CANCER SCREENING OF WOMENS REPRODUCTIVE SYSTEM CANCERS

1. Cancer Screening
Ovarian and Breast
Unit 3

2. Screening Generally
Is to seek about
certain problem in
certain high risk
group.

3. Validity of Screening Test
 Validity of test determined by ability to correctly categorise subjects to
test-positive or test-negative
Disease status
Test result Positive Negative Total
Positive True pos a False pos b a+b
Negative False neg c True neg d c+d
Total a+c b+d

4. Validity of Screening Test
 Sensitivity = ability of test to give a positive result when disease is present
= true positives / true positives+ false negative
 Specificity= ability of test to give a negative result when disease is absent
= true negative / true negative +false positive

5. Validity of Screening Test
 Predictive value is determined by sensitivity & specificity and also by the
prevalence of preclinical disease
 Positive predictive value =
probability that a person with a positive test actually has the disease
= True positive / true positive + false positive
 Negative predictive value =
probability that a person with a negative test is truly disease-free
= True negative / true negative + false negative

6. When to Suspect Gynecologic Cancer
 Woman with:
 Ovarian mass/cyst
 Growth or ulcer of cervix, vagina or vulva
 Abdominal mass, increased abdominal girth
 Postcoital bleeding
 New onset of hematuria or renal failure
 New onset of bowel obstruction

7. CRITERIA FOR SCREENING
 Disease:
 Must be serious enough
 Must be widespread enough
 Must be fairly reliably diagnosable
 Must be treatable
 Must be affordable

8. Criteria for Screening Test
 1. Simple & quick
 2. Capable of being performed by paramedics
 3. Inexpensive
 4. Acceptable to population
 5. Accurate
 6. Repeatable
 7. Sensitive
 8. Specific

9. Ovarian Cancer Screening
 Benefit to screening is unproven
 Annual bimanual gynecologic examination
 Transvaginal ultrasound
 CA 125 serum levels
 Screening may result in more unnecessary surgeries than new ovarian cancers

10. Screening For Early Diagnosis Ovarian
Malignancy
 Modalities:
 1- Clinical.
 2- Cul-de-sac aspiration.
 3- Imaging techniques.
 4- Tumour markers.
 5- Radio immuno scientography.

11. Screening …
 Unfortunately, there are no good screening methods for ovarian cancer at present;
 most use a combination of physical exam, CA125 levels, and TVS.
 No role of routine screening in general population .
 Some follow women with high risk factors (e.g., family history, BRCA mutation) using CA-
125 and TVS.

12. TVS
 Mural nodules, Mural thickening or irregularity,
solid components, thick septations (3 mm) and
associated findings such as ascites, peritoneal
implants, and/or hydronephrosis suggest malignancy

13. Screening
Tumor Markers :-
 One of the limitations of CA125 is that 15% to 20% of ovarian cancers do not
express the antigen.
 LDH (lactate dehydrogenase)— dysgerminoma
 HCG (human chorionic gonadotropin)– choriocarcinoma.
 AFP (alpha fetal protein)-- endodermal sinus tumor.

14. Screening …
 Risk of Malignancy Index (RMI)
 Most valuable clinical tool by combining serum CA125 values with ultrasound
findings and menopausal status to calculate a Risk of Malignancy Index (RMI).
 RMI = U x M x CA125
 ultrasound result is scored 1 point for each of the following characteristics: multilocular cysts,
solid areas, metastases, ascites and bilateral lesions.
 menopausal status is scored as 1 = pre-menopausal and 3 = post-menopausal
 Serum CA125 in IU/ml and can vary between 0 and hundreds or even thousands of units.

15. New
 Use of proteomic patterns to identify ovarian cancer using surface enhanced laser
desorption ionization time of flight (SELDI –TOF) technology.
 Sensitivity 100%
 Specificity 95%
 Positive predictive value of 94%

16. Breast
 Population - women, age 20 +
Breast self-examination Monthly, starting at age 20
Clinical breast examination Every three years, age 20-39
Annual, starting at age 40 *
Mammography Annually, starting at age 40 *
MRI High risk (20%) every year
Medium risk (15-20%) as per adviced
Low risk ,(15%) not required
Beginning at age 40, annual clinical breast examination should be performed prior to
mammography. Most other affluent countries recommend mammography every other
year between ages 50 and 70.

17. BREAST SELF EXAMINATION
 It's best to check about a week after your period, when breasts are not swollen or
tender.
 If you no longer have a period, examine yourself on the same day every month.
 If you see or feel a change in your breasts, see your doctor immediately. But
remember, most of the time breast changes are not cancer.

18. BREAST SELF EXAMINATION
Using a mirror, inspect your
breasts with your arms at your
sides, with your hands on your
hips, and with your arms
raised while flexing your chest
muscles.

19. BREAST SELF EXAMINATION
Look for any changes in
contour, swelling, dimpling of
skin, or appearance of the
nipple. It is normal if your right
and left breasts do not match
exactly.

20. BREAST SELF EXAMINATION
 Using the pads of your fingers,
press firmly on your breast,
checking the entire breast and
armpit area. Move around your
breast in a circular, up-and-down,
or wedge pattern. Remember to
use the same method every
month. Check both breasts.

21. BREAST SELF EXAMINATION
There are three patterns you
can use to examine your
breast: the circular, the up-
and-down, and the wedge
patterns.
Use the pattern that is easiest
for you, and use the same
pattern every month.

22. BREAST SELF EXAMINATION
Gently squeeze the nipple of
each breast and report any
discharge to your doctor
immediately.
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23. BREAST SELF EXAMINATION
 Examine both breasts lying
down. To examine the right
breast, place a pillow under your
right shoulder and place your
right hand behind your head.
 Using the pads of your fingers,
press firmly, checking the entire
breast and armpit area.
 Use the same pattern you used
while standing. Repeat for your
left breast.

24. BREAST SELF EXAMINATION
 The most effective way to fight breast cancer is to detect it early.
 Although the most effective tools to detect breast cancer are mammography and
clinical breast exam by your health professional, the breast self-exam may also be
an effective tool to find cancer early.
 In fact, women who perform regular breast self-exam find 90% of all breast
masses.

25. Early Cancer Detection of
Vulva
Colposcopy Taulidine blue VIN
Biopsy Acetic Acid