Cancer screening and early detection of cancer program 

Screening and Early Detection of Female Cancer

Cancer screening involves medical tests conducted to detect various cancers. These can be performed even when you are healthy and don’t have any signs of illness. The frequency and types of cancer detection tests performed are based on the chances of getting cancer. Your family history of cancer and medical history also help your doctor determine your possibilities of developing cancer. Early detection of cancers makes treating cancer easier and can save your life.

Early detection of female cancers

Early detection tests for some of the female cancers include:

Breast cancer

  • Breast self-examination should be performed regularly after the age of 20. Any abnormality or change in the look (size, shape or colour) or feel (lumps) of your breasts should be reported to your doctor immediately.
  • Clinical breast examination should be conducted once every 3 years when you are between the age of 20 to 30 years, and every year after the age of 40.
  • You should get a mammography (imaging test of your breasts) done every year starting at age of 40.
  • If you have a familial history of breast cancer, an MRI can be performed in addition to mammograms.

Cervical Cancer

Tests for early detection of cervical cancer should begin when a woman is 21 years of age.

  • Pap smear test (cells scraped from the cervix region are examined) should be performed once every 3 years starting at age21 to 29 years of age.
  • If you are between 30 and 65 years of age, you should undergo an annual Pap smear test as well as a HPV (human papilloma virus) test every 3 years.
  • If you are above the age of 65 and have not had any positive results for the Pap smear till date, you need not continue testing for cervical cancer, unless you have a history of cervical cancer.
  • Despite being vaccinated for HPV, you should continue with the recommended screening procedure of the HPV test.

Cervical cancer testing is not performed if you are below the age of 20 or if you have had your uterus removed.

Endometrial (Uterine) Cancer

You should be well informed about the symptoms and risks of endometrial cancer following menopause, so that you can report any kind of bleeding or spotting immediately to your doctor. If you have a history of uterine cancer, you can have an endometrial biopsy every year.

Mammography

What is a Mammogram?

A mammogram is a safe test used to look for any problems with a woman’s breasts. The test uses a special, low-dose x-ray machine to take pictures of both breasts. The results are recorded on x-ray film or directly onto a computer for a radiologist to examine. The recorded results will allow the doctor to have a closer look for breast lumps and changes in breast tissue. They can show small lumps or growths that a doctor or woman may not be able to feel when doing a clinical breast exam.

Mammography is the best screening tool that doctors have for finding breast cancer.

Types of Mammograms

Screening mammograms are done for women who have no symptoms of breast cancer. When you reach age 40, you should have a mammogram every one to two years.

Diagnostic mammograms are done when a woman has symptoms of breast cancer or a breast lump. This mammogram takes longer than screening mammograms because more pictures of the breast are taken.

Digital mammograms take an electronic image of the breast and store it directly in a computer. Current research has not shown that digital images are better at finding cancer than x-ray film images.

Why is it done?

Mammograms are used as a screening tool to detect early breast cancer in women experiencing no symptoms or to detect and diagnose breast disease in women experiencing abnormal symptoms such as a lump, pain or nipple discharge. Mammography plays a central part in early detection of breast cancers because it can show changes in the breast up to two years before a patient or physician can feel them.

How to prepare?

Before scheduling a mammogram, you should discuss any new findings or problems in your breasts with your doctor. Here are some general guidelines to follow:

  • Make your mammogram appointment for one week after your period. Your breasts are usually less tender after your period.
  • If you have breast implants, be sure to tell your mammography facility that you have them when you make your appointment.
  • Wear a shirt with shorts, pants, or a skirt. This way, you can undress from the waist up and leave your shorts, pants, or skirt on when you get your mammogram.

How is the Procedure Performed?

You will be asked to stand in front of a special X-ray machine. The radiologic technologist places your breasts one at a time between two plastic plates. The plates press your breast to make it flat. You will feel pressure on your breast for a few seconds. It may cause you some discomfort such as feeling squeezed or pinched. The flatter your breast is between the plates, the better the picture for the doctor to review. Most often, two pictures are taken of each breast, one from the side and one from above. A screening mammogram takes about 15 minutes from start to finish.

Breast compression is necessary in order to:

  • Even out the breast thickness so that all of the tissue can be visualized.
  • Spread out the tissue so that small abnormalities are less likely to be obscured by overlying breast tissue.
  • Allow the use of a lower x-ray dose since a thinner amount of breast tissue is being imaged.
  • Hold the breast still in order to minimize blurring of the image caused by motion.
  • Reduce X-ray scatter to increase sharpness of picture.
  • The technologist will stand behind a glass shield during the X-ray exposure. You will be asked to change positions between images. The routine views are a top-to-bottom view and an oblique side view. The process will be repeated for the other breast.

The examination process should take about 30 minutes.

What are the Risks?

