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Cancer Screening in the Normal Risk 2018

2018 Updated Guidelines for Cancer Screening from ACS and USPSTF

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Cancer Screening in the Normal Risk 2018

  1. 1. TITLE Speaker CANCER SCREENING in the NORMAL RISK ASYMPTOMATIC FILIPINO Mary Ondinee Manalo-Igot, MD, MSCM, FPCP, FPSO, FPSMO Medical Oncologist / Neuro-Oncologist DLSUMC – Department of Internal Medicine Acacia Hotel Manila / September 20, 2018
  2. 2. OUTLINE • Cancer Situation in the Philippines • Principles of Cancer Screening • 2018 Screening Guidelines from ACS and USPSTF • Screening in a Resource Limited-Setting • DOH Cancer Control Program • Summary
  3. 3. CLINICAL SCENARIO in the clinic: • 69/M, office executive • good functional capacity • healthy lifestyle • no comorbids • no vices • no personal or family history of cancer
  4. 4. “Doc, magpapa-cancer screening po ako kasi di ko nagagamit ang HMO ko, sayang naman.”
  5. 5. Cancer Situation in the Philippines • Cancer is an epidemic. • Cancer is the third leading cause of morbidity and mortality in the country. • 189 of every 100,000 Filipinos are afflicted with cancer while four Filipinos die of cancer every hour or 96 cancer patients every day. Department of Health web portal: https://portal2.doh.gov.ph/philippine-cancer-control-program Philippine Health Statistics, 2009
  6. 6. Estimated Leading New Cancer Cases, Both Sexes, 2015 CANCER SITES NUMBER % Breast 20267 19 Lung 13679 13 Colon/Rect um 9625 9 Liver 8649 8 Cervix 7289 7 Prostate 5526 5 Leukemia 4270 4 Thyroid 3288 3 Stomach 2715 3 Ovary 2657 2 2015 Philippine Cancer Society Facts and Estimates (Manila Cancer Registry and Rizal Cancer Registry)
  7. 7. Estimated Leading New Cancer Cases in the Philippines, Both Sexes, 2015 CANCER SITES NUMBER % Breast 20267 19 Lung 13679 13 Colon/Rec tum 9625 9 Liver 8649 8 Cervix 7289 7 Prostate 5526 5 Leukemia 4270 4 Thyroid 3288 3 Stomach 2715 3 Ovary 2657 2 2015 Philippine Cancer Society Facts and Estimates (Manila Cancer Registry and Rizal Cancer Registry)
  8. 8. SCREENING
  9. 9. CANCER SCREENING • Refers to a test or examination performed on an asymptomatic individual. • Goal of cancer screening is to prevent death and suffering from the disease in question through early intervention. • Screening is a public health intervention. • Opportunistic or programmatic De Vita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 10th edition.
  10. 10. Benefits and limitations of regular cancer screening? BENEFITS • Getting screened reassures you if the result is normal. • Cancer screening may help prevent cancer by finding changes in your body that would become cancer if left untreated. • The earlier a cancer is detected, the better your chance of survival. LIMITATIONS • Sometimes test results suggest you have cancer even though you don't (called a false positive). • The test may not detect cancer even though it is present (called a false negative). • Some cancers would not necessarily lead to death or decreased quality of life (overdiagnosis). • Having screening tests may lead to more tests and procedures that may be harmful. http://www.cancer.ca/en/prevention-and-screening
  11. 11. Principles of Cancer Screening • Disease should have a high incidence • Biological behavior and natural history of the disease should be known • Test should have high sensitivity, specificity, and positive predictive value • Test should be rapid, inexpensive, non-invasive, and acceptable to patients • An acceptable and efficacious method of treatment must exist for patients diagnosed with disease • Screening should lower the disease-specific morbidity and increase survival De Vita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 10th edition.
  12. 12. Who’s Right When it Comes to Screening?
  13. 13. American Cancer Society (ACS) versus U.S. Preventive Services Task Force (USPSTF) Cancer Screening Guidelines
  14. 14. 5 Cancers with Guidelines for Screening • Breast Cancer • Colorectal Cancer • Cervical Cancer • Lung Cancer • Prostate Cancer
  15. 15. BREAST CANCER SCREENING
  16. 16. 5-YEAR SURVIVAL RATE FOR BREAST CANCER BY STAGE Stage 5-Year Survival, % 0 99 I 92 IIA 82 IIB 65 IIIA 47 IIIB 44 IV 14 Modified from data of the National Cancer Institute: Surveillance, Epidemiology and End Results (SEER).
  17. 17. Not the average risk • Have a known BRCA1 or BRCA2 mutation • Have a first-degree relative with breast cancer, and have not had genetic testing themselves • Had radiation therapy to the chest when they were between the ages of 10 and 30 years • Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes • Have a lifetime risk of breast cancer of about 20% to 25% or greater, according to risk assessment tools that are based mainly on family history Li-Fraumeni Syndrome: caused by mutation in TP53. Cancers include soft tissue & bone sarcomas, breast cancer, brain cancer, adrenocortical adenoCA, & leukemia. Cowden syndrome: caused by a PTEN mutation characterized by multiple hamartomas & an increased risk of developing cancers of the breast, thyroid, endometrium, CRC, kidney and melanoma. Bannayan-Riley-Ruvalcaba syndrome: caused by a PTEN mutation characterized by macrocephaly, multiple hamartomas and dark freckles on the penis of males. More than half will have developmental delays, hypotonia, hyperextensibility, scoliosis and pectus excavatum.
  18. 18. Breast Cancer Risk Assessment Tool (Gail Model) • It uses 7 key risk factors for breast cancer. – Age – Age at first period – Age at the time of the birth of a first child (or has not given birth) – Family history of breast cancer (mother, sister or daughter) – Number of past breast biopsies – Number of breast biopsies showing atypical hyperplasia – Race/ethnicity • Women with a 5-year risk of 1.67 percent or higher are classified as "high-risk." https://bcrisktool.cancer.gov/calculator.html
  19. 19. Who’s Right When it Comes to Screening?
  20. 20. Previous Screening Recommendations for Breast Cancer Test or Procedure American Cancer Society U.S. Preventive Services Task Force Breast self examination Women ≥ 20 years: Breast self-exam is an option “D” = AGAINST Clinical examination Women 20–39 years: Perform every 3 years Women ≥40 years: Perform annually Women ≥40 years: “I” = INSUFFICIENT EVIDENCE Mammography Women ≥40 years: Screen annually for as long as the woman is in good health Women 50–74 years: Every 2 years (“B”) Women ≥75 years: “I” “A”: The USPSTF recommends the service, because there is high certainty that the net benefit is substantial. “B”: The USPSTF recommends the service, because there is high certainty that the net benefit is moderate or moderate certainty that the net benefit is moderate to substantial. “C”: The USPSTF recommends selectively offering this service to individual patients based on professional judgment. There is at least moderate certainty that the net benefit is small. “D”: The USPSTF recommends against the service, because there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. “I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service.
  21. 21. 2018 Screening Recommendations for Breast Cancer Test or Procedure American Cancer Society U.S. Preventive Services Task Force Breast self examination No recommendation “D” Clinical examination No recommendation Women ≥40 years: “I” INSUFFICIENT EVIDENCE Mammography Women 40-44 years: Should be able to start screening if they want to Women ≥45 years: Screen annually for as long as the woman is in good health and is expected to live for 10 years or more Women ≥55 years: Can continue yearly or every 2 years Women 40–49 years: The decision should be an individual one, and take patient context/values into account (“C”) Women 50–74 years: Every 2 years (“B”) Women ≥75 years: “I” “B”: The USPSTF recommends the service, because there is high certainty that the net benefit is moderate or moderate certainty that the net benefit is moderate to substantial. “C”: The USPSTF recommends selectively offering this service to individual patients based on professional judgment. There is at least moderate certainty that the net benefit is small. “D”: The USPSTF recommends against the service, because there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. “I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service.
  22. 22. American Society of Clinical Oncology (ASCO) (counterpart of the Philippine Society of Medical Oncology) • Recommends annual screening starting age 40 years • Greatest reduction in breast cancer deaths, with nearly 40% reduction in breast cancer related deaths
  23. 23. COLORECTAL CANCER SCREENING
  24. 24. Who’s Right When it Comes to Screening?
  25. 25. Stage 5-Year Survival, % Stage 5-Year Survival, % I 92 I 88 IIA 90 IIA 83 IIB 87 IIB 81 IIIA 72 IIIA 72 IIIB 65 IIIB 58 IIIC 53 IIIC 50 IV 12 IV 13 Modified from data of the National Cancer Institute: Surveillance, Epidemiology and End Results (SEER). American Cancer Society. Colorectal Cancer Facts and Figures 2017- 2019. Atlanta, Ga: American Cancer Society; 2017. 5-YEAR SURVIVAL RATE FOR COLON CANCER BY STAGE 5-YEAR SURVIVAL RATE FOR RECTAL CANCER BY STAGE
  26. 26. AVERAGE RISK • No personal history of: – adenomatous polyps – colorectal cancer – inflammatory bowel disease – confirmed or suspected hereditary colorectal cancer syndrome (FAP or Lynch syndrome) • No family history of colorectal cancer
  27. 27. 2008 Screening Recommendations for Colorectal Cancer Test or Procedure American Cancer Society U.S. Preventive Services Task Force Sigmoidoscopy Adults ≥50 years: Screen every 5 years Note: For all CRC screening tests, stop screening when benefits are unlikely due to life-limiting comorbidity. Adults 50–75 years: Every 5 years in combination with high-sensitivity fecal occult blood testing (FOBT) every 3 years (“A”)a Adults 76–85 years: “C” Adults ≥85 years: “D” Fecal occult blood testing (FOBT) Adults ≥50 years: Screen every year with high sensitivity guaiac based FOBT or fecal immunochemical test (FIT) only Adults 50–75 years: Annually, for high- sensitivity FOBT (“A”) Adults 76–85 years: “C” Adults ≥85 years: “D” Colonoscopy Adults ≥50 years: Screen every 10 years Adults 50–75 years: every 10 years (“A”) Adults 76–85 years: “C” Adults ≥85 years: “D” “A”: The USPSTF recommends the service, because there is high certainty that the net benefit is substantial. “C”: The USPSTF recommends selectively offering this service to individual patients based on professional judgment. There is at least moderate certainty that the net benefit is small. “D”: The USPSTF recommends against the service, because there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. “I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service.
  28. 28. 2018 Screening Recommendations for Colorectal Cancer Test or Procedure American Cancer Society U.S. Preventive Services Task Force Stool-Based Tests Fecal occult blood testing (FOBT) Adults ≥45 years: Screen every year with high sensitivity guaiac based FOBT or fecal immunochemical test (FIT) only Adults 50–75 years: Annually, for high-sensitivity FOBT (“A”) Adults 76–85 years: “C” Adults ≥85 years: “D” Fecal immunochemical testing (FIT) Adults ≥45 years: Screen every year “I” Fecal DNA testing Adults ≥45 years: Screen, but interval uncertain “I” “A”: The USPSTF recommends the service, because there is high certainty that the net benefit is substantial. “C”: The USPSTF recommends selectively offering this service to individual patients based on professional judgment. There is at least moderate certainty that the net benefit is small. “D”: The USPSTF recommends against the service, because there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. “I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service.
  29. 29. 2018 Screening Recommendations for Colorectal Cancer Test or Procedure American Cancer Society U.S. Preventive Services Task Force Direct Visualization Tests Colonoscopy Adults ≥45 years: Screen every 10 years Adults 50–75 years: every 10 years (“A”) Adults 76–85 years: “C” Adults ≥85 years: “D” Sigmoidoscopy Adults ≥45 years: Screen every 5 years Adults 50–75 years: Every 5 years in combination with high-sensitivity fecal occult blood testing (FOBT) every 3 years (“A”)a Adults 76–85 years: “C” Adults ≥85 years: “D” CT colonography Adults ≥45 years: Screen every 5 years “I” “A”: The USPSTF recommends the service, because there is high certainty that the net benefit is substantial. “C”: The USPSTF recommends selectively offering this service to individual patients based on professional judgment. There is at least moderate certainty that the net benefit is small. “D”: The USPSTF recommends against the service, because there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. “I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service.
  30. 30. Which test to choose for screening? • “The ACS and USPSTF found no head-to-head studies demonstrating that any of the screening strategies are more effective than others, although the tests have varying levels of evidence supporting their effectiveness, as well as different strengths and limitations.” • “Offering choice in colorectal cancer screening strategies may increase the proportion of patients who will actually do the screening.”
  31. 31. CERVICAL CANCER SCREENING
  32. 32. Stage 5-Year Survival, % 0 93 IA 93 IB 80 IIA 63 IIB 58 IIIA 35 IIIB 32 IVA 16 IVB 15 Modified from data of the National Cancer Institute: Surveillance, Epidemiology and End Results (SEER). American Cancer Society. Cancer Facts and Figures 2018. Atlanta, Ga: American Cancer Society; 2018 5-YEAR SURVIVAL RATE FOR CERVICAL CANCER BY STAGE
  33. 33. Who’s Right When it Comes to Screening?
  34. 34. 2012-2018 Screening Recommendations for Cervical Cancer Test or Procedure American Cancer Society (2012) U.S. Preventive Services Task Force Pap test (cytology) Women <21 years: No screening Women ages 21–29 years: Screen every 3 years Women 30–65 years: Acceptable approach to screen with cytology every 3 years (see HPV test) Women >65 years: No screening following adequate negative prior screening Women after total hysterectomy for noncancerous causes: Do not screen Women ages 21–65 years: Screen every 3 years (“A”) Women <21 years: “D” Women >65 years, with adequate, normal prior Pap screenings: “D” Women after total hysterectomy for noncancerous causes: “D” HPV test Women <30 years: Do not use HPV testing Women ages 30–65 years: Preferred approach to screen with HPV and cytology cotesting every 5 years (see Pap test) Women >65 years: No screening following adequate negative prior screening Women after total hysterectomy for noncancerous causes: Do not screen Women ages 30–65 years: Screen in combination with cytology every 5 years if woman desires to lengthen the screening interval (see Pap test) (“A”) Women <30 years: “D” Women >65 years, with adequate, normal prior Pap screenings: “D” Women after total hysterectomy for noncancerous causes: “D” “A”: The USPSTF recommends the service, because there is high certainty that the net benefit is substantial. “D”: The USPSTF recommends against the service, because there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.
  35. 35. Simplified Cervical Cancer Screening Woman’s Age How often should a woman have a Pap Test? <21 years old No testing needed 21-30 years old Pap test every 3 years 30-65 years old Pap test every 3 years, or Pap test and HPV cotesting every 5 years >65 years old No testing needed if no abnormal results for the past 10 years
  36. 36. LUNG CANCER SCREENING
  37. 37. Stage 5-Year Survival, % IA1 92 IA2 83 IA3 77 IB 68 IIA 60 IIIA 36 IIIB 26 IIIC 13 IVA 10 IVB <1 Modified from data of the National Cancer Institute: Surveillance, Epidemiology and End Results (SEER). Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2016;11(1):39- 51. 5-YEAR SURVIVAL RATE FOR NON SMALL CELL CANCER BY STAGE
  38. 38. 2002 03 04 05 06 07 08 09 10 T0 NLST Design and Time Posts • RCT • 1:1 randomization to CT or CXR • Launched across ~ 33 sites FinalAnalysis CXR CT 53,476 High- Risk Subjects T2 T1 Follow up Interim analyses National Lung Screening Trial National Cancer Institute TSLN
  39. 39. NLST Summary • CT scan detects more lung cancers than CXR by 2.3 folds • 20% lung cancer mortality reduction CT vs CXR − Absolute risk reduction = 0.4% (AR CT= 1.3% | CXR = 1.7%) • Few major complications • NNS (Number needed to screen) : 320 − NNS (Breast Cancer): US: 238, NZ: 781 • NCI_2012 and J med Screen, 2001;8(3):114-5 • Need for diagnostic algorithm to decrease false positives
  40. 40. SCREENING CRITERIA •Currently smoke or have quit within the past 15 years, and •Have at least a 30-pack-year smoking history, and •Receive smoking cessation counseling if they are current smokers, and •Have been involved in informed/shared decision making about the benefits, limitations, and harms of screening with LDCT scans, and •Have access to a high-volume, high quality lung cancer screening and treatment center.
  41. 41. 2018 Screening Recommendations for Lung Cancer Test or Procedure American Cancer Society U.S. Preventive Services Task Force Low dose helical CT scan Current or former smokers aged 55-74 years in good health: Screen every year Adults aged 55-80 years with a history of smoking: Screen every year, “B” • Screening should be discontinued once: • a person has not smoked for 15 years, or • develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery “A”: The USPSTF recommends the service, because there is high certainty that the net benefit is substantial. “B”: The USPSTF recommends the service, because there is high certainty that the net benefit is moderate or moderate certainty that the net benefit is moderate to substantial. “C”: The USPSTF recommends selectively offering this service to individual patients based on professional judgment. There is at least moderate certainty that the net benefit is small. “D”: The USPSTF recommends against the service, because there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. “I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service.
  42. 42. PROSTATE CANCER SCREENING
  43. 43. Stage 5-Year Survival, % I Local Stage 100 II 100 IIIA Nearly 100 IIIB Regional Stage Nearly 100 IVA Nearly 100 IVB Distant Stage 29 Howlader N, Noone AM, Krapcho M, et al (eds). SEER Cancer Statistics Review, 1975-2014, National Cancer Institute. Bethesda, MD, bhttps://seer.cancer.gov/csr/1975_2014/, based on November 2016 SEER data submission, posted to the SEER web site, April 2017. 5-YEAR SURVIVAL RATE FOR PROSTATE CANCER BY STAGE
  44. 44. Who’s Right When it Comes to Screening?
  45. 45. 2008-2016 Screening Recommendations for Prostate Cancer Test or Procedure American Cancer Society U.S. Preventive Services Task Force Prostate Specific Antigen (PSA) Men ≥50 years: should talk to a doctor about the pros and cons of testing so they can decide if testing is the right choice for them. Men ≥45 years: should talk to a doctor about the pros and cons of testing if African American or have a father or brother who had prostate cancer before age 65. How often they are tested will depend on their PSA level. Men 55-69 years: “D” Men ≥70 years: recommends against PSA testing “D” Digital rectal examination As for PSA; if men decide to be tested, they should have the PSA blood test with or without a rectal exam. No individual recommendation “C”: The USPSTF recommends selectively offering this service to individual patients based on professional judgment. There is at least moderate certainty that the net benefit is small. “D”: The USPSTF recommends against the service, because there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.
  46. 46. 2018 Screening Recommendations for Prostate Cancer Test or Procedure American Cancer Society U.S. Preventive Services Task Force Prostate Specific Antigen (PSA) Men ≥50 years: should talk to a doctor about the pros and cons of testing so they can decide if testing is the right choice for them. Men ≥45 years: should talk to a doctor about the pros and cons of testing if African American or have a father or brother who had prostate cancer before age 65. How often they are tested will depend on their PSA level. Men 55-69 years: make an individual decision about whether to be screened after a conversation with their clinician about potential benefits and harm “C” Men ≥70 years: recommends against PSA testing “D” Digital rectal examination As for PSA; if men decide to be tested, they should have the PSA blood test with or without a rectal exam. No individual recommendation “C”: The USPSTF recommends selectively offering this service to individual patients based on professional judgment. There is at least moderate certainty that the net benefit is small. “D”: The USPSTF recommends against the service, because there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.
  47. 47. WHERE ARE WE RIGHT NOW IN TERMS OF CANCER SCREENING?
  48. 48. CLINICAL SCENARIO at Service OPD: • IM resident during Cancer Consciousness Week • Giving a lecture to 30-50 people from low to no income families on the benefits of cancer screening • What will you offer them?
  49. 49. Philippine Cancer Control Program Administrative Order No. 89-A s. 1990, amending A.O. No. 188-A s. 1973 • National Cancer Prevention and Control Action Plan (NCPCAP) 2015-2020: 1. POLICY AND STANDARDS DEVELOPMENT – Development of “National Policy on the Integration of Palliative and Hospice Care into the Philippine Health Care System” – Development and Operationalization of National Cancer Prevention and Control Website and Social Media Sites – Development of “Comprehensive National Policy on Cancer Prevention and Control” – Establishment of National Cancer Center and Strategic Satellite Cancer Centers – Expansion of Philhealth Z Benefit Package Coverage to Other Cancers
  50. 50. The reality is that more than 80% of Philippine families cannot afford out-of- pocket expenses needed for basic medical care. • Contrary to the continuing misperception that most Filipinos lack awareness that certain common cancers are curable when detected and treated early, it could be that due to socio-economic realities, majority actually have no choice.
  51. 51. Combined monthly income of those in the poverty line : ≤ P9,000 / MONTH • According to a controversial statement from NEDA, a family of 5 would need around P42,000 / month to live comfortably.
  52. 52. I ESTIMATED PRICES OF SCREENING TESTS (as of September 2018, c/o front desk personnel) SCREENING TEST Private Hospital in Alabang De La Salle – UMC DLS-UMC Charity Rate (with Social Service Help) BREAST CANCER Mammogram P3,594.00 P1,393.00 P1,114.00 COLORECTAL CANCER Colonoscopy P16,000.00 plus PF P9,000.00 plus PF P9,000.00 Sigmoidoscopy P13,000.00 plus PF P9,000.00 plus PF P9,000.00 CT colography P24,552.00 None None FOBT P480.00 P220.00 P180.00 CERVICAL CANCER Pap smear (conventional) P1,600.00 plus PF P400.00 plus PF P200.00 Pap smear (cytology) P2,800.00 plus PF None None HPV test P7,000.00 None None Pap smear with HPV cotesting P8,600.00 plus PF None None LUNG CANCER Low dose helical CT scan P9,277.00 P6,550.00 P6,550.00 PROSTATE CANCER PSA P4,780.00 P1,820.00 P1,456.00 * Philhealth coverage still deductible where applicable.
  53. 53. Philippine Cancer Control Program Administrative Order No. 89-A s. 1990, amending A.O. No. 188-A s. 1973 • National Cancer Prevention and Control Action Plan (NCPCAP) 2015-2020: 2. ADVOCACY AND PROMOTIONS • National Cancer Consciousness Week • Colon and Rectal Cancer Awareness Month • Cancer in Children Awareness Month • Cervical Cancer Awareness Month • Prostate Cancer Awareness Month • Lung Cancer Awareness Month • Liver Cancer Awareness Month • Breast Cancer Awareness Month • Cancer Pain Awareness Month In the Philippines, in spite of nearly two decades of “Awareness Campaigns” conducted by the public and private sectors, such as those on breast, cervix and colorectal cancers, majority of these cancers are still not diagnosed and treated at an earlier, more curable stage.
  54. 54. Philippine Cancer Control Program Administrative Order No. 89-A s. 1990, amending A.O. No. 188-A s. 1973 • National Cancer Prevention and Control Action Plan (NCPCAP) 2015-2020: 3. SERVICE DELIVERY • Availability of Free Cervical Cancer Screening in all trained RHUs • Availability of cryotherapy equipment in every province (81 provinces) • Availability and accessibility of screenings for selected cancers in all trained RHUs • School-based HPV vaccination of 9-13 year old females • Hepatitis B vaccination for all health workers nationwide
  55. 55. Philippine Cancer Control Program Administrative Order No. 89-A s. 1990, amending A.O. No. 188-A s. 1973 • Availability of Free Cervical Cancer Sceening in all trained RHUs via Visual Inspection with Acetic Acid (VIA) – VIA: • Uses bright white light to visualize the cervix with unaided eye • Clean cervix with dilute 3-5% acetic acid solution • Wait at least 1 minute • Abnormal tissue temporarily appears white (acetowhite) • Get IMMEDIATE results • Alternative to cytology in screening for cervical cancer in poorly- resourced locations • Can be done by nurses/midwives/BHW trained to deliver the service – SERVICE OPD of OB at the DE LA SALLE – UMC: • Service is FREE • Pay P50.00 for the speculum to be used • Additional ≈P500 for biopsy if with abnormal findings VIA NEGATIVE VIA POSITIVE
  56. 56. IN SUMMARY • HIGH – MODERATE INCOME SETTING – Screen patient if average risk / falls under the screening criteria – Discuss risks and benefits of cancer screening – Use ACS or USPSTF Guidelines • RESOURCE LIMITED – Take advantage of AWARENESS WEEKS to score some freebies  – Refer to Service OPD CANCER TEST Breast (October) Mammogram Colorectal (March) FOBT Cervical (May) VIA c/o service OPD or RHU Prostate (June) - Lung (November) -
  57. 57. Whose responsibility is cancer screening?
  58. 58. Whose responsibility is cancer screening? ALL PHYSICIANS. The more cancer we catch early, the more lives we save.
  59. 59. TITLE Speaker

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