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All of us know that prevention is better than cure and its importance cannot be overemphasized. However, not every disease is preventable and screening provides us with the second best option by catching them early. Although there are various definitions for screening, it can simply be summed up as detecting disease early in asymptomatic (those without any symptoms) individuals.
SCREENING – WHY AND WHEN ?
It is estimated that screening results in mortality reduction ranging from 3 to 35% depending on various factors. Cervical cancer is an excellent example of mortality reduction as a result of screening. Apart from reduction in deaths from cancer, screening also gives us an opportunity to detect cancer at a stage where minimal treatment is required. For example, a very early breast cancer may just require a small surgery and the patient may be able to avoid chemotherapy and radiation therapy completely. Also, most of the screen detected cancers would require less mutilating operations with much lesser hospital stay and the cost of treatment. However, you must discuss the pros and cons of any screening investigations with your oncologist before having it done.
SCREENING – HOW ?
Screening can be broadly divided into having following components:
GENERAL GUIDELINES (for normal risk general population)
High risk individuals by virtue of their family history, habits or any other risk factor need to be counselled separately and usually require more intense screening methods.
Breast Cancer screening
Cervical Cancer Screening
Should begin approximately 3 years after beginning of vaginal intercourse
It includes pelvic examination every 3 years and Pap smear yearly for three years and, if found normal for three consecutive years, thereafter the frequency can be decreased. If pap smear is combined with HPV DNA testing the frequency of screening can be decreased and it can safely be done every three years
Colon Cancer screening
One of the following is recommended for a normal risk individual above 50 years of age:
Individuals with family history of colon cancer or personal history of precancerous lesions like polyps (small benign growths in colon / rectum) require the screening to begin at a younger age and done more frequently depending on the level of risk.
A combination of clinical examination and serum PSA test (blood test) may be beneficial in reducing deaths for individuals between the age of 55 and 69 years.
Although there are no guidelines for oral cancer screening (largely due to the fact that it is a unique problem of our country and is seen much less in developed), it is a good idea to keep doing monthly self-examination of inside of the mouth for any ulcer, white or red patches and neck for any lump.
Screening is an effective tool to diagnose cancers at a pre-clinical stage thereby providing an opportunity to attain high cure rates by using less aggressive treatment options thus improving the quality of life as well.