Breast and Cervical Cancer

Awareness

Dr Alok Gupta

MD, DM,

Consultant Medical Oncologist

Max Super Speciality Hospital, Saket

Ex-Asst. Professor, AIIMS, New Delhi

What is cancer?

World Cancer Epidemiology

14.1 million new cases every year.

8.2 million deaths every year (2nd MC).

5 MC in India are breast, cervix, oral cavity, lung and

colorectal (large intestine).

Estimates for India

Problem Statement

Multifaceted Aspects of Cancer Management

1. Pathogenesis/cancer development

2. Cancer prevention/Risk factor modification

3. Cancer screening/early detection

4. Diagnosis and Treatment

5. Surveillance and Cancer Survivorship

Multifaceted Aspects of Cancer Management

1. Pathogenesis/cancer development

2. Cancer prevention/Risk factor modification

3. Cancer screening/early detection

4. Diagnosis and Treatment

5. Surveillance and Cancer Survivorship

What is Screening?

Test and exam used to find a disease (like a pre-

cancer or cancer) in people who do not have

any symptoms. Examples..

Not a DIAGNOSTIC test

Aim: Reduction of morbidity and mortality

Breast Cancer

In India, 1 out of every 2 women diagnosed with

breast cancer dies of this disease, mainly

because the tumor is diagnosed too late.

Epidemiology

Problem Statement

Is screening feasible in breast cancer?

Survival in Breast Cancer

Benefits of screening for breast cancer

Important public health problem/outcome vary

with stage

Early detection/stage migration

30% reduction in mortality

Methods of screening for breast cancer

Breast-self examination

Ultrasound

Mammography

MRI

Clinical breast examination

Breast Self-Examination (BSE)

Potential Benefits

Simple and non-invasive test

Women gain a sense of control over their health

Some breast cancer has been detected with BSE

Clinical Breast Examination (CBE)

Mammography

Screening (asymptomatic)

Diagnostic (symptomatic)

Mammography

Mammography

Ultrasonography

Useful adjunct to mammography

Assist in suspicious lesion detected on

mammography or physical examination

Useful in the guidance of biopsies and

therapeutic procedures.

Originally, used as method of

differentiating cystic from solid breast

masses

Limitations as screening test:

Failure to detect microcalcifications

Poor specificity (34%)

Useful in detecting occult breast cancer in dense breasts.

Highly operator-dependent

Magnetic Resonance Imaging (MRI)

Explored in women at high risk and in younger women

MRI found to be highly sensitive (99% when combined with

mammography and CBE)

An important adjunct screening tool for women

BRCA1 or BRCA2 mutations, identifying cancers at earlier stages.

MRI has limited use as a screening tool:

Cost. 10-fold higher cost than mammography

Poor specificity (26%) false-positive reads

Screening Recommendations for Average Risk

Between 40–75 years – Annual CBE + Annual

Mammography.

Breast self-examination(BSE), start at 20 yrs,

monthly.

Clinical Breast Examination (CBE) 3 yearly, 20-

40 years.

Screening Recommendations for High Risk (>20%)

CBE 6 monthly, start at 25 years.

MRI annually, start at 25 years.

Mammography annually, start at 30 years. (6

monthly interval from MRI)

Cancer Cervix

What is cervix?

The cervix is the lower part of the womb also known as uterine cervix. The cervix connects the body of the uterus to the vagina(birth canal).

Epidemiology

Problem Statement

90%

10%

90%

1% 0.1%

Is it feasible to screen for Cancer Cervix?

Method - PAP (Cervical) Smear Test

A cervical smear test is a simple procedure which involves gently scraping some cells from the surface of the cervix and putting them on a slide. The cells are then examined under a microscope in the laboratory to see if they are normal.

Timing of PAP Test

Benefit of screening in cervical cancer

70% reduction in cervical cancer deaths.

Now ranks 14th for cancer deaths in developed

world.

5-year survival rate is approximately 92%.

Screening Recommendations

<21 years: No screening

21-30 years: PAP smear every 3 years

30-65 years: PAP smear every 3 years or PAP

smear + HPV testing every 5 years

>65 years: No screening

Summary

Breast cancer followed by cervical cancer are the two

most common cancers among women in India.

If detected in early stage, >90% patients can be

completely cured.

Mammography can help in detecting breast cancer at an

early stage/pre-cancerous stage.

PAP test can help in detecting cervical cancer at an early

stage/pre-cancerous stage.

THANK YOU