1. Done by : Naif alarjani and ahmed allohaidan

2. Objectives - What dose it mean by screening ? - Criteria for screening - Common cancers to be screened e.g. Breast, Cervix, Colon, Prostate Cancers - Target people - How these common cancers are screened (Examination, Markers, …..) - Cost effectiveness

3. Introduction we know that early detection is one of the most important factors to surviving cancer. Whether you have a family medical history, lifestyle, and other factors that indicate that you are at greater risk for cancer, or if you are in a low-risk group with no symptoms of the disease, regular screenings are critical to successfully diagnosing and treating cancer.

4. What dose it mean by screening ? Screening, in medicine, is a strategy used in a population to identify the possible presence of an as-yet undiagnosed disease in individuals without signs or symptoms. This can include individuals with pre-symptomatic or unrecognized symptomatic disease.

5. Criteria for screening WHO criteria for a good screening test: the condition screened for should be an important one there should be an acceptable treatment for patients with the disease the facilities for diagnosis and treatment should be available there should be a recognized latent or early symptomatic stage there should be a suitable test or examination which has few false positives - specify - and few false negatives – sensitivity the test or examination should be acceptable to the population the cost, including diagnosis and subsequent treatment, should be economicallybalanced in relation to expenditure on medical care as a whole

6. Breast cancer Breast cancer is the most common cancer occurring in women, with over 200,000 new cases diagnosed yearly in the United States alone, and it is the second leading cause of cancer-related deaths in women.

7. Targeted people for screening : - Female gender - Age : The risk of getting breast cancer increases with age. - Heredity : Two autosomal dominant genes, BRCA1 and BRCA2, account for most of the cases of familial breast cancer. - Prior cancers - Menstrual history : women who started menstruating younger than age 12 have a higher risk for breast cancer later in life. - Pregnancy, childbearing and breastfeeding - White race

8. - Weight : Obesity is associated with an overall increase in morbidity and mortality. - Tall stature : Increased height is associated with a higher risk of breast cancer - Estrogen levels : High endogenous estrogen levels increase the risk of breast cancer

9. Breast cancer screening tests : Breast cancer screening refers to testing otherwise-healthy women for breast cancer in an attempt to achieve an earlier diagnosis under the assumption that early detection will improve outcomes a number of screening tests have been employed including : 1- Clinical and self-breast exam A clinical or self breast exam involves feeling the breast for lumps or other abnormalities. Clinical breast exams are performed by health care providers, while self breast exams are performed by the person themselves.

10. 2- Mammography : Mammographic screening for breast cancer uses X-rays to examine the breast for any uncharacteristic masses or lumps. During a screening, the breast is compressed and a technician takes photos from multiple angles. The main benefit of mammography screening is reduction of breast-cancer related death.

11. 3- Genetic screening 4- Ultrasound 5- Magnetic resonance imaging

12. Brest cancer screening plan : A number of national bodies recommend breast cancer screening. For the average woman, the U.S. Preventive Services Task Force recommends mammography every two years in women between the ages of 50 and 74

13. Cost-effectiveness of breast cancer screening : Breast cancer is the second leading cause of death by cancer among women in the United States. The total cost of illness for breast cancer has been estimated to be $3.8 billion, of which $1.8 billion represents medical care costs. It has been estimated that breast cancer detected early is considerably less expensive than when the tumor is discovered at a later stage

14. Cervical cancer Cancer of the uterine cervix is the third most common gynecologic cancer diagnosis and cause of death among gynecologic cancers in the United States

15. Targeted people for screening : - Human papillomavirus : Human papillomavirus types 16 and 18 are the cause of 75% of cervical cancer globally. - Smoking - Oral contraceptives : Long-term use of oral contraceptives is associated with increased risk of cervical cancer. - Multiple pregnancies : Having many pregnancies is associated with an increased risk of cervical cancer

16. Cervical cancer screening tests : There are several ways to screen for cervical cancer. The traditional screening test is called a Pap test. 1- Pap smear : WHO SHOULD HAVE A PAP SMEAR? Younger women : the first Pap test is recommended at age 21 Older women : Most experts feel that women who are 65 years or older can stop having Pap tests if: ●she had Pap tests on a regular basis in the past ●she had at least three normal Pap tests in a row over the past 10 years After hysterectomy: Women who have had a total hysterectomy

17. 1- Pap smear : WHO SHOULD HAVE A PAP SMEAR? Younger women : the first Pap test is recommended at age 21; some other countries suggest that screening begin at age 25 Older women : Most experts feel that women who are 65 years or older can stop having Pap tests if: ●she had Pap tests on a regular basis in the past ●she had at least three normal Pap tests in a row over the past 10 years After hysterectomy: Women who have had a total hysterectom

18. 2- HPV testing: WHO SHOULD HAVE HPV TESTING? 30 years or older, the doctor or nurse may recommend HPV testing in addition to a Pap test. If HPV test and Pap test are negative, repeat testing is not usually needed for five years. HPV testing may also be done if the results of your Pap test results are unclear.

19. - Human Pappiloma Virus Immunization : Advantage : HPV vaccine have been shown to prevent cervical dysplasia from the high-risk HPV types 16 and 18 and some protection against a few closely related high-risk HPV types Disadvantage : 1- There are some factors that exclude people from receiving HPV vaccines. These factors include: - immediate hypersensitivity to vaccine componentsimmediate hypersensitivity - Patients with a hypersensitivity to yeasthypersensitivityyeast - People with moderate or severe acute illnessesacute illnesses 2- pregnant women

20. Cost-effectiveness of cervical cancer screening : The most cost-effective strategies were those that required the fewest visits, resulting in improved follow-up testing and treatment. Screening women once in their lifetime, at the age of 35 years, with a one-visit or two-visit screening strategy involving visual inspection of the cervix with acetic acid or DNA testing for human papillomavirus (HPV) in cervical cell samples, reduced the lifetime risk of cancer by approximately 25 to 36 percent, and cost less than $500 per year of life saved.

21. Colon cancer Colorectal cancer (CRC) is a common and lethal disease Colorectal cancer is the third most common cancer affecting both males and females in the United States. Globally, colorectal cancer is the third most commonly diagnosed cancer in males and the second in females

22. Targeted people for screening : - Family history of colorectal cancer - Prior colorectal cancer or polyps - Increasing age - Lifestyle factors : Several lifestyle factors increase the risk of colorectal cancer, including: A diet high in fat and red meat and low in fiber A sedentary lifestyle Cigarette smoking Alcohol use Obesity

23. - Large increase in risk — Some conditions greatly increase the risk of colorectal cancer.. Familial adenomatous polyposis. Hereditary nonpolyposis colon cancer. Inflammatory bowel disease

24. Colon cancer screening tests : Several tests available for colorectal cancer screening can detect pre-cancerous polyps (adenomas), and can lead to cancer prevention and/or detect cancers at an early, more treatable stage. 1- Colonoscopy 2- Sigmoidoscopy 3- CT colonography ("virtual colonoscopy") 4- Stool tests 5- Fecal occult blood test

25. Colon cancer screening plans : The colon cancer screening plan depends upon the risk of colorectal cancer. 1- Average risk of colorectal cancer — People with an average risk of colorectal cancer should begin screening at age 50 : ●Colonoscopy every 10 years ●Computed tomographic colonography every 5 years ●Flexible sigmoidoscopy every five years ●Stool testing every year (for guaiac and immunochemical occult blood tests)

26. 2- Increased risk of colorectal cancer — Screening plans for people with an increased risk may entail screening at a younger age, more frequent screening, and/or the use of more sensitive screening tests (usually colonoscopy). 3- Family history of colorectal cancer 4- Inflammatory bowel disease

27. Cost-effectiveness of colorectal cancer screening : All studies found that colorectal cancer screening was cost-effective or even cost-saving compared with no screening. However, the studies disagreed as to which screening method was most effective or had the best incremental cost-effectiveness ratio for a given willingness to pay per life-year gained

28. prostate cancer Prostate cancer is the second most common cancer in men worldwide, with an estimated 1,100,000 cases and 307,000 deaths in 2012

29. targeted people for screening - Age : the risk greatly increases with older age - Ethnic background : African American men develop prostate cancer more often than white and Hispanic men - Family medical history : Men who have a first-degree relative with prostate cancer are more likely to develop the disease. - Diet : A diet high in animal fat or low in vegetables may increase a man's risk of prostate cancer.

30. Prostate cancer screening tests : - Prostate specific antigen (PSA) : Prostate specific antigen (PSA) is a protein produced by the prostate. The PSA test measures the amount of PSA in a sample of blood. - Rectal examination - Prostate biopsy

31. Prostate cancer screening plan : - IS PROSTATE CANCER SCREENING RIGHT FOR ME ? Most expert groups recommend that you have an open discussion with your clinician about the risks and benefits of treatment. ●Consider your own prostate cancer risk factors ●Know the potential benefits and harms of screening, diagnosis, and treatment ●Talk to your clinician about concerns or questions

32. - If you choose to have prostate cancer screening. you should begin at age 50. Men with risk factors for prostate cancer (such as black men or a man with a father or brother who had prostate cancer) may want to begin screening at age 40 to 45.. it should occur every two to four years and should include a PSA blood test. * Screening is generally not recommended for men who are 70 years and older or for men who have serious health problems. In these situations, the potential benefits of screening are outweighed by the likely harms.

33. Cost-effectiveness of prostate cancer screening : Screening at short intervals of three years or less was more cost-effective than using longer intervals. Screening at ages 55 to 59 years with two-year intervals had an incremental cost- effectiveness ratio of $73000 per QALY gained and was considered optimal. With this strategy, lifetime prostate cancer mortality reduction was predicted as 13%, and 33% of the screen-detected cancers were over diagnosed

34. Conclusion In conclusion we can see the benefit of screening for cancers and it’s impact on reduction of mortality number