Screening for Breast, Cervical, Prostate and Lung Cancer Jo-Anna L. Rorie, PhD (c) Assistant...

Screening for Breast, Screening for Breast, Cervical, Prostate and Cervical, Prostate and

Lung CancerLung CancerJo-Anna L. Rorie, PhD (c)Jo-Anna L. Rorie, PhD (c)

Assistant ProfessorAssistant ProfessorRHA Training Program RHA Training Program

Module 11Module 11

Definition of CancerDefinition of Cancer

What is 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

Breast Cancer ScreeningBreast Cancer Screening

The DataThe Data

Not counting some kinds of skin cancer, breast cancer Not counting some kinds of skin cancer, breast cancer in the United States is:in the United States is:

The most common cancer in women, no matter your The most common cancer in women, no matter your race or ethnicity. race or ethnicity.

The most common cause of death from cancer among The most common cause of death from cancer among Hispanic women. Hispanic women.

The second most common cause of death from cancer The second most common cause of death from cancer among white, black, Asian/Pacific Islander, and among white, black, Asian/Pacific Islander, and American Indian/Alaska Native women.American Indian/Alaska Native women.

http://www.breastcancer.org/symptoms/understand_bc/statistics.jsphttp://www.breastcancer.org/symptoms/understand_bc/statistics.jsp

The DataThe Data

2011 estimates for US Women2011 estimates for US Women 230,480 new cases of invasive breast cancer were expected 230,480 new cases of invasive breast cancer were expected

to be diagnosed to be diagnosed in 2011in 2011 57,650 new cases of carcinoma in situ (CIS) were expected to 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 be found (CIS is non-invasive and is the earliest form of breast

cancer).cancer). About 39,520 deaths from breast cancer were expected inAbout 39,520 deaths from breast cancer were expected in http://www.breastcancer.org/symptoms/understand_bc/statistics.jsphttp://www.breastcancer.org/symptoms/understand_bc/statistics.jsp

Who is at risk?Who is at risk? Research has found several risk factors that may increase your Research has found several risk factors that may increase your

chances of getting breast cancer, including:chances of getting breast cancer, including: Getting older. Getting older. Being younger when you first had your menstrual period. Being younger when you first had your menstrual period. Starting menopause at a later age. Starting menopause at a later age. Being older at the birth of your first child. Being older at the birth of your first child. Never giving birth. Never giving birth. Not breastfeedingNot breastfeeding

http://www.cdc.gov/cancer/breast/basic_info/risk_factors.htmhttp://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm

Who is at risk?Who is at risk? Personal history of breast cancer or some non-cancerous breast Personal history of breast cancer or some non-cancerous breast

diseases. diseases. Family history of breast cancer (mother, sister, daughter). of breast cancer (mother, sister, daughter). Treatment with radiation therapy to the breast/chest. Treatment with radiation therapy to the breast/chest. Being overweight (increases risk for breast cancer after Being overweight (increases risk for breast cancer after

menopause). menopause). Long-term use of hormone replacement therapy (estrogen and Long-term use of hormone replacement therapy (estrogen and

progesterone combined). progesterone combined). Drinking alcohol (more than one drink a day). Drinking alcohol (more than one drink a day). Not getting regular exercise Not getting regular exercise http://www.cdc.gov/cancer/breast/basic_info/risk_factors.htmhttp://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm

SymptomsSymptoms

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

http://www.breastcancer.org/symptoms/http://www.breastcancer.org/symptoms/

ScreeningScreening

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

ScreeningScreening

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

ScreeningScreening

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

http://www.breastcancer.org/symptoms/http://www.breastcancer.org/symptoms/

ScreeningScreening

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

http://www.cdc.gov/cancer/breast/basic_info/screening.htmhttp://www.cdc.gov/cancer/breast/basic_info/screening.htm

Prostate CancerProstate Cancer

American Cancer SocietyAmerican Cancer Society

http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-what-is-prostate-cancerhttp://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-what-is-prostate-cancer

About the ProstateAbout the Prostate The prostate is a gland found only in males. It is The prostate is a gland found only in males. It is

located in front of the rectum and below the urinary located in front of the rectum and below the urinary bladder. In younger men, it is about the size of a bladder. In younger men, it is about the size of a walnut, but it can be much larger in older men. walnut, but it can be much larger in older men.

The prostate's job is to make some of the fluid that The prostate's job is to make some of the fluid that protects and nourishes sperm cells in semen, making protects and nourishes sperm cells in semen, making the semen more liquid. Just behind the prostate are the semen more liquid. Just behind the prostate are glands called glands called seminal vesiclesseminal vesicles that make most of the that make most of the fluid for semen. The fluid for semen. The urethra,urethra, which is the tube that which is the tube that carries urine and semen out of the body through the carries urine and semen out of the body through the penis, goes through the center of the prostatepenis, goes through the center of the prostate

American Cancer SocietyAmerican Cancer Societyhttp://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-what-is-prostate-cancerhttp://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-what-is-prostate-cancer

Who is at risk?Who is at risk?

AgeAgeThe chances of having prostate cancer rises rapidly after 50The chances of having prostate cancer rises rapidly after 50

2 out 0f 3 men over the age of 65 are found to have prostate2 out 0f 3 men over the age of 65 are found to have prostate

cancer.cancer.

Race/ethnicityRace/ethnicityProstate 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




Family HistoryFamily HistoryHaving a father or brother with prostate cancer more than doubles a man’s risk

of developing the disease

GenesRecently 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

DietThe exact role of diet in prostate cancer is not clear.




ObesityRelationship unknown-no firm conclusions

SmokingRelationship unknown-no firm conclusions

Sexually Transmitted InfectionsRelationship unknown-no firm conclusions

VasectomyMen who have had a vasectomy before the age of 35 may have a

slightly higher risk of developing prostate cancer

SymptomsSymptoms

In the early stages there are usually 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

Screening for Prostate CancerScreening for Prostate Cancer

Screening should take place at age 50 for men Screening should take place at age 50 for men with an average risk for prostate cancer and with an average risk for prostate cancer and age 45 for men at high risk this includes age 45 for men at high risk this includes African American men and men who have a African American men and men who have a first degree relative who had the disease at an first degree relative who had the disease at an earlier age.earlier age.

http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-detectionhttp://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-detection

Screening for Prostate CancerScreening for Prostate Cancer

Screening includes a digital rectal examination Screening includes a digital rectal examination and prostate-specific antigen (PSA) blood test.and prostate-specific antigen (PSA) blood test.

Men with a PSA less than 2.5 may only need Men with a PSA less than 2.5 may only need to be retested every 2 yearsto be retested every 2 years

Men with a PSA greater than 2.5 should be Men with a PSA greater than 2.5 should be tested yearly.tested yearly.

Cervical CancerCervical Cancer

Described by Papanicolaou in 1940’sDescribed by Papanicolaou in 1940’s Malignant transformation of cervical epithelial cellsMalignant transformation of cervical epithelial cells Begins in “Transformation Zone” “TZ”Begins in “Transformation Zone” “TZ”

between original cervical canal glands & squamous between original cervical canal glands & squamous cells lining the outer cervix cells lining the outer cervix

“ “Squamocolumnar junction” or SCJSquamocolumnar junction” or SCJ Invasive cervical cancer final stage in a series of Invasive cervical cancer final stage in a series of

abnormal changes in cervical cellsabnormal changes in cervical cells

The DataThe Data Once # 1 now 10Once # 1 now 10thth in cancer-related deaths in cancer-related deaths 15,000 new cases per year15,000 new cases per year 4,800 will die of cervical cancer4,800 will die of cervical cancer Death rate decreased > 70% since 1950’sDeath rate decreased > 70% since 1950’s African-American women STILL have 2Xs African-American women STILL have 2Xs

greater incidence rates compared to whitesgreater incidence rates compared to whites

ACOG DataACOG Data

Early detection by

Pap smear testing

decreases cervical cancer-related deaths

ScreeningScreening

Initial pap test and pelvic exam:Initial pap test and pelvic exam:-when sexual activity begins or by age 18 -when sexual activity begins or by age 18 -then repeat yearly-then repeat yearly

Pap test may be performed less frequently in a Pap test may be performed less frequently in a low-risk womanlow-risk woman at health care providers at health care providers discretion discretion after 3 or more consecutive, satisfactory after 3 or more consecutive, satisfactory annual exams with normal findingsannual exams with normal findings

ACOG RecommendationsACOG Recommendations

Consider more frequent pap Consider more frequent pap testing Whentesting When

Multiple sexual partners or partner’s hx multiple partnersMultiple sexual partners or partner’s hx multiple partners Sexual activity initiated at early age (<age 17) Sexual activity initiated at early age (<age 17) Male partners whose partners have had cervical cancerMale partners whose partners have had cervical cancer Current or prior hx of sexually transmitted infections:Current or prior hx of sexually transmitted infections:

GonorrheaGonorrhea Chlamydia Chlamydia HPVHPV HSVHSV HIVHIV Smokers, substance abuse, including alcoholSmokers, substance abuse, including alcohol History cervical dysplasiaHistory cervical dysplasia History cervical, vaginal, vulvar or uterine cancerHistory cervical, vaginal, vulvar or uterine cancer **low socio-economic status (marker for higher risk of **low socio-economic status (marker for higher risk of

developing cervical cancer)developing cervical cancer)

Human Papilloma VirusHuman Papilloma Virus

90% of Squamous lesions associated with 90% of Squamous lesions associated with HPVHPV

Type 16: most commonType 16: most common

50% of moderate to severe SIL & cervical 50% of moderate to severe SIL & cervical cancer cancer

AND in normal paps, therefore AND in normal paps, therefore not specificnot specific

Lung CancerLung Cancer

Lung Cancer DataLung Cancer Data Lung cancer is the leading cause of cancer death in the U.S. It is the most 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 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 (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 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 than of colon, breast, and prostate cancers combined. Lung cancer is fairly rare in people under the age of 45. rare in people under the age of 45.

The average lifetime chance that a man will develop lung cancer is about 1 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 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 non-smokers. For smokers the risk is much higher, while for non-smokers the risk is lower.the risk is lower.

http://www.cancer.org/Cancer/LungCancer-SmallCell/OverviewGuide/lung-cancer-small-cell-overview-what-causeshttp://www.cancer.org/Cancer/LungCancer-SmallCell/OverviewGuide/lung-cancer-small-cell-overview-what-causes

Lung Cancer DataLung Cancer Data

The American Cancer Society's most recent The American Cancer Society's most recent estimates for lung cancer (both small cell and estimates for lung cancer (both small cell and non-small cell) in the United States are for non-small cell) in the United States are for 2012:2012:

About 226,160 new cases of lung cancer (both About 226,160 new cases of lung cancer (both small cell and non-small cell) small cell and non-small cell)

About 160,340 deaths from lung cancerAbout 160,340 deaths from lung cancer

Who is at Risk?Who is at Risk?

Smoking is by far the leading risk Smoking is by far the leading risk factor causing 8 out 10 cases of lung factor causing 8 out 10 cases of lung

cancer.cancer.

SymptomsSymptoms

The most common symptoms of lung cancer are:The most common symptoms of lung cancer are: A cough that does not go away or gets worse A cough that does not go away or gets worse Chest pain, often made worse by deep breathing, coughing, or laughing Chest pain, often made worse by deep breathing, coughing, or laughing Hoarseness Hoarseness Weight loss and loss of appetite Weight loss and loss of appetite Coughing up bloody or rust-colored sputum (spit or phlegm) Coughing up bloody or rust-colored sputum (spit or phlegm) Shortness of breath Shortness of breath Feeling weak or tired Feeling weak or tired Infections such as bronchitis and pneumonia that don’t go away or keep coming Infections such as bronchitis and pneumonia that don’t go away or keep coming

back back New onset of wheezingNew onset of wheezing

http://www.cancer.org/Cancer/LungCancer-SmallCell/OverviewGuide/lung-cancer-small-cell-overview-http://www.cancer.org/Cancer/LungCancer-SmallCell/OverviewGuide/lung-cancer-small-cell-overview-diagnoseddiagnosed

ScreeningScreening Until recently, no lung cancer screening test had been shown Until recently, no lung cancer screening test had been shown

to lower the risk of dying from this disease. Studies of 2 to lower the risk of dying from this disease. Studies of 2 possible screening tests, chest x-ray and sputum cytology, did possible screening tests, chest x-ray and sputum cytology, did find that these tests detected lung cancers at an early stage, but find that these tests detected lung cancers at an early stage, but neither test helped patients live longer. For this reason, major neither test helped patients live longer. For this reason, major medical organizations have not recommended routine medical organizations have not recommended routine screening with these tests for the general public or even for screening with these tests for the general public or even for people at increased risk, such as smokers. Recently, though, a people at increased risk, such as smokers. Recently, though, a different lung cancer screening test has been shown to help different lung cancer screening test has been shown to help lower the risk of dying from this disease.lower the risk of dying from this disease.

http://www.cancer.org/Cancer/LungCancer-SmallCell/DetailedGuide/small-cell-lung-cancer-http://www.cancer.org/Cancer/LungCancer-SmallCell/DetailedGuide/small-cell-lung-cancer-detectiondetection

Screening for Breast, Cervical, Prostate and Lung Cancer Jo-Anna L. Rorie, PhD (c) Assistant...

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