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Screening for Breast,
Cervical, Prostate and
Lung Cancer
Jo-Anna L. Rorie, PhD (c)
Assistant Professor
RHA Training Program
Module 11
Definition of Cancer
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What is cancer?
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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.
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http://www.cancer.org/Cancer/LungCancer-SmallCell/OverviewGuide/lung-cancer-small-cell-overviewwhat-is-cancer
Breast Cancer Screening
The Data
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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
The Data
2011 estimates for US Women
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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).
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About 39,520 deaths from breast cancer were expected in
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http://www.breastcancer.org/symptoms/understand_bc/statistics.jsp
Who is at risk?
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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
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http://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm
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Who is at risk?
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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
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http://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm
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Symptoms
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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 noncancerous conditions like infection or a cyst.
http://www.breastcancer.org/symptoms/
Screening
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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.
Screening
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Between ages 20-30 years you should have a
clinical breast exam done by a health provider
every 3 years.
Screening
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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/
Screening
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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.
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http://www.cdc.gov/cancer/breast/basic_info/screening.htm
Prostate Cancer
American Cancer Society
http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-what-is-prostate-cancer
About the Prostate
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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
Who is at risk?
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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.
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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
Who is at risk?
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Family History
Having a father or brother with prostate cancer more than doubles a man’s risk
of developing the disease
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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
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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
Who is at risk?
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Obesity
Relationship unknown-no firm conclusions
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Smoking
Relationship unknown-no firm conclusions
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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
Symptoms
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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 Cancer
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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.
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http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-detection
Screening for Prostate Cancer
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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.
Cervical Cancer
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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
The Data
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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
Early
detection
by
Pap smear
testing
decreases
cervical
cancerrelated
deaths
Screening
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Initial pap test and pelvic exam:
-when sexual activity begins or by age 18
-then repeat yearly
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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
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ACOG Recommendations
Consider more frequent pap testing When
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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)
Human Papilloma Virus
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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
Lung Cancer
Lung Cancer Data
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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.
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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.
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http://www.cancer.org/Cancer/LungCancer-SmallCell/OverviewGuide/lung-cancer-small-cell-overview-what-causes
Lung Cancer Data
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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
Who is at Risk?
Smoking is by far the leading risk
factor causing 8 out 10 cases of lung
cancer.
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Symptoms
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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-overviewdiagnosed
Screening
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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.
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http://www.cancer.org/Cancer/LungCancer-SmallCell/DetailedGuide/small-cell-lung-cancerdetection