Cancer control programINTRODUCTION Cancer is a disease characterized by variation of the genome and the proteome. These alternations allow the cancerous cells to avoid normal cellular control mechanisms and to initiate growing unregulated. A national cancer control programme (NCCP) is a public health programme designed to reduce the number of cancer cases and deaths and improve quality of life of cancer patients.Even with recent development and progression in diagnosis and treatment, cancer has remained a major cause of death. It is reported that cancer is the second main cause of death after heart disease.
Every year over 10 million people in the world detected with cancer and high percentage of this report die as a result of unsuccessful treatment of the disease. [2,3] Success percentage in cancer therapy is restricted due to difficulties in detection, late appearance of cancer and unavailability of differential therapy .Background to the research problemit is unavailable for most cancer sites, and no optimal screening strategies exist. The implementation research can improve the ability of national cancer control plans to reduce the cancer burden.
 The common sites for cancer are oral cavity, lungs, oesophagus and stomach in males and cervix, breast and oral cavity among females.The cancers of the oral cavity, uterine cervix and female breast are very amenable to early detection.Periodic examination by Pap smear and Mammography are the accepted standards for early detection of cervix and breast cancers in the developedcountries. Pap smear and mammography are however not practical and affordable methods for cervix and breast cancer screening.
Problem statementCancer is the uncontrolled growth of cells which cause harm to the human organism, because when the cells in the certain tissue grow chaotically all the time, tumors appear which cause harm to organs and tissues of the human body preventing them from regular functioning. There are no less than 100 types of cancer which affect various organs of the human body. They can attack nervous tissues, cardiovascular, reproductive and digestion systems, the human muscles and other parts of the organism.Cancer occurs when the cell life cycle is broken. Normally, the cell appears, develops and dies, but when it does not die, the quantity of the cells in the definite part of body starts to increase constantly forming a tumor.Cancer biology focuses on the cause of cancer and tries to understand the growing risk of cancer in the developed countries, learns its effect, stages, risks and tries to find the appropriate solutions to the problem and the most effective remedies which can cure the disease once for all.ObjectiveNaturally, cancer is extremely difficult for treatment.I focuses on the cause of cancer and tries to understand the growing risk of cancer in the developed countries, learns its effect, stages, risks and tries to find the appropriate solutions to the problem and the most effective remedies which can cure the disease once for all.I think that it will be important to keep cancer registration going because the circumstances of the different registries are quite different. It has taken a long time to establish cancer registration. Their recording rates are very, very different from the rates seen among black Amercians in the United States. And so it will be important to continue to monitor what the real evidence is on cancer incidence rates in different populations.SCOPEThe scope of cancer control activities and the research that supports them have evolved over time, in response to changes in science and society. In recent years, while there has been an explosion of discovery in the basic or fundamental sciences, the behavioral and social sciences have matured so that they are better able to address mechanism and strategies for individual, community and societal change. It is increasingly clear that an understanding of the social and environmental determinants of health and how they operate through behavioral and biological pathways is key to the prevention of cancer.Literature review Components of cancer controlPrevention Prevention of cancer, especially when integrated with the prevention of chronic diseases and other related problems (such as reproductive health, hepatitis B immunization, HIV/AIDS, occupational and environmental health), offers the greatestpublic health potential and the most cost-effective long-term method of cancer control. We now have sufficient knowledge to prevent around 40% of all cancers. Most cancers are linked to tobacco use, unhealthy diet, or infectious agents.Early detection detects (or diagnoses) the disease at an early stage, when it has a high potential for cure (e.g. cervical or breast cancer). Interventions are available which permit theearly detection and effective treatment of around one third of cases (see Early Detection module).There are two strategies for early detection: early diagnosis, often involving the patient’s awareness of early signs and symptoms, leading to a consultation with a health provider ” who then promptly refers the patientfor confirmation of diagnosis and treatment; national or regional screening of asymptomatic and apparently healthy individuals to detect pre-cancerous lesions or an early stage of cancer, and to arrange referral for diagnosis and treatment.Treatment Treatment aims to cure disease, prolong life, and improve the quality of remaining life after the diagnosis of cancer is confirmed by the appropriate available procedures. The most effective and efficient treatment is linked to early detection programmes and follows evidence-based standards of care.Patients can benefit either by cure or by prolonged life, in cases of cancers that although disseminated are highly responsiveto treatment, including acute leukaemia and lymphoma. This component also addresses rehabilitation aimed at improving the quality of life of patients with impairments due to cancer .Palliative careMeets the need of all patients requiring relief from symptoms ,and the needs of patients and their families for physiological and supportive care. This is particularly true when patients are in advanced stages and have a very low chance of being cure or when they are facing the terminal phase of the disease. Because of the emotional, spiritual, social and economic consequences of cancer and its management, palliative care services addressing the needs of patients and their families, from the time of diagnosis, can improve quality of life and the ability to cope effectively .Despite cancer being a global public health problem, many governments have not yet included cancer control in their health agendas. There are competing health problems, and interventions may be chosen in response to the demands of interest groups, rather than in response to population needs or on the basis of cost-effectiveness and affordability.Low-income and disadvantaged groups are generally more exposed to avoidable cancer risk factors, such as environmental carcinogens, tobacco use, alcohol abuse and infectious agents. These groups have less political influence, less access to health services, and lack education that can empower them to make decisions to protect and improve their own health.Research methodologyScreening for Cervix CancerIn many developed countries a decline in the incidence of and mortality due to cervix cancer has been observed in the past 30 years due to cytology screening [15,16]. Cytology based screening programmes are difficult to organise because of issues related to absence of trained manpower, infrastructure, logistics, quality assurance, frequency of screening and costs involved. Visual inspection of the cervix after application of 4- 5% acetic acid (VIA) is a simple, inexpensive test that can be provided by trained health workers. The accuracy of VIA to detect cervical neoplasia has been extensively studied and found to be satisfactory .Results from pooled analysis of data from two completed studies indicated an approximate sensitivity of 93.4% and specificity of 85.1% for VIA to detect CIN 2 or worse lesions. The efficacy of VIA inreducing incidence of an mortality from cervical cancer and its cost-effectiveness is currently being investigated in two cluster randomized controlled intervention trials. One of these studies (n=150000) is a 4-arm trial addressing the comparative efficacy of VIA, cytology and primary screening with HPV DNA testing. This trial will provide valuable information on comparative detection rates of CIN 2-3 lesions.In the last six years in the search for viable and effective alternate screening methods for the early detection of cervix cancer. The Specificity was however poor (83-85%) as compared to conventional cytology (98%). A combination of VIA and VILI yielded a slightly better test with a sensitivity of 78.8%, specificity of 82.1%, PPV – Positive Predictive Value of 8.7% and a NPV – Negative Predictive Value of 99.4%, indicating that the VIA-VILI combination test may be an acceptable simple technological tool for cervix cancer screening in resource poor countrie.Screening for Breast CancerAlthough it is established that screening by Mammography can substantially reduce mortality from breast cancer, especially in women over the age of 50 years, breast cancer screening programs involving imaging techniques are expensive and for this reason cannot be adopted in developing countries as a routine public heath measure. Economic constraints of Mammography apart, compared to the west, a relatively large proportion of breast cancers in India occur in younger women. screening may not be as effective in women under the age of 50 .It has been suggested that breast cancer would be best tackled through an early detection programme using Clinical Breast Examination (CBE) performed by trained paramedical personnel such as female health workers. A recently published review of the effectiveness of CBE found indirect support for the effectiveness of this modality of screening. The study emphasized the importance of the technique and quality of the examination. Although screening by clinical examination by itself does not rule out breast cancer, the high specificity of certain abnormal findings greatly increases the probability of breast cancer.It has been argued that screening by CBE can bepotentially as effective as screening by Mammography(16). The only randomized trial which has compared CBE with CBE + Mammography was unable to demonstrate any added benefit of mammography over CBE alone (17). It has been suggested that given the socio-economic realities of a developing country and the unsuitability of mammography, CBE may be an attractive screening procedure (14).Tata Memorial Hospital has been involved in a randomized controlled trial (n=150000) which compares the efficacy of health education and Clinical Breast Examination (CBE) provided by trained primary health care workers with just health education provided by the same workers in women aged 30-6- years. This study has now entered its 6th year and 3rd round of screening. The study already shows a good compliance- to screening rate (70%) and down staging is already evident. The principal objectives of the study i.e. demonstration of a reduction in incidence and mortality will however become evident only after another 10-15 years.Screening for Oral CancerThere are no international standards of methods or practices for early detection of oral cancers, simply due to the fact that these cancers are mostly found in developing countries, particularly South Asian Countries. Simple oral examination with adequatelight is a fairly good screening method for the early detection of pre-cancerous lesions of the oral cavity e.g.Leukoplakia, erythroplakia, non-healing ulcers and oral sub-mucous fibrosis. Oral examination followed by indirect/ direct laryngoscopy if needed is thestandard procedure. Smokers are also routinely investigated for pulmonary lesions by simple x-ray of the chest. However, the only randomized controlled trial to Published studies suggest that Mammographic evaluate the efficacy of screening in reducing oral cancer mortality.The feasibility of the alternative methods of screening mentioned above by horizontal integration into the existing health care services at the primary care level is yet to be ascertained. Comprehensive cancer care facilities are also far from adequate evenat some of the regional cancer centres today. Even the best screening program is a complete waste without adequate treatment backup. Therefore a strong emphasis on health education and providing opportunistic screening services may be the most costeffective option for cancer control.Time Line for Study Period Major Activities 0-2 months Sample colleting 2-4 months Components of cancer control 4-6 months Screening of cancer control6-8 months Data entry and analyses. 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