Cancer screening and Early Detection

1. Cancer screening and Early Detection Eryn Quinn D.O. Internal Medicine Metro Health January 25, 2014

2. Disclosures The author has no financial disclosures related to this talk

3. Cancer in America • 1,660,000 annual diagnosis • 580,000 annual deaths • 1600 deaths per day • 170,000 deaths of the deaths attributed to smoking • About 180,000 cancer cases attributed to alcohol, overweight, inactivity, poor nutrition, HPV, Hep B, HIV, environmental factors

4. Female- 805,500 Breast 29% Lung 14% Colon 10% Uterine 6% Thyroid 6% Non- Hodgkin's 4% Melanoma 4% Renal 3% Pancreas 3% Ovary 3% Male -854,790 Prostate 28% Lung 14% Colon 9% Bladder 6% Melanoma 5% Renal 5% Oral cavity 3% Leukemia 3% Pancreas 3% 2013 Non skin-Cancer Cases

5. Female- 273,430 Lung 26% Breast 14% Colon 9% Pancreas 7% Leukemia 4% Non Hodgkin's 4% Uterine 3% Liver/ Billiary 2% Male- 306,920 Lung 28% Prostate 10% Colon 9% Pancreas 6% Liver/Billiary 5% Leukemia 4% Urinary Bladder 4% Non Hodgkin 3% Renal 3% 2013 Cancer deaths

6. 5 Year Survival Rates • Prostate 99% • Thyroid 98% • Melanoma 91% • Breast 89% • Colon 64% • Ovary 44% • Lung 16% • Pancreas 6%

7. Prevention • Don’t smoke • Don’t drink • Don’t become obese • Don’t be physically inactive

8. Lung Cancer • 228,000 annual diagnosis • 160,000 die annually • 80% plus caused by smoking • Other risk factors: Radon, environmental, Obesity, Heavy metals

9. Lung Cancer screening • CXR of Little help • Low radiation CT of chest • High risk population only • National Lung Cancer Screening Trial 2001 • age 55 to 74 • In fairly good health • Have at least 30 pk year history, and either still smoke or quit in the last 15 years

10. Lung Cancer Screening • Supported by : • American College of Chest Physicians • American society of clinical Oncology • American Thoracic Society • American Cancer Society • US Preventative Services Task Force • Affordable Care Act mandates that the Health Insurance Industry cover the screenings that are recommended by the USPSTF

11. Colo-rectal Cancer • Third most common cancer and the second leading cause of death • US incidence 147,000 cases diagnosed annually • US mortality 50,000 annually • Risk factors: Age,Race,DM type2,Obesity, Heavy alcohol use, smoking, family or personal history of polyps,IBD, Familial adenomitous polyposis, Hereditary non-polyposis colorectal cancer,Inherited syndromes • Screening not offered or not obtained

12. Colo-rectal Cancer Screening • Fecal Occult Blood • FIT test • Flex Sig • Double Contrast Barium Enema • CT Colonography • Fecal DNA • Colonoscope

13. Colorectal Cancer Screening • Colonoscope • Age 50 until 75ish?? • Needs to be done well • Test of choice

14. Colo-rectal Cancer Screening • American College of Gastroenterologist • Cancer prevention vs Cancer detection • African Americans should start colon cancer screening at age 45 • USPSTF • FOBT, FIT, Flex Sig, colonoscope • 50 to 75 ish • Individual cases may require earlier screening

15. Colo-rectal cancer screening • Offer and get a test done

16. Cervical cancer • 12,000 annual cases • 4, 000 annual deaths • Risks: • HPV • Early age of sexual activity • Smoking • Long term BCP

17. Cervical Cancer Screening • PAP test • Age 21-29 Every three years • Age 30-65 every three years or add HPV testing and screen every 5 years • Age 65/ or post hysterectomy with removal of the cervix, stop screening, if no prior significant abnormalities. • Support: ACOG, USPSTF,ACS,ASCCP • Remember Gardicil

18. Breast Cancer • 237,340 cases per year ( 2240 Men) • 40,000 deaths annually • Risks: • ERT- progesterone • Obesity • Etoh • Inactivity • Breast density • Hyperplasia on biopsy • Family history- BRCA 1&2 • Smoking

19. Breast Cancer Screening • Self and clinical breast exam • 20-39 every 3 years • 40 and over -yearly • Mammogram • 40 and over , until health declines- yearly- ACS • 50 -74 biennial - USPSTF

20. Breast Cancer Screening • Mammogram • Film- All • Digital-Young women and women with dense breasts • MRI with contrast • To help detect cases in very high risk only • Genetic testing • BRCA 1,2

21. Prostate Cancer • 2nd leading cause of cancer related deaths,most over age 75 • 1 in 6 will be diagnosed and 33-70% of these will never have cancer related symptoms • Significant Morbidity and some mortality associated with work up and treatment of Prostate cancer • 99% 5 ear survival

22. Prostate Cancer • Risk • Age • African American • Family History • Obesity- More aggressive Prostate Cancer • Fire Fighters • Prevention • Finasteride, Dutasteride

23. Prostate Cancer Screening • From The USPSTF 2012

25. Prostate Cancer Screening • Confused?? • Consider age, family history, Race • Screening must come with education • ACP • Education • Age 50-69 , they have life expectancy 10-15 years • Stop after 69 • Every 4 years unless PSA over 2.5 Age 40-45 for high risk African American, father or Brother with prostate cancer before age 65

26. Prostate Cancer Screening • American Urological Academy • Start Screening at age 40 for all • PLCO cancer screening trial • We are left with educating the patient and leaving it up to them. And hope the insurance will pay for the screening.

27. Other • Skin- 2 million cases annually • Testes • Ovaries/ Uterine • Thyroid • Oral cavity • Lymph nodes • Bladder

28. In Memory of Charlie