Cancer is a nightmare for all of us. It is the second most common cause of death after cardiovascular diseases. Its incidence is increasing due to air pollution, chemicals, sunlight and increasing life expectancy. However, now, thanks to screening programs, cancer is detected at an early stage and intervened with appropriate treatment methods, and death rates from cancer are decreasing compared to before. The screening program includes examination, imaging or laboratory procedures to detect cancer before there are signs and symptoms of cancer. If cancer is detected early with some screening practices, complete recovery can be achieved, and the disease can be controlled by applying medications or interventions with fewer side effects. Apart from human health, another area of interest is that these programs provide significant savings in health expenditures.
The types of cancer for which national and international cancer organizations recommend screening programs are breast cancer, large intestine cancer, cervix cancer and prostate cancer. In addition, due to its increasing frequency recently, screening programs for lung cancer have been developed in some special cases. The implementation of national screening programs also varies from country to country. While stomach cancer screening programs are accepted in Far Eastern countries where stomach cancer is common, these programs are not accepted at the national level in Western countries, as in our country.
Although the most important parts of screening programs are imaging methods and laboratory examinations, physical examination should not be neglected. . During the examination, breast examination and rectal examination, called rectal examination, are especially important in the anal region. In addition, lymph nodes are examined and other organs are examined to look for any palpable stiffness. Mammography, barium colon radiography, ultrasonography and colonoscopy are used among imaging methods. As laboratory examinations; Hormone tests (Beta HCG, thyrocalcitonin), enzyme tests such as prostate specific antigen (PSA) or genetic tests (retinoblastoma, BRCA-1) may be applied. The use of various types of Carsinoembryogenic Antigen (CEA) and Cancer Antigen (CA) in cancer screening sometimes leads to confusion. These tests have false positives, that is, It is important to know that just as it can give results as if there is a cancer when it is not present, it can also give false negative results, that is, as if there is no cancer when it is present.
Cancer types investigated within the scope of the screening program:
BREAST CANCER.
Every woman should have her own breast examination regularly every month, starting from the age of 20. One can learn how to do this from a doctor. Between the ages of 20 and 45, they should also be examined by a physician every year. Breast cancer screening with mammography is recommended every two years after the age of 40 in some guidelines, and in others after the age of 45. In addition to mammography, breast ultrasonography can also be used as a supporting method to mammography. This applies to women without risk factors. If there are risk factors, it is necessary to implement screening programs starting from earlier periods and increasing the frequency of periods. For example, if there is a history of cancer in first-degree family members or if the person has a remarkable finding and radiotherapy has been applied, standard practice can be deviated from and a screening program can be started at an earlier period. The rule here is to apply screening methods 10 years before the age at which cancer is seen in a first-degree relative.
CORPHONAL CANCER
In large intestine cancers, if there is no risk factor. , a risk is generally not mentioned for men and women until the age of 50. Screening programs for colon cancer start at the age of 50, and once a year, even if there are no complaints, the test for occult blood in the stool must be performed on three different stool samples at different times. Starting from the age of 50, sigmoidoscopy or barium colon radiography should be performed every 5 years, and colonoscopy should be performed every ten years.
PROSTATE CANCER
With early diagnosis, it can be completely eliminated. One of the cancers that has a nearly complete cure chance is prostate cancer. If there are no risk factors, the program usually starts from age 50. A digital anal examination, which we call rectal examination, and a PSA test in the blood must be performed. Starting from the age of 50, these tests should be performed every year for men with a life expectancy of more than 10 years.
CERVIX CANCER
When will cancer screening begin, what is your sexual life like? time begins It's about. Starting sexual intercourse early is a risk in this respect. These tests must begin within three years of the first sexual intercourse. What is meant by screening is the PAP test, also called the smear test, which should be done every year. Performing a smear test is to observe whether there is a malignant transformation in the cells by applying a swab to the cervix and subjecting the cells shed from there to a dye. It starts within three years of first intercourse and should be done every year. If the PAP test is normal for three consecutive years at the age of 30 and above, then the frequency of screening can be reduced and performed every three years. If three consecutive tests are normal at the age of 70 and over, there is no point in continuing the tests.
What is the situation for other types of cancer?
There is no such routine in other types of cancer. Applying a cancer screening test has not been found beneficial, primarily in terms of patient health and cost. An important complaint for other types of cancer is to consult a physician at an early stage, and for the physician to comprehensively evaluate the patient and perform a complete systemic examination, and to perform the necessary tests in a timely manner when cancer is suspected. Applications such as performing a biopsy if there is a cold nodule larger than 1 cm in the thyroid, investigating chronic cough with chest radiography and, if necessary, tomography, performing endoscopy in case of early satiety or feeling of fullness in the stomach, investigating the urinary system in case of blood in the urine, performing ultrasound and cystoscopy if necessary.
Is it important to be followed by the same physician?
After finding the appropriate physician, it is a good thing to be followed by the same physician. The physician should never refrain from asking for consultation and should seek the opinion of other physicians for his patient when deemed necessary. Another important issue is that medical records are kept well. Medical records must be kept both electronically and in hard copy. It is very useful for the patient to take his/her medical records with him/her when going to the doctor. By comparing old findings with new findings, the physician can draw meaningful conclusions and avoid some unnecessary repetitions.
From time to time, imaging methods are harmful. This comes to the agenda…
The important thing is to apply the test to patients for whom the benefit of applying this method is greater than the risk taken. There is no doubt that radiation has negative effects. However, since the early detection of the disease will have very satisfactory results, the risks that may occur here can be ignored. When these applications are performed by experts and in the periods recommended by national and international guidelines, there is no threat to the patient. It is important that the quality of the device used in mammography and barium colon radiography and the appropriate dose are appropriate. There are no examinations using intravenous dyes in screening programs. Colonoscopy is also an imaging method and has no risks if performed by skilled hands. However, if it is not done carefully or if the patient is not prepared adequately, it may cause intestinal damage.
What are the points to be considered in screening programs?
The method of performing tomography by administering contrast material to the body is used for cancer cancer. It has no place in scanning programs. To use this method, the physician must have a valid preliminary diagnosis and must know whether the patient is at risk for this examination. If there is a risk, instead of taking a tomography image by administering a substance that can seriously damage the kidneys, diagnosis can be made with other methods or less contrast material can be used. When requesting this examination, the clinical suspicion, that is, the expectation of disease, must be high. But undoubtedly, if that point has been reached and there is a need for this to confirm the diagnosis, it should be done. There is no doubt that very good, quality devices have developed in imaging. But it is important to use them appropriately. Again, under the name of cancer screening programs, we sometimes see that blood tests called "cancer tests" are requested unnecessarily. These tests, which we call tumor markers, are performed at regular intervals to eliminate the suspicion of metastasis in the treatment phase of patients diagnosed by biopsy. In other words, these are actually tests used to follow up cancer cases. It is not right to request these tests just to satisfy curiosity, without any clinical suspicion and radiological imaging.
HPV Test: The relationship between HPV DNA and cervical cancer has now been proven, and viks
The presence of HPV DNA has been shown in 99.9% of patients with cancer. In case the HPV test is negative
The probability of developing cervical cancer in the following five years is very low. HPV tests to be used in cervical
cancer screening; It must have FDA approval showing its usability in internationally valid and population-based health screenings, it must have an IVD (In
Vitro Diagnostics) or the specificity of the test must be with low-risk HPV genotypes for CIN2/3
It must meet the requirements of the European Guidelines published by Meijer et al (IJC 2009)
for screening populations regarding minimal cross-reactivity, and this must be done in a test with at least 2,500 samples. It must be shown in the general population primary cancer screening study.
Pap-smear Test: Pap-smear test is a cytological screening test based on collecting and examining shed cervical cells
. With this cytological screening test, preinvasive and early invasive cervical lesions that have not yet become symptomatic are detected. Pap-smear tests
Can be done conventionally or liquid-based.
HPV or Pap-smear test is repeated every five years. Community-based cancer screening
individuals who undergo screening are registered with their citizenship identification numbers to avoid duplicate tests.
TARGET POPULATION AND SCREENING FREQUENCY: Considering the conditions of our country
the achievable target is, It is a community-based screening for women that starts at age 30 and ends at age 65 (ages 30 to 65 will be included). The population to be screened should be defined based on individuals registered with family physicians. The HPV or Pap-smear test is repeated every five years, with methods to be developed. Screening should be discontinued in women aged 65
whose last two HPV or Pap-smear tests are negative.
MANAGEMENT TO BE APPLIED IN PATIENTS WITH NORMAL RESULTS: HPV
Negative HPV test or Pap-smear test. -If the pathology report of the smear is normal, the person is informed
. According to the HPV test, it is said that they do not carry the virus that causes cervical cancer, and according to the Pap-smear test, there are no pre-cancerous cells in the swab taken. These results indicate that there is no cervix
cancer.
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