have no obvious symptoms at all. Symptoms that are similar to those of breast cancer may be the result of non-cancerous conditions like infection or a cyst. • http://www.breastcancer.org/symptoms/

9. Screening • Diagnosis is a process than can take several weeks .Breast self-exam (BSE) should be part of your monthly health care routine, and you should visit your doctor if you experience breast changes. BSE is recommended for women beginning in their twenties.

10. Screening • Between ages 20-30 years you should have a clinical breast exam done by a health provider every 3 years.

11. Screening • If you're over 40 or at a high risk for the disease, you should also have an annual mammogram and physical exam by a doctor. The earlier breast cancer is found and diagnosed, the better your chances of beating it. • http://www.breastcancer.org/symptoms/

12. Screening • Mammogram. A mammogram is an X-ray of the breast. Mammograms are the best method to detect breast cancer early when it is easier to treat and before it is big enough to feel or cause symptoms. Having regular mammograms can lower the risk of dying from breast cancer. If you are age 50 to 74 years, be sure to have a screening mammogram every two years. If you are age 40–49 years, talk to your doctor about when and how often you should have a screening mammogram. • http://www.cdc.gov/cancer/breast/basic_info/screening.htm

13. Prostate Cancer American Cancer Society http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-what-is-prostate-cancer

14. About the Prostate • The prostate is a gland found only in males. It is located in front of the rectum and below the urinary bladder. In younger men, it is about the size of a walnut, but it can be much larger in older men. • The prostate's job is to make some of the fluid that protects and nourishes sperm cells in semen, making the semen more liquid. Just behind the prostate are glands called seminal vesicles that make most of the fluid for semen. The urethra, which is the tube that carries urine and semen out of the body through the penis, goes through the center of the prostate American Cancer Society http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-what-is-prostate-cancer

15. Who is at risk? • Age The chances of having prostate cancer rises rapidly after 50 2 out 0f 3 men over the age of 65 are found to have prostate cancer. • Race/ethnicity Prostate cancer occurs more often among African American men More likely to be diagnosed at an advanced stage African American men are 2-3 times more likely to die from prostate cancer than white men American Cancer Society http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-what-is-prostate-cancer

16. Who is at risk? • Family History Having a father or brother with prostate cancer more than doubles a man’s risk of developing the disease • Genes Recently studies have found some common genes variations have been linked to a higher risk of prostate cancer, however, gene testing for most genes changes is not yet avaialble • Diet The exact role of diet in prostate cancer is not clear. American Cancer Society http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-what-is-prostate-cancer

17. Who is at risk? • Obesity Relationship unknown-no firm conclusions • Smoking Relationship unknown-no firm conclusions • Sexually Transmitted Infections Relationship unknown-no firm conclusions Vasectomy Men who have had a vasectomy before the age of 35 may have a slightly higher risk of developing prostate cancer

18. Symptoms • In the early stages there are usually no symptoms. • In the more advanced stages-urinary frequency especially at night • In the very advanced cases-blood in urine or impotence • The symptoms can also be consistent with other conditions other than prostate cancer

19. Screening for Prostate Cancer • Screening should take place at age 50 for men with an average risk for prostate cancer and age 45 for men at high risk this includes African American men and men who have a first degree relative who had the disease at an earlier age. • http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-detection

20. Screening for Prostate Cancer • Screening includes a digital rectal examination and prostate-specific antigen (PSA) blood test. • Men with a PSA less than 2.5 may only need to be retested every 2 years • Men with a PSA greater than 2.5 should be tested yearly.

21. Cervical Cancer • Described by Papanicolaou in 1940’s • Malignant transformation of cervical epithelial cells • Begins in “Transformation Zone” “TZ” between original cervical canal glands & squamous cells lining the outer cervix “Squamocolumnar junction” or SCJ • Invasive cervical cancer final stage in a series of abnormal changes in cervical cells

22. The Data • Once # 1 now 10th in cancer-related deaths • 15,000 new cases per year • 4,800 will die of cervical cancer • Death rate decreased > 70% since 1950’s • African-American women STILL have 2Xs greater incidence rates compared to whites • ACOG Data

23. Early detection by Pap smear testing decreases cervical cancer-related deaths

24. Screening • Initial pap test and pelvic exam: -when sexual activity begins or by age 18 -then repeat yearly • Pap test may be performed less frequently in a low-risk woman at health care providers discretion after 3 or more consecutive, satisfactory annual exams with normal findings • ACOG Recommendations

25. Consider more frequent pap testing When • Multiple sexual partners or partner’s hx multiple partners • Sexual activity initiated at early age (<age 17) • Male partners whose partners have had cervical cancer • Current or prior hx of sexually transmitted infections: Gonorrhea Chlamydia HPV HSV HIV • Smokers, substance abuse, including alcohol • History cervical dysplasia • History cervical, vaginal, vulvar or uterine cancer • **low socio-economic status (marker for higher risk of developing cervical cancer)

26. Human Papilloma Virus • 90% of Squamous lesions associated with HPV • Type 16: most common 50% of moderate to severe SIL & cervical cancer AND in normal paps, therefore not specific

27. Lung Cancer

28. Lung Cancer Data • Lung cancer is the leading cause of cancer death in the U.S. It is the most common cancer in men and women combined, after skin cancer. Lung cancer (both small cell and non-small cell) is by far the leading cause of cancer death for both men and women. More people die of lung cancer than of colon, breast, and prostate cancers combined. Lung cancer is fairly rare in people under the age of 45. • The average lifetime chance that a man will develop lung cancer is about 1 in 13. For a woman it is 1 in 16. These numbers include both smokers and non-smokers. For smokers the risk is much higher, while for non-smokers the risk is lower. • http://www.cancer.org/Cancer/LungCancer-SmallCell/OverviewGuide/lung-cancer-small-cell-overview-what-causes

29. Lung Cancer Data • The American Cancer Society's most recent estimates for lung cancer (both small cell and non-small cell) in the United States are for 2012: • About 226,160 new cases of lung cancer (both small cell and non-small cell) • About 160,340 deaths from lung cancer

30. Who is at Risk? • Smoking is by far the leading risk factor causing 8 out 10 cases of lung cancer.

31. Symptoms • The most common symptoms of lung cancer are: • A cough that does not go away or gets worse • Chest pain, often made worse by deep breathing, coughing, or laughing • Hoarseness • Weight loss and loss of appetite • Coughing up bloody or rust-colored sputum (spit or phlegm) • Shortness of breath • Feeling weak or tired • Infections such as bronchitis and pneumonia that don’t go away or keep coming back • New onset of wheezing • http://www.cancer.org/Cancer/LungCancer-SmallCell/OverviewGuide/lung-cancer-small-cell-overview-diagnosed

32. Screening • Until recently, no lung cancer screening test had been shown to lower the risk of dying from this disease. Studies of 2 possible screening tests, chest x-ray and sputum cytology, did find that these tests detected lung cancers at an early stage, but neither test helped patients live longer. For this reason, major medical organizations have not recommended routine screening with these tests for the general public or even for people at increased risk, such as smokers. Recently, though, a different lung cancer screening test has been shown to help lower the risk of dying from this disease. • http://www.cancer.org/Cancer/LungCancer-SmallCell/DetailedGuide/small-cell-lung-cancer-detection