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CANCER SCREENING AND PREVENTION. Dr. Ajay Mehta MBBS, MD, DTCD, DPMR Sr. Consultant & HOD Department of Medical Oncology FORTIS HEALTHCARE. Fortis Hospital, Shalimar Bagh. CANCER SCREENING AND PREVENTION. HEADINGS CANCER FACTS CANCER GLOBAL BURDEN CAUSES OF CANCER

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slide1

CANCER SCREENING AND PREVENTION

Dr. Ajay Mehta

MBBS, MD, DTCD, DPMR

Sr. Consultant & HOD

Department of Medical Oncology

FORTIS HEALTHCARE

Fortis Hospital, Shalimar Bagh

slide3

CANCER SCREENING AND PREVENTION

  • HEADINGS
  • CANCER FACTS
  • CANCER GLOBAL BURDEN
  • CAUSES OF CANCER
  • 7 DANGER SIGNALS
  • SCREENING DEFINITION
  • SCREENING BASICS
  • PRINCIPLES OF SCREENING
  • COMMONLY SCREENED DIAGNOSIS
slide4

CANCER SCREENING AND PREVENTION

  • CANCER PREVENTION DEFINITION
  • LEVELS OF PREVENTION
    • PRIMARY PREVENTION
    • SECONDARY PREVENTION
    • TERTIARY PREVENTION
  • FUTURE TRENDS
facts about cancer
FACTS ABOUT CANCER
  • 70 – 80 % CANCER CASES ARE DETECTED AT LATE STAGE WHEN TREATMENT IS NOT POSSIBLE
  • EARLY DETECTION OF CANCER HELPS IN COMPLETE CURE OF SOME CANCER
  • PREVENTION BY TAKING SOME PRECAUTIONARY MEASURES IS THE BEST WAY TO PREVENT CANCER
by 2015

By 2015,

66 % of all cancers will be in

the developing world !

global scenario
GLOBAL SCENARIO

FEMALES

MALES

india scenario
INDIA: SCENARIO

Males

Females

Globocan database

what is cancer
What Is Cancer?
  • Cancer is a large group of diseases (over 200) characterized by uncontrolled growth and spread of abnormal cells.*

*American Cancer Society, Cancer Facts and Figures 2005

normal cell characteristics
NORMAL CELL CHARACTERISTICS:
  • Metabolism. Strictly controlled & predictable
  • Maturation & Specialisation. Occurrs before dividing. Strictly controlled.
  • Reproduction = Cell death
  • Contact Inhibition. Mechanism for switching off division when in contact with different cells
  • Recognition. Like cells stay together.
cancer cell characteristics
Cancer Cell Characteristics:
  • Unchecked & Uncontrolled Growth
  • Loss of contact inhibition
  • Loss of capacity to differentiate
  • Increased growth fraction
  • Chromosomal Instability
  • Capacity to metastasise
  • Altered biochemical properties
normal cells vs cancer cells
Normal Cells Vs. Cancer Cells
  • Cancer cells:
    • Lose control over growth and multiplication
    • Do not self-destruct when they become worn out or damaged
    • Crowd out healthy cells
growth of cancer cells
Size of cancer cells:

One million cancer cells = head of a pin

One billion cancer cells = a small grape

230 = 1,073,741,824 = 1 billion cells

GROWTH OF CANCER CELLS
  • Cancer cells reproduce every 2-6 weeks.