  • There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
  • False negatives can happen. This means everything may look normal, but cancer is actually present. False negatives don’t happen often. Younger women are more likely to have a false negative mammogram than are older women. This is because the breast tissue is denser, making cancer harder to spot.
  • False positives can also happen. This is when the mammogram results look like cancer is present, even though it is not. False positives are more common in younger women than older women.

Abnormal Pap smear

Pap smear or Pap test is conducted as part of a woman’s routine health examination, after the age of 21 years. It is not a diagnostic test, but is a screening tool used to detect any abnormal cells in the cervix. The cervix is the lower part of the uterus that opens into the vagina.

Pap smears help in early detection of any serious medical conditions such as cervical cancer.

Abnormal Pap smear may indicate the presence of infection or abnormal cells called dysplasia. An abnormal Pap smear may not necessarily denote cancer. These results highlight the requirement of supplementary testing to identify and confirm an underlying problem.

Causes of abnormal Pap smear

An abnormal pap smear may indicate any of the following:

  • An infection or an inflammation
  • Herpes
  • Trichomoniasis
  • Dysplasia (abnormal cells that may be pre-cancerous)
  • Recent sexual activity
  • HPV (Human Papilloma Virus) infection; also called genital warts

Presentation

Usually abnormal cells do not produce any symptoms. Moreover, even the presence of HPV in an abnormal Pap smear is asymptomatic. Therefore a regular Pap smear is beneficial in early detection of any abnormalities.

However, an abnormal Pap smear secondary to a sexually transmitted infection may induce the following symptoms:

  • Abnormal discharge from the vagina, such as change in the amount, colour, odour, or texture
  • Abnormal sensations such as pain, burning, or itching in pelvic or genital area during urination or sex
  • Sores, lumps, blisters, rashes, or warts on or around the genitals

Treatment

Following an abnormal Pap smear, the next step is further testing to confirm the cause of the abnormal cells. A repeat Pap smear or test for human papilloma virus (HPV), a major risk factor for cervical cancer, may also be recommended.

Depending on the age of the patient and the type of abnormal cells, the doctor may recommend the following treatment options:

  • Cryosurgery: It involves freezing the abnormal cells which are then surgically removed.
  • Cone biopsy or LEEP procedure: In this procedure, a triangle segment of cervical tissue including abnormal cells is removed by specially designed instruments for evaluation.

Abnormal Pap smear during pregnancy

A Pap smear during pregnancy is very safe. In case of an abnormal Pap smear, a colposcopy can be performed during pregnancy. However, further treatments are delayed until the birth of the baby. Often, the birth process washes away the abnormal cervical cells.

Colposcopy

Colposcopy is a procedure in which a special magnifying instrument called a colposcope is used to look into the vagina and into the cervix. The colposcope gives an enlarged view of the outer portion of the cervix. Colposcopy is done when there are abnormal changes in the cells of the cervix as seen on a Pap test. Further, it may be done to assess problems such as genital warts on the cervix, inflammation of the cervix, benign growths or polyps, pain and bleeding.

Procedure

During a colposcopy, you will lie on your back with feet raised just as you do when you have a regular pelvic exam. The doctor uses an instrument called a speculum to hold the walls of the vagina apart. Then the colposcope is placed at the opening of your vagina. A mild solution may be applied to the vagina and cervix with a cotton swab. This makes abnormal areas to be seen easily. The doctor will look inside the vagina to locate any problem. If there are any abnormalities, the doctor may take a small tissue sample called a biopsy. You may feel a mild pinch or cramp while the biopsy sample is taken. The tissue is then sent to a laboratory for further study.

Your gynaecologist will talk to you about any problems detected during colposcopy. If a sample of tissue was taken from your cervix (biopsy), the laboratory results should be ready in 2 to 3 weeks.

Most women feel fine after colposcopy. You may feel a little lightheaded and if you had a biopsy, you may have some mild bleeding. Talk to your gynaecologist about how to take care of yourself after the procedure and when you need to return for a checkup.

Risks

There may be a risk of infection when you have a colposcopy. Mild pain and cramping during the procedure and mild bleeding afterwards are common. This most often happens when a biopsy is done. If there is heavy bleeding, fever, or severe pain after the procedure, contact your gynaecologist immediately.

Vaginal Ultrasound Scan

An ultrasound scan is a widely used, safe and effective tool for evaluating fertility. A fertility ultrasound examination is performed to assess for fertility issues in both men and women. The test examines the condition of the uterus (womb), ovaries and fallopian tubes (the tubes that connect the uterus and the ovaries) in women and the condition of the prostate and seminal vesicles in men. The ultrasound procedure can be performed one of three ways depending on your situation:

Transvaginal ultrasound scan: During the procedure, a small probe is placed into the vagina. The test helps your doctor to examine the health of your fallopian tubes, ovaries and uterus. Your doctor uses the results to evaluate the thickness of the uterine lining, presence of cysts, tumours and other abnormal growths, which could be causing infertility.

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