1. Fight Back Against Cancer: Screening and Early Detection
Bolded parts are notes to you as the speaker. They are not always part of the presentation. They can be used for your information or to help you if you are asked a question that was not covered in the presentation.
The speaking notes all end with the following, [End of Notes] so you will ensure that you have received all the important information required for that slide.
There are several opportunities throughout the presentation where you are inviting the participants to be involved in the presentation by answering questions…
Thank you so much for inviting me here today.
My name is ________________ and I am one of the thousands of community-based Canadian Cancer Society volunteers/staff dedicated to making cancer history.
SPEAKER: If you work for the society you can explain how your role relates to giving these kinds of presentations (i.e. building relationships in the community, outreaching to the public, providing information on the importance of screening so that we will take that next step and get screened themselves.
As you know, I am here today to talk to you about the importance of screening. But before I launch into our topic for today, I thought I would just tell you a little bit about the Canadian Cancer Society.
[End of Notes]
Presentations prepared by: Canadian Cancer Society, Ontario Division, Public Affairs, Prevention
May 2012
Presentations prepared by: Canadian Cancer Society, Ontario Division, Public Affairs, Prevention June 2010

2. How we’re fighting cancer
doing everything we can to prevent cancer
funding research to outsmart cancer
empowering, informing and supporting Canadians living with cancer
advocating for public policies to improve the health of Canadians
rallying Canadians to get involved in the fight against cancer
So before we dive into our discussion about screening for cancer, here’s a bit about who we are and how we’re fighting all types of cancer.
You may be surprised to hear just how many people are touched by this disease … I know I was: Every three minutes, another Canadian is faced with fighting cancer.
It’s for this reason that we’re working tirelessly, alongside our volunteers and donors, to fight back against cancer. Across Ontario we are fighting cancer by:
doing everything we can to prevent cancer
funding research to outsmart cancer
empowering, informing and supporting Canadians living with cancer
advocating for public policies to improve the health of Canadians
rallying Canadians to get involved in the fight against cancer
And it’s thanks to the dedication of our volunteers and the generosity of our donors that we’re having more impact, against more cancers, in more communities, than any other cancer charity.
Speaker – Ask: Do you know any good news about the prevention of cancer?
The good news is …
CLICK
that we know that at least half of cancers can be prevented through healthy living and policies that protect the health of Canadians. And that is really good news!!! So today I am here to talk about screening as a way to find some cancers early before it becomes a serious health concern.
[End of Notes]

3. Screening
So as we start…. What is screening?
(CLICK SLIDE TO GET FULL DEFINITION)
Screening is the early detection of cancer by testing or checking for disease in a group of people who don't show any symptoms of the disease.
Many forms of cancer respond best to treatment if they found and treated as early as possible. In some cases, as we will see today, it will stop pre-cancerous cells from turning into cancer!
Let me explain it another way, many, if not most of us, who own a car are very diligent about bringing it in for a regular tune up on a set schedule. We do this to ensure that we avoid any problems with the car or to deal with a small issue before it becomes a big one. Cancer screening is similar to the car tune-up.
As you may know, cancer is actually a collection of over 200 disease. Because of this, not surprisingly, there isn't one screening test that works for all types of cancer. In fact, most types of cancers don't have a screening test.
You are going to hear me say this a lot today, but it's important to talk to your doctor to learn more about your personal risk of cancer and to take advantage of any screening tests or programs that are available that might help to find cancer early.
So… screening tests… screening programs…. What do I mean by these terms? 
[End of Notes]
Testing or checking for a disease in people who don’t show any symptoms of the disease.

4. Early Detection of Cancer
Screening for cancer
No signs and symptoms present
Follows recommendations and guidelines
Testing for cancer
Signs or symptoms are present
Know what is normal for your body
Well, there are a two methods, if you will, for detecting cancer early….
(SPEAKER: if you have a smaller group, you can ask the room what they think the different methods for early detection are – discuss with the group that we are talking about methods and not different tests, help them along to try and guess what the methods might be – if they really are not getting it then put them up on screen, and then go through in detail what the different sections are, making sure the room is clear before you move on – this will help you later).
CLICK
Cancer Screening – there are government-funded programs with key guidelines outlining who should be screened. For a test to become part of a screening program, it must be shown to save lives when those of get the test routinely. Screening for breast, cervical and colon cancers saves lives. Screening is done on people who do not have any cancer symptoms (or who are asymptomatic). The purpose of cancer screening is to detect pre-cancerous changes, or cancer at an early stage.
Tests for cancer – are tests that are recommended for people who have signs or symptoms. Sometimes these same tests are done even for people without signs or symptoms.
It is also important that we have a clear sense of what is “normal” for our body and discuss any changes with our doctor.
Ultimately, the big take home message here is TALK TO YOUR DOCTOR – you really need to let her or him know about changes and discuss when you should start a screening program or complete any kind of cancer testing based on your individual needs.
So this is our AGENDA today. We are going to first talk about the screening programs we have in place in Ontario, follow it up with some information on cancer investigation testing, and close it off with what you should be looking for in your body and what you should report to your doctor.
[End of Notes]

5. Why is screening important to you?
In most cases, finding cancer early increases the chances of successful treatment.
Screening saves lives!
You may think:
I am afraid of learning that if I have cancer and would rather not do the tests OR
I am too busy to do routine testing and will go to the doctor only if I feel unwell
I don’t want to do these tests as I have heard they can be uncomfortable or embarrassing.
I think we owe it to our health to take the time, bring up our courage, put embarrassment aside and focus on our health.
But if you had to ask the question… why is screening important to you?
It is this simple: Click
Routine screening – in these three programs – has been shown to save lives by detecting cancer early.
For example, when caught early through regular screening, there is a 90% chance that colon cancer can be treated!!
(Click)
There is no two ways about it… screening saves lives!
[End of Notes]

6. Pros & Cons of Screening
Earlier detection of cancer
Reducing the anxiety of “not knowing”
Effective screening saves lives
Cons
False positive results
False negative results
Over-diagnosis
Almost every test or procedure carries benefits and risks. The important thing is to be aware of them so that you can make an informed decision that is right for you.
No screening test is 100% accurate but a good screening test is one that results in a decrease in death rates in people with cancer.
Researchers also look for other benefits of screening including improved quality of life or less harmful treatments as a result of finding the cancer early.
Click
Benefits of regular screening
Earlier detection of cancer: In most cases, the earlier a cancer is detected, the better your chance of survival. Early detection may also mean less treatment and less time spent recovering.
Reducing the anxiety of "not knowing": Many people prefer to have ‘check-ups’, just like a physical exam with your family doctor.
Effective screening tests will save lives
Risks of regular screening
False positive results: When test results suggest cancer even though cancer is not present. False positives can result in anxiety, stress and possibly painful and unnecessary tests to rule out cancer (that is, to make sure you don’t have cancer when the screening test has suggested you might).
False negative results: When cancer not detected by the test even though it is present. False negative results can cause you or your physician to ignore other symptoms that indicate the presence of cancer, causing a delay in diagnosis and treatment.
Over-diagnosis. Some cancers would not necessarily lead to death or decreased quality of life. For example, some prostate cancers never become clinically apparent, meaning that they do not cause any symptoms, nor do they affect life expectancy or quality of life. Men with these tumours may not ever develop symptoms or need treatment for cancer.
More information about screening, and what makes a good screening test, can be found on cancer.ca
[End of Notes]

7. Currently there are three cancer screening programs, what are they?
Breast
Cervical
Colon
Lets start then with the Screening Programs in Ontario
(SPEAKER: If you have a small enough group, ask the room…)
So I ask all of you…. What are the 3 screening programs in Ontario? The three routine screening programs in Ontario?
(SPEAKER: give the room time to answer – and praise them for getting it right when they do!)
(CLICK)
EXACTLY – So remember, for something fall to be designated as a routine screening program, the test must be shown to save lives! Routine screening tests for breast, colon and cervical cancers have been shown to save lives. Therefore they fall into the screening program category, and in the 1990s the government launched programs for both Breast and Cervical testing
Does anyone know what the most effective test that screens for breast cancer is called? – answer mammography
And what about for cervical cancer? What is the common term used for that test? – answer Pap test
GREAT!
The screening program for colon cancer is relatively new – it was launched by the Ontario Government in The colon cancer screening program uses the FOBT. Does anyone know what FOBT stands for?? We’ll answer that later.
[End of Notes]

8. What percentage are getting screened?
Regular Breast Screening
Regular Cervical Screening
Regular Colon Screening
(FOBT only)
66.6%
72.5%
And now that we know what the three screening programs are, what percentage of people do you think are getting routine screening in this province?
SPEAKER: again here you can ask the room if it is a small enough group, even if it is a large group, you can let a few audience members shout it out)
What about routine mammography for women 50 to 69… what percent do you think are getting routine screening? CLICK % (CSQI, 2011)
And how about for cervical screening – what percent of women (20 – 69 years) do you think are getting routine Pap tests? CLICK 72.5% (CSQI, 2011)
What do you think the percentage of men and women (50-74 yrs) going for the FOBT part of colon screening is? CLICK 29.9% (CSQI, 2011)
Speaker: For Colon screening we only have information on FOBT, not on the whole program.
All information comes from Cancer System Quality Index, 2011, Cancer Quality Council of Ontario and Cancer Care Ontario
As you can see we have a long way to go!!
[End of Notes]
29.9%
Cancer System Quality Index, 2011, Cancer Quality Council of Ontario and Cancer Care Ontario

9. Breast cancer screening
The first type of screening we will focus on is for women’s breast cancer screening.
Breast cancer starts in the cells of the breast which could be anywhere from the the armpit across to the breastbone in the centre of the chest.
(SPEAKER: again if this is a smaller group, it is nice to ask the crowed to touch their collarbone on themselves to drum home the point how far up on the body we are talking about).
You should know that breast cancer can occur in men, but it is extremely rare.
Risk factors for breast cancer include, for example:
age – particularly after 50
family history of breast cancer (especially in a mother, sister or daughter diagnosed before menopause or if mutations on BRCA1 or BRCA2 genes are present)
family history of ovarian cancer
dense breast tissue (as shown on a mammogram)
radiation treatment to the chest area (for example, to treat Hodgkin lymphoma), especially before age 30
Alcohol consumption
Being overweight or obese
A complete list can be found on
[End of Notes]

10. Screening guidelines for average risk
Breast cancer
Screening guidelines for average risk
Women
40 to 49
Talk to your doctor about your risk of breast
cancer, along with the benefits and risks
mammography.
Women should know what is normal for breasts and report any changes to their doctors. A doctor may also do a physical examination of the breasts.
Note to Speaker: You may be asked what a clinical breast exam is. This is a physical examination of the breasts by a doctor.
In addition to knowing your breasts, the Canadian Cancer Society recommends the following the screening guidelines.
Screening in Ontario
Talk to your doctor or nurse practitioner about the risk of breast cancer based on genetics and family history. He or she will determine whether you are high-risk or average-risk. Since most women are average-risk we are going to start with these women first. We will talk about what is makes a woman high-risk in a minute
CLICK
Average-risk women should talk to your doctor about your risk for breast cancer and the risks and benefits of mammography.
If asked why mammograms is only recommended for average-risk women aged 50-69:
These are the ages that mammograms are most appropriate for on a population based screening tool – mammograms have only been shown to save lives for women ages so that is why we recommend it. The benefits for women under 50 are still unclear. There is some suggestion that women aged 40–­49 could benefit from regular mammography, but the issue is confusing.
Click
Women 50 – 69 should have a mammogram every two years.
In Ontario, getting a mammogram is easy. If you’re a woman who is 50+, you can talk to your healthcare professional or call the Ontario Breast Screening Program to make your own appointment. It’s that simple.
Women 70 and over should talk to their doctor about being tested for breast cancer.
So remember to get screened, talk to your doctor, or if you are 50 or over, call the Ontario Breast Screening Program directly.
Any woman concerned that she’s at higher risk of developing breast cancer should talk to her doctor.
Now let’s talk these mammograms! I would suspect that most women do not like to have their breasts squished like a pancake ???? 
It is no doubt uncomfortable to say the least… but and this what we want to stress… the benefit of having your breasts screened is undeniable!!!!
[End of Notes]
Women
50 to 69
Have a mammogram every 2 years.
Women
70 or older
Talk to your doctor about how often you should be tested for breast cancer.

11. Detecting breast cancer early
Why is breast screening important?
Breast cancer mortality rates in Canadian women have fallen by more than 40% since 1986, likely due to both improved cancer treatments and increased participation in breast screening (ref: Canadian Cancer Statistics, 2012).
Unfortunately, as we noted earlier, only approximately 66.6% of women aged in Ontario are participating in breast screening.
Click
To highlight he importance mammography plays in detecting the disease early, the Canadian Cancer Society has developed the Thingamaboob.
Now I know what you’re thinking – that’s a funny name, and you’re right it is! But, this pretty pink tool also delivers a life-saving message - if you’re and of average risk take action and commit to getting a mammogram every 2 years.
The Thingamaboob shows women hands-on how important regular mammograms are in detecting breast cancer early when it’s most treatable. Now I know that getting a mammogram and having your breasts squished like a pancake, is likely not on your ‘top 10’ list of things to do BUT while it may be a bit uncomfortable, and this is what I want to stress, the benefit of having a mammogram far outweighs any discomfort – it could save your life!!!!
SPEAKER: USE A REAL THINGAMABOOB, AS A ‘SHOW AND TELL’ WHEN DESCRIBING THE DIFFERENT SIZED BEADS. ONCE DONE EXPLAINING, PASS IT AROUND THE AUDIENCE.
Here’s what the different bead sizes represent:
The largest bead is about the size of a cherry tomato, which is the average size lump found by women checking their own breasts.
The second largest bead is about the size of a grape, which is the average size lump found by a physical exam done by a healthcare professional.
The next bead – the second smallest – is about the size of a pea and it’s the average size lump found by a first mammogram.
The smallest bead shows the average size lump found by regular mammograms – approximately the size of an apple seed.
The message is that mammograms (breast x-rays) can detect changes in breast tissue at the earliest stages, when treatment is most likely to be successful. We highly recommend that women should receive a mammogram every 2 years from ages What other screening guidelines do we promote….
Speaker: If participants have many questions on this cancer and you are concerned about the time:
remind them that we have a specific presentation that goes into more detail about the risk factors and what they can do to help prevent it
remind them of cancer.ca or Cancer Information Service (number at the end of the presentation)
[End of Notes]

12. High-Risk Screening Guidelines
As we mentioned previously, a women will first go her doctor or nurse practitioner to discuss her risk profile.
High Risk Women (based on discussion with doctor/nurse practitioner)
Genetic testing of self or first degree relative confirming a mutation (i.e. BRCA1, BRCA2, or TP53)
family history of hereditary breast cancer syndrome and 25% or greater of lifetime risk of breast cancer confirmed by genetic assessment
radiation therapy before age 30yrs and more than 8yrs ago as treatment for cancer or another condition.
High-risk women are referred to OBSP for a mammogram and a MRI or Magnetic Resonance Imaging.
SPEAKER: The high-risk expansion of OBSP will begin as of July 1, 2011 at selected sites across the province. These sites will act as High Risk Screening Centers. As the program matures, more OBSP sites will be added.
If you are:
You should:
High-risk women
30 to 69yrs
Mammogram
Magnetic resonance imaging (MRI),

13. Cervical cancer screening
Another cancer that has a screening program in Ontario is cervical cancer.
Cervical cancer starts in the cells of the cervix. You can see that the cervix is the narrow lower part of the uterus. It is the passage way that connects the uterus to the vagina. Cervical cancer only affects women.
The most important risk factor for developing cervical cancer is infection of the cervix with human papillomavirus (HPV). A more complete listing of factors which increase your risk of developing cervical cancer can be found on cancer.ca.
[End of Notes]

14. Human Papillomavirus cause of almost all cervical cancers
linked with cancers of the anus, vulva, vagina, mouth and throat.
HPV spread mainly through sexual contact
HPV is spread mainly through sexual contact (including sexual intercourse, genital skin-to-skin contact and oral sex) and the virus can appear years after you have been exposed to it.

15. Human Papillomavirus (HPV) Vaccine
Cervical cancer
Human Papillomavirus (HPV) Vaccine
2 types of vaccines available in Canada
protect against the 2 types of HPV that cause 70% of cervical cancers.
girls and women between the age of 9 – 45 should be vaccinated
works best before a person becomes sexually active
women still need to get Pap tests
Girls and women between the age of 9 – 45 should be vaccinated against HPV to help reduce their risk of HPV-related cancers. These include cervical, vaginal, vulvar and anal cancer and precancerous conditions associated with the cancers.
The vaccination is also available to males aged 9 – This will help protect against HPV-related cancers such as anal cancer.
In Ontario, the HPV immunization is available through school-based immunization programs for grade 8 females.
Males (aged 9-26) and females (aged 9-45 not in grade 8) can talk to their doctors and nurse practitioners to obtain the vaccine.

16. Pap Test Recommendations
Cervical cancer
Pap Test Recommendations
Women who are sexually active should have Pap tests by the time they are 21 every 3 years.
Women who are no longer having sex should continue to have the test.
A Pap test is the screening test for cervical cancer. This test may be done by your family doctor or a nurse practitioner.
If you are 21 years old and sexually active, you should start having a Pap test.
You’ll need a Pap test every 3 years.
Even if you have stopped having sex, you should continue to have the test.
If you have had a hysterectomy, you may still need a Pap test, but again talk to your doctor about whether this is necessary. 
[End of Notes]

17. Colon cancer
So the last screening program I want to address is dedicated to colon cancer. As I have mentioned before, it’s the newest screening program available in Ontario.
Just so we are all clear what part of the body we are referring to, I have put up this diagram.
Most colon cancers start in the cells that line the inside of the colon or the rectum. The colon and rectum make up the large intestine (large bowel). Organs of the digestive system change food into energy and help pass waste out of the body.
Colon cancer usually has a slow and predictable growth, which is really good news, because if we can detect it early, then we have time to get surgery in place and remove the early stage cancer long before it spreads to other parts of the body.
Risk factors for colon cancer include, for example:
age – particularly after 50
family history of colon cancer - especially if the relative (parent, sibling, child) developed colon cancer before the age of 45
diet high in red meat (beef, pork, lamb and goat)
processed meat (ham, salami, sausage, hot dogs)
alcohol consumption
Smoking
physical inactivity
Researchers are also looking at how diet affects the risk of developing colon cancer. A diet high in vegetables and fruit is known to lower risk. A diet high in fibre and low in animal fats also seems to decrease risk, but more research is necessary to be sure.
A complete list can be found on
[End of Notes]

18. Colon Cancer screening guidelines
Average risk
men and women
50 and older
Fecal Occult Blood Test (FOBT) at least every two years
High risk
men and women (first-degree relative with colon cancer)
Colonoscopies starting at age 50 or 10 years before age of diagnosed relative
The screening guidelines for colon cancer are that men and women 50 years and over, who are of average risk – should complete and FOBT kit every 2 years.
Click
Those of high risk according to ColonCancerCheck’s guidelines a first-degree relative with colon cancer, such as a parent, sibling or child, due to should have a colonoscopy (starting at age 50 or 10 years before age of diagnosed relative) and talk to doctor about how to be screened.
Other high individuals risk should talk to their doctor about a screening routine. These people include, for example, those with inflammatory bowel disease (ulcerative colitis or Crohn’s disease) or those with specific inherited diseases like FAP (familial adenomatous polyposis) or HNPCC hereditary nonpolyposis colon cancer.
Source: based on cancer.ca and coloncancercheck.ca.
[End of Notes]
Other high risk
men and women
Talk to your doctor about screening

19. ColonCancerCheck Colon cancer
province-wide colon cancer screening program
screens with FOBT (average risk), colonoscopy (higher risk)
FOBT kits available from your doctor, pharmacist or through ColonCancerCheck directly
follow-up included
Speaker Ask Has anyone seen the Invisible Man/Woman commercial on TV?
Click to move the picture and see the name of the program.
These TV commercials depicting the invisible men and women by Cancer Care Ontario and the Ministry of Health and Long-Term Care and outline the ColonCancerCheck program which is a newly introduced Ontario-wide, screening program aimed at reducing deaths from colon cancer by increasing early detection of the disease.
Through this program, people of average risk complete an FOBT kit.
And people of higher risk* have a colonoscopy, a procedure that lets a doctor look at the lining of the entire colon, beyond the rectum and lower colon.
Talk to your doctor if you’re concerned about your risk factors and which test is appropriate for you. if you don’t have a doctor, not to worry, you can get help to determine which kit is right for you and if appropriate, receive the FOBT test through a number (hold up brochure) or at your local pharmacy.
higher risk according to the ColonCancerCheck program means people with a family member who has had colon cancer (parent, child, sibling).
The contact number for ColonCancerCheck is
[End of Notes]
ColonCancerCheck.ca. 2009 19

20. Fecal Occult Blood Test (FOBT)
Colon cancer
Fecal Occult Blood Test (FOBT)
So what is the FOBT that is used for people who are of average risk and how does it work?
(SPEAKER: use this time to go through the process of how to administer the FOBT test using the sample that you have with you – going step by step through the process – check inside of the kit for the instructions –
FOBT stands for Fecal Occult Blood Test (FOBT) : and this test finds blood in the stool that is not visible to the naked eye. If blood is found, more testing is necessary to find out if it was caused by cancer.
As we saw in the previous screen, FOBT kits are available through primary health care providers. Individuals without a primary health care provider can obtain a kit from a pharmacist or by calling ; TTY :
The test is a home kit that enables you to take three separate stool samples. Once the samples have been collected (full instructions are on the kit and available on ColonCancerCheck.ca), you mail or take the kit to a laboratory which assesses if there is any blood in the stool.
Show the FOBT kit and illustrate how it would be used.
Results:
If everything is okay (a “negative” test result), you will be notified to repeat the FOBT in two years .
If blood is found in the stool samples, then you will be told to contact your doctor for follow-up tests. If you don’t have a doctor, ColonCancerCheck (at coloncancercheck.ca) will arrange a physician to meet with you and discuss the results and next steps. Note: a positive results does not necessarily mean you have colon cancer!
As I mentioned, the FOBT is for those persons who are of average risk. Adults who are at “higher risk” should have a ‘colonoscopy’ (a procedure that lets a doctor look at the lining of the entire colon, beyond the rectum and lower colon), beginning at age 50 or 10 years earlier than their relative’s age of diagnosis.
Individuals who are at higher risk include those with:
- a first-degree relative with colon cancer (such as a parent, sibling or child)
Some individuals are at even higher risk, and should talk to their doctor about a screening routine. These people include, for example, those with inflammatory bowel disease (ulcerative colitis or Crohn’s disease) or those with specific inherited diseases.
If asked, the specific inherited diseases include familial adenomatous polyposis (FAP) or hereditary nonpolyposis colon cancer (HNPCC).
In Ontario in 2011 it’s estimated that colon cancer is the second most common cause of cancer deaths, after lung cancer. What is interesting, however, is that approximately only about 30% of those who are 50 years or older are participating in colon cancer screening in Ontario. We hope that this will change as more people learn about ColonCancerCheck. When caught early through regular screening, colon cancer is 90% treatable. Colon cancer screening can be the difference between life and death.
Speaker: If participants have many questions on this cancer and you are concerned about the time:
remind them that we have a specific presentation that goes into more detail about the risk factors and what they can do to help prevent it
remind them of cancer.ca or Cancer Information Service (number at the end of the presentation)
[End of Notes]

21. Early Detection of Cancer
Screening for cancer
No signs and symptoms present
Follows recommendations and guidelines
Testing for cancer
Signs or symptoms are present
Know what is normal for your body
That brings us to the end of the section on cancer screening tests and programs that we have in Ontario which will help the medical team determine if cancer is present in those persons who do not have signs or symptoms.
In this next section we are talking about testing for cancers where there are either signs or symptoms of the disease or you and your doctor determine based on your risk that testing is necessary.
Based on time, and the number of cancers that this could involve, we are only going to touch on a few.
End of Notes]

22. Early Detection Know what is normal for you
Report any changes to your doctor
There are many cancers that involve keeping an eye on your own body so that you can notice any changes…
(SPEAKER: make sure that you have “If you see one of these warning signs” check list either to hand out at this time, or perhaps it is already in the audience packages.)
Here is a list of different warning signs you can look for and report to your doctor if you notice any of them – I am bringing this up now because sometimes people have had, for example a cough that doesn’t seem to go away, or a heavier than normal menstrual period, and they don’t think anything of it… again taking the attitude that it will just go away… (If you have time) So lets review that list now:
Here are some warning signs you should not ignore:
Remember, having any of these signs does not mean that you have cancer. They may be due to some other medical problem, or they may not be serious at all. Only your doctor can tell for sure. Don't take any chances with your health. Bring any warning sign to the attention of your doctor right away. 
a new or unusual lump or swelling in the breast, testicles or any other part of the body
any gland that remains swollen for more than 3 weeks
any sore that does not heal anywhere on the body or in the mouth
obvious change in the shape, size or colour of a mole or wart
a nagging cough or hoarseness that lasts more than 4 weeks
difficulty swallowing that lasts more than 4 weeks
blood in the urine, stool or phlegm
unusual bleeding or discharge of any sort from the nipple or vagina
change in bladder habits, such as pain or difficulty urinating
any change in bowel habit (constipation or diarrhea) that continues for more than a few days
persistent indigestion
unexplained weight loss, fever or fatigue
unexplained aches and pains that go on for more than 4 weeks
any new growth on the skin, or patches of skin that bleed, itch or become red
Again, I warned you at the beginning, I was going to say this a lot… but talk to your doctor if you see any of these changes or if you have any further questions about any of this for your personal and individual health needs and concerns.
[End of notes]

23. Other tests for cancer
There are some tests for cancers which are sometimes used to screen for cancer in people without any symptoms. These are also often used for people who have symptoms of cancer. In Ontario, these are only free for people who have symptoms or certain risks of developing cancer.
Ones you may have heard about in the news include:
CA-125 testing for ovarian cancer
X-rays or other imaging studies for lung cancer
PSA testing for prostate cancer
More information on these tests can be found on cancer.ca
Lung Cancer Tests
There is currently no evidence-based lung cancer screening test. Research to date suggests that screening for this type of cancer is associated with a high-false positive rate (the incorrect identification of cancer that does not exist). And this can result in unnecessary and invasive follow-up testing. As well, studies have not yet shown a reduction in lung cancer deaths from these
Ovarian Cancer Tests
Studies investigating the potential use of biomarkers (e.g., CA 125) or routine clinical investigations (e.g., pelvic examinations, transvaginal ultrasound or CT scans) for the early detection of ovarian cancer have not been associated with a reduction in ovarian cancer death. However, they do increase the likelihood of invasive surgery.
[End of notes]

24. Prostate cancer I want to touch on Prostate cancer for minute.
You can see from the slide the prostate is about the size of a walnut or a golf ball. It is located close to the rectum just below the bladder at the base of the penis. The prostate is part of the male reproductive system. Its main function is to make part of the liquid that mixes with sperm from the testicles to make semen.
Prostate cancer is the most common cancer in Canadian men with approximately men being diagnosed. Fortunately, it usually grows slowly and can often be treated or managed successfully. That said, it is estimated that men will die of prostate cancer in (Canadian Cancer Statistics, 2011)
[End of Notes]

25. Tests for prostate cancer
Digital Rectal Exam (DRE)
Prostate Specific Antigen (PSA) test
There are two tests for prostate cancer that I want to review today – one is a Digital Rectal Exam and the other is a Prostate Specific Antigen test which is a blood test that measures the amount of “PSA” in the blood.
DRE- During your annual physical check-up, your doctor places a gloved finger into the rectum to feel the prostate gland. Most prostate cancers develop in the peripheral zone, which is the part of the prostate that lies closest to the rectum. This makes it easy to feel for lumps, irregularities or changes in size or consistency.
PSA is produced by the prostate and is normally present in a man’s blood in very small amounts. High levels of PSA may indicate the presence of cancer although high levels can be caused for many other reasons too.
[End of Notes]

26. Testing for prostate cancer
There is a bit of debate on PSA testing. Based on the current evidence, the Canadian Cancer Society advises men over 50 to discuss with their doctor about whether they should be tested for prostate cancer. If you are at a higher risk because of your family history or African ancestry, talk to your doctor about whether you should be tested from an earlier age. 
Most research shows that the PSA test is mainly effective as a diagnostic test for men who are at above average risk of developing prostate cancer, or demonstrate symptoms of prostate cancer.
The PSA (blood test) can help detect prostate cancer early but there are some significant weaknesses to the test. Sometimes the PSA misses prostate cancer when it is actually present and an individual, therefore, does not get the care required.
Other times, the test can say that someone is positive for prostate cancer when they actually are not. In these cases, an individual get treatments that they may not have needed, and which can cause many long-term side effects. In some cases, these tests can detect prostate cancer that may not pose a serious threat to your health.
Ultimately the problem is that 2 out of 3 men who have a high PSA will NOT have prostate cancer and they will need to have ultrasounds and biopsies to prove this.
In most cases, early detection is very important for fighting cancer. However, unlike many other cancers, some prostate cancers can be present for years without affecting a man’s health. It is still important to know, though, that in 2010, and estimated 4,300 men will die from prostate cancer.
Because there are both risks and benefits to the PSA test, it’s important to talk to your doctor about your personal risk of developing prostate cancer. And to work with your doctor to decide what is best for you.
Speaker: If participants have many questions on this cancer and you are concerned about the time:
remind them that we have a specific presentation that goes into more detail about the risk factors and what they can do to help prevent it
remind them of cancer.ca or Cancer Information Service (number at the end of the presentation)
[End of Notes]

27. Our brochures...
If you want more detailed information on what we talked about today….just go to Cancer.ca, making sure you are Visiting Ontario in the top right of the screen and click on Publications.
You can down load a pdf of these brochures online or you can pick them up from your local Canadian Cancer Society office or by calling our Cancer Information Line… which is
My last slide has the number on it, as well as any Society literature and on our website you can find the number too.
[End of Notes]

28. So as we have covered a lot of information today
So as we have covered a lot of information today. Are there any other questions that you have…. Did that make sense?
[Ask probing questions based on the reactions or discussion in the group – and based on the size of the presentation.]
Hold up pamphlet and show them again where they can get FOBT kits may prompt someone to ask question If no one seems to be asking any
I have one final question for you Where can you go to for reliable cancer information that is based on research evidence????
[End of Notes]
Questions ? 28

29. For the most up-to-date information:
visit
call the Canadian Cancer Society Cancer Information Service at
Final slide
To get the most up-to-date information on cancer or to learn more about cancer prevention, visit our website at
Or you can call Cancer Information Service at It’s free, and available in over 120 different languages.
Finally, if you would like to get involved with the Canadian Cancer Society as a volunteer, you can do so by either visiting our website or by calling the Cancer Information Service line.
Thank you again for inviting me here today to talk to you about screening and early detection of cancer. It is because of people like you, and our volunteers and donors that the Canadian Cancer Society is able to help thousands of people each year. Together we will fight back against cancer.
(Speaker: Questions can be entertained at this time or participants can be referred to speak to you at the display table.)
Please feel free to take home the materials on the display table. I’ll be here for a while longer if anyone has any additional questions.
[End of notes]
Thank you!
Presentation prepared by:
Canadian Cancer Society, Ontario Division, Public Affairs, Prevention
May 2011