2-6 weeks

2-6 weeks

2-6 weeks

causes tobacco
CAUSES - TOBACCO
  • CIGARETTE SMOKING IS A MAJOR CAUSE OF CANCER
  • SMOKING MAY BE – ACTIVE OR PASSIVE – BOTH ARE HARMFUL
  • CONSUMPTION OF TOBACCO IN FORM OF KHAINI, ZARDA AND GHUTKA ALSO CAUSES CANCER
  • TOBACCO NOT ONLY CAUSES CANCER BUT ALSO OTHER DISEASES
causes betelnut
CAUSES – BETELNUT
  • BETELNUT CONTAINS CARCINOGENS
  • THE NUTS KEPT BURRIED IN THE GROUND FOR LOND PERIOD LEADS TO THE GROWTH OF FUNGUS WHICH IS CARCINOGENIC
  • PEOPLE CONSUMING BETELNUT ALSO HAVE THE HABIT OF CONSUMING TOBACCO
causes alcohol
CAUSES - ALCOHOL
  • ALCOHOL CONSUMPTION LEADS TO CANCER OF ORAL CAVITY, PHARYNX, LARYNX, ESOPHAGUS, STOMACH, LIVER
  • PEOPLE WHO DRINK ALSO SMOKES FURTHER INCREASING THE RISK OF DEVELOPING CANCER
causes fat fibre
CAUSES – FAT/FIBRE
  • HIGH INTAKE OF FAT (ANIMAL) INCREASES THE RISK OF DEVELOPING CANCER (BREAST AND COLON)
  • DIETARY FIBRE OF PLANT ORIGIN HAS A PROTECTIVE ROLE AGAINST CANCER
causes barbequed food
CAUSES – BARBEQUED FOOD
  • HIGH FAT AND HIGH PROTEIN FOOD WHEN GRILLED AT HIGH TEMPARATURE PRODUCES A CHEMICAL KNOWN TO BE HAVING CARCINOGENIC EFFECT
  • HIGHLY BROWN AND CHARRED FOOD HAS CANCER CAUSING COMPOUNDS
causes pollution
CAUSES - POLLUTION
  • AIR POLLUTION – MAY ALSO CAUSE CANCER (ASBESTOS)
  • INDUSTRIAL WORKERS ARE EXPOSED TO VARIOUS CHEMICALS WHICH ARE KNOWN TO BE CARCINOGEN
causes water pollution
CAUSES – WATER POLLUTION
  • WATER MAY CONTAIN A NUMBER OF CANCER CAUSING SUBSTANCE AS THE INDUSTRIES DUMP CHEMICAL DIRECTLY INTO WATER OR BURRY THEM IN THE GROUND
causes x ray
CAUSES – X-RAY
  • X-RAYS MAY STIMULATE THE DEVELOPMENT OF CANCER
  • REPEATED X-RAYS SHOULD BE AVOIDED
  • X-RAY DONE ON PREGNANT WOMEN MAY INCREASE THE FREQUENCY OF CHILDHOOD CANCER
causes virus
CAUSES - VIRUS
  • CERTAIN VIRUSES MAY CAUSE CANCER
  • THESE VIRUSES ARE – HEPATITIS –B & C, EPSTEIN BARR VIRUS, HUMAN PAPILLOMA VIRUS, CMV. Etc.
  • THESE VIRUSES CAN BE TRANSMITTED BY BLOOD TRANSFUSION, USE OF CONTAMINATED NEEDLES, FROM MOTHER TO CHILD DURING PREGNANCY OR BREAST FEEDING ANDTHROUGH SEXUAL INTERCOURSE
causes heredity
CAUSES - HEREDITY
  • FEW CANCER LIKE RETINOBLASTOMA (EYE), COLON CANCER ARISING FROM GENETICALLY CAUSED POLYPS
  • EVEN BREAST CANCER AND ESOPHAGEAL CANCER
how to detect disease early
HOW TO DETECT DISEASE EARLY

SEVEN DANGER SIGNALS

  • CHANGE IN BLADDER & BOWEL HABITS
  • SORE THROAT NOT HEALING
  • UNUSUAL BLEEDING OR DISCHARGE
  • THICKENING OR LUMP IN BREAST OR ANYWHERE
  • INDIGESTION AND DIFFICULTY IN SWALLOWING
  • OBVIOUS CHANGE IN WART OR MOLE
  • NAGGING COUGH OR HOARSENESS OF VOICE
cancer screening
CANCER SCREENING
  • Screening is the process whereby Asymptomatic Individuals are Tested to Detect a disease that is YET to be Symptomatic.

CRITERIA laid down for

  • - Disease in question
  • - Screening test
  • - Screening problem .
cancer screening1
CANCER SCREENING

Disease

  • natural history is well understood.
  • has a recognizable early stage .
  • Treatment at early stage is more successful than at late stage .
  • it is sufficiently common in target population to warrant screening.
cancer screening2
CANCER SCREENING

Test

  • Sensitive and specific .
  • Acceptable .
  • Safe .
  • inexpensive.
cancer screening3
CANCER SCREENING

Programme

  • adequate facilities for diagnosis in those with a positive test .
  • high quality of Treatment for screen detected disease .
  • benefit outweighs physical and psychological harm .
  • benefit must justify financial cost.
screening tests
SCREENING TESTS
  • Universal screening
    • Screening all individuals of a certain category (e.g. PKU screening in kids)
  • Case finding
    • Screening a small group of individuals based on the presence of risk factors (e.g cancer clusters, family members diagnosed with hereditary disease)
screening tests1
SCREENING TESTS
  • Biases
    • Lead time bias
    • Length time bias
    • Selection bias
    • Overdiagnosis bias

Avoid bias by using Randomized Control Trials (RCTs)

the principles of screening
THE PRINCIPLES OF SCREENING
    • The choice of disease for which to screen;
  • The nature of the screening test or tests to be used;
  • The availability of a treatment for those found to have the disease;
  • The relative costs of the screening
slide40

The disease must be an important health problem.

  • There should be a recognizable latent or early symptomatic stage.
  • The natural history of the disease, including latent to declared disease, should be adequately understood
screening tests2
SCREENING TESTS
  • Universal screening
    • Screening all individuals of a certain category (e.g. PKU screening in kids)
  • Case finding
    • Screening a small group of individuals based on the presence of risk factors (e.g cancer clusters, family members diagnosed with hereditary disease
screening tests3
SCREENING TESTS
  • Adverse effects
    • Stress and anxiety caused by false positive results
    • Unnecessary radiation/chemical exposure and test discomfort
    • Prolonged knowledge of a disease with no treatment
    • False sense of security over false negative results
    • Overuse of medical resources
screening tests4
SCREENING TESTS
  • Adverse effects
    • Stress and anxiety caused by false positive results
    • Unnecessary radiation/chemical exposure and test discomfort
    • Prolonged knowledge of a disease with no treatment
    • False sense of security over false negative results
    • Overuse of medical resources
screening tests5
SCREENING TESTS
  • Biases
    • Lead time bias
    • Length time bias
    • Selection bias
    • Overdiagnosis bias

Avoid bias by using Randomized Control Trials (RCTs)

commonly screened diagnoses
COMMONLY SCREENED DIAGNOSES
  • Cancer (Breast, lung, colorectal, prostate, pancreatic, cervical, ovarian, skin, testicular, thyroid)
  • Cardiovascular (AAA, Blood pressure, Lipid disorders, carotid artery stenosis, PAD)
  • Infectious disease (HIV, Hep B/C, STDs, Tuberculosis)
  • Injury and violence (domestic violence, Youth violence/gang activity, seatbelt use)
  • Mental health/substance abuse (Etoh, illicit drugs, tobacco, depression, suicide risk)
  • Endocrine/Metabolism (Diabetes, IDA, obesity, physical activity)
  • MSK –osteoporosis
  • OB/Gyn (Pre-eclampsia, Rh incompatibility, neural tube defects, asymptomatic bacteruria, Down’s syndrome)
  • Pediatrics (PKU, sickle cell disease, visual impairment, lead intoxication, hearing loss, dental caries)
introduction
INTRODUCTION
  • CANCER IS PREVENTABLE
  • 80 – 90% CANCER ARE DUE TO OUR HABITS AND ACTIVITIES
  • CANCER INVOLVES ALMOST EVERY PARTS OF THE BODY
  • CANCER CELLS MULTIPLY IN AN UNCONTROLLABLE & HAPAZARD MANNER
scenario
SCENARIO
  • CANCER IS THE CAUSE OF 12% OF ALL DEATHS
  • IN INDIA 1.5 – 2 MILLION ESTIMATED CANCER CASES AT ANY POINT OF TIME
  • EVERY YEAR 8 LAKHS NEW CASES ARE DETECTED IN INDIA
  • EVERY YEAR 5.5 LAKHS CANCER PATIENTS DIE IN OUR COUNTRY
cancer prevention
CANCER PREVENTION

LEVELS OF PREVENTION

1 PRIMARY PREVENTION .

2 SECONDARY PREVENTION .

3 TERTIARY PREVENTION .

cancer prevention1
CANCER PREVENTION
  • PRIMARY PREVENTION
  • Is when there is NO ABNORMALITY
  • OBJECTIVES
  • - Strengthening Healthy Lifestyle .
  • - Decreasing Weakness .
  • - Preventing and Minimizing Risk Factors of CARCINOGENESIS Exposure .
cancer prevention2
CANCER PREVENTION

SECONDARY PREVENTION

Is when Abnormality is found .

OBJECTIVES

- Early Diagnosis // Investigations for Abnormality .

- Assessment of Risk Groups .

- CANCER SCREENINGS .

- Early Detection .

cancer prevention3
CANCER PREVENTION

TERTIARY PREVENTION

EXAMPLES : Use of Vit. A in prevention of Lung Ca/Leukemias , Tamoxifen in Breast Ca/Uterine Ca.

presentation overview
Presentation Overview
  • Land Area 7.50 acre
  • Built-Up Area 3.50 Lac sq.ft.
  • No. of Floors 7 floors
  • ICUs 5