Cancer prevention: screening tests for top Indian cancers

The incidence of cancer is rising in India and it is already the second biggest cause of death in Indian population (after CVD). There are no clear cut cancer symptoms, which are there in all cancers of any site. So what can you do for prevention of cancer in your family or at least detect it early? 

While the list of what all can give you cancer is long, often people with no significant risks also get cancer. Therefore it is best to make a habit of getting cancer screens as per expert advice by cancer prevention agencies. Often, even doctors fail to counsel about cancer screening, so it is best that you take charge of this yourself!

Five commonest cancers among Indian men are lip and mouth (oral cavity), Lung, Stomach, Large intestine (colorectum) and pharynx (throat). Among women, cervix of uterus, breast, colorectum, lip/oral cavity,  and ovary are the commonest sites of cancer

What is striking in these facts is that barring lung, ovarian and stomach cancer, all other top cancers listed here can be detected early by standard screening tests. Early diagnosis leads to very significant cure rates and decrease in mortality due to cancer. But, in India more than half of all cancers are first detected in advanced stages

So what are screening tests? These are tests done in individuals who do not have any signs or symptoms of the disease for which the test is being done. Thus, screening tests are especially useful in detecting early disease which has not yet troubled the patients. Expert associations of doctors and health agencies world over collect data and analyze the effectiveness of these tests, before recommending them for population or special risk groups.

Such validated screening tests include:

  • PAP smear for cervical cancer in women
  • SBE (Self Breast Examination), CBE (Clinical Breast Examination) and Mammography for breast cancer in women
  • FOBT (Fecal Occult Blood Test), Sigmoidoscopy and Colonoscopy for colon cancer
  • Self examination and clinical examination for oral cavity and lip cancer

Find below FHI recommendations for cancer prevention and screening

Cervical cancer screening for women

Cervical cancer is the commonest cancer in Indian women and one women dies of cervical cancer in every 8 minutes in India. The guidelines for PAP smear are the following:

  • Sexually active women  aged 21 years or more should get a Pap smear done every three years
  • Women between 30-65 years of age should ideally have a Hybrid test (Pap Smear+ HPV test) done and if it is normal, repeat every 5 years. However having a Pap smear every three years is also acceptable
  • Even women who have received HPV vaccine need to get Pap tests done
  • Women over 65 should discuss the need for Pap test with your doctor
  • Women who have their uterus removed do not need Pap smear

Breast cancer screening for women

  • Women aged 20 years or more should do BSE (Breast Self Examination), once every month (after your menses), check out the links to know how

How to do SBE video

  • Women between 45-55  years of age  should have CBE by a doctor and Mammography  annually
  • After 55 years of age, mammogram once in two years should be done till they are normal
  • Women, who have any history listed below, should discuss the need for early Mammogram/MRI and genetic screening with their doctor :
    • Mother, sister, aunt or cousin getting breast cancer before 45 years of age
    • Two family members, on the same side of the family, having had breast cancer
    • One member with more than two different breast cancers or more than one ovarian cancer
    • Male breast cancer in the family
    • More than three cancers in the family including ovarian, pancreatic, thyroid, endometrial, kidney cancer, brain tumor, gastric cancer etc.

Screening for cancers of oral cavity and lip

  • All people who consume tobacco in anyway and/or drink alcohol should do oral and extra-oral self examination once every month. Check out these links to learn how to do OR
  • Also, such people should have regular dental examination (ideally every six months) which should include an oral and extra oral examination  by your dentist

Even though these tests are recommended for high risk people, even people with no high risk behavior get oral cavity and lip cancers. Therefore, it is a good idea for everyone to start practicing self examination every month

Screening for Colon Cancer/colorectal cancer

  • Men and Women over 50 years of age who do not having any family history of colon cancer should get screening for colorectal cancer done by getting one of the tests from each group

Discuss with your doctor

Stool tests: 

Guaiac-based fecal occult blood test (gFOBT) every year

Fecal immunochemical test (FIT) every year

Stool DNA test (sDNA) every 3 years

Invasive tests: 

Colonoscopy every 10 years, is the best, otherwise one of the following can be done

Double-contrast barium enema every 5 years

CT colonography (virtual colonoscopy) every 5 years

Flexible sigmoidoscopy every 5 years

  • Men and women who have a family history of Colorectal cancer  in any first-degree relative before age 60, or in 2 or more first-degree relatives at any age, should have a colonoscopy every five years, beginning at the age of Age 40, or 10 years before the youngest case in the immediate family, whichever is earlier

Prostate cancer screening:

Starting at age 50, men should talk to a doctor about the pros and cons of screening for prostate cancer by PSA, since the benefits are not clearly established

Men who have history of a first degree relative having had prostate cancer before age 65, should have this talk with a doctor starting at age 45

What to do if any screening test has abnormal results?


FHI recommendation on cancer prevention strategies other than screening

Being aware of warning symptoms of cancer:

These seven warning signs of cancer are:

  1. Unexplained weight loss and loss of appetite
  2. A wound or sore that does not heal in more than 2 weeks in the mouth or 3 weeks in any other part of body
  3. Any blood or liquid/discharge coming out of any opening in the body
  4. Difficulty in swallowing
  5. Chronic indigestion or change in bowel habits
  6. Chronic cough or change in voice over a few weeks/month
  7. Any rapidly growing swelling or change in mole

Lifestyle modifications and reducing risks

  1. Give up on smoking. It is the single most effective step for reducing cancer risk
  2. Eat healthy. Eat more of vegetable and fