Prevention

Prevention is the most effective weapon in fighting cancer and that’s why the ANT foundation has been paying special attention to awareness-raising projects and health education in schools and the country and to early warning projects, offering more than 225,000 free consultations throughout the country.

Cancer victims are increasing according to the World Health Organisation; in 2030 they will exceed 11 million and cancer will become the leading cause of all deaths. However, 20-30% of cancers can be prevented by adopting healthy lifestyles and by undergoing regular checkups and early detection screening.

The origin of the disease is multifactorial and depends on the combination of several risk factors, some modifiable.

You can in fact change lifestyles, but you can not take any action on a person’s gender, their particular genetics and age structure.

In almost all cancers, any DNA alteration that plays a major role in the onset of the disease can be identified; however, several environmental factors and personal factors (lifestyle) cooperate with those genetic phenomena in the initiation and spread of cancer. The risk index of getting cancer can be defined for each individual, although a high-risk person will not necessarily develop the disease; nor is it inconceivable that a person with low risk can not be struck by cancer.

In oncology, there are three forms of prevention: primary, secondary and tertiary.

 

1. Primary prevention

The goal is to prevent the development of cancer by avoiding exposure to recognized disease factors (known carcinogens such as smoking, asbestos, aromatic amines, etc.) at the workplace in particular, but especially by changing the daily habits that, if harmful, in time can cause the onset of a neoplastic disease.

In this regard, some simple tips in the prevention handbook can be very useful.

• DON’T SMOKE
• EAT A LOT OF FRUIT AND VEGETABLES
• LIMIT THE USE OF FATS, ESPECIALLY ANIMAL FATS
• REDUCE THE CONSUMPTION OF ALCOHOLIC BEVERAGES
• AVOID USING NARCOTICS
• PERFORM PHYSICAL ACTIVITY
• KEEP AN EYE ON YOUR BODY WEIGHT
• DON’T EXPOSURE YOURSELF TO TOO MUCH SUNLIGHT AND LIMIT THE USE OF TANNING LAMPS
• LEAD A RESPONSIBLE SEXUAL LIFE
• PERFORM REGULAR MEDICAL CHECK-UPS FOR CORRECT EARLY DIAGNOSIS

A correct primary prevention approach is not only based on the identification of risk factors, but also and especially on information and health education of people, particularly young people.

Among the tools available for primary prevention, we also include vaccines against specific infectious agents that increase the risk of cancer such as the hepatitis B virus (liver cancer) and human papilloma virus (HPV, responsible for cervical cancer).

 

2. Secondary prevention:

Secondary prevention is the best known and most requested form of prevention.

It has the goal of identifying cancer at a very early stage so that it can be effectively treated, healing the cancer and thereby reducing the mortality rate.

Secondary prevention coincides with the early detection measures. It generally covers the period between the biological onset of the disease and the manifestation of the first symptoms.

In 1968, the World Health Organization (WHO) established the universal criteria by which a disease that affects a large slice of the population is likely to be the subject of preventive screening:

• the disease must be a real health problem;
• there must be a suitable treatment to cure the diagnosed disease;
• A latent stage has to be recognized or the first symptoms of the disease have to be recognizable;
• screening should be universally accepted by the population.

Oncological screening is targeted at a healthy population to be subjected to low risk diagnostic tests and with low socio-economic and psychological costs in order to diagnose the early onset of tumors susceptible to effective treatment.

In Italy, the national secondary prevention programs have provided concrete results in the early detection of breast, bowel and cervical cancer.

There are three active screening programs in Emilia Romagna:

– Early detection of breast cancer aimed at women aged 45 to 74 years old

annual mammogram from 45 to 49 years old

biennial mammography from 50 to 74 years old

– Early detection of cervical cancer aimed at women aged 25 to 64 years old

pap test every 3 years

– Early detection of colorectal cancer aimed at women and men aged 50 to 69 years old

Faecal occult blood test every 2 years.

 

HOW TO DIAGNOSE CANCER EARLY

Follow the guidelines for proper prevention:

• BREAST

monthly self-examination

Annual clinical examination after 20 years of age

ultrasound from 30 years of age

mammogram every year from 45 to 49; every two years from 50 to 74

• CERVICAL (the Cervix)

yearly gynecological examination after 18 years of age (earlier if sexually active)

Pap test every 3 years (between 25 and 65 years old)

HPV tests (Papilloma Virus Test) on medical advice

Colposcopy on medical advice

 

• COLORECTAL

Faecal occult blood test every two years (from 50 years old)

colonoscopy at 50 years old and thereafter every 3-5 years in case of the detection of polyps

With cases of familial adenomatous polyposis or a family history of colorectal cancer, a colonoscopy is recommended before aged 50.

 

• SKIN

A yearly dermatological examination with dermoscopy

Self-examination of the skin and moles (the ABCDE rule *)

* advice when examining moles

A Asymmetry-> shape irregularities: one half of the mole is different

B Borders-> irregular, jagged edges

C Colour-> dark or uneven with shades within the same mole

D Dimension-> greater than 6 mm in diameter

E Evolution-> elevation, extension, spontaneous bleeding independent of any trauma

In cases of any suspicious lesions, their surgical removal with histological evaluation is necessary

 

• THYROID

thyroid ultrasound to detect any possible nodules

further investigation (instrumental and laboratory) on medical advice

 

• ENDOMETRIUM (uterine corpus)

yearly gynecological visit

transabdominal and transvaginal pelvic ultrasound + yearly Echo color doppler ultrasound in women in peri- and post-menopause and on medical advice

Endometrial cytology for atypical bleeding and on medical advice

 

• OVARY

yearly gynecological visit

yearly transabdominal and transvaginal pelvic ultrasound on medical advice. Periodic check-ups is particularly recommended for women with a family history of ovarian cancer or in case of any genetic mutations such as those found in hereditary cancer syndromes of the breast / ovary and non polypoid colorectal cancer of the rectum

• ORAL CAVITY

yearly dental visit

Velscope examination-> a technique that uses a high-intensity light able to stimulate the natural fluorescence of tissue. Alterations of these tissue properties are indicative of pathology

in cases of suspicious lesions, it is necessary to proceed with a biopsy and histologic examination

 

• PROSTATA

Digital rectal examination (from age 50)

transrectal ultrasound on medical advice

PSA determination on medical advice

 

3. Tertiary prevention:

This term means the prevention of any recurrence or metastasis of a tumor after the disease has been treated with surgery, radiotherapy and chemotherapy (or all three together).

It also includes the adjuvant treatments that aim to eliminate any residual cells after the treatment of the regional site of the disease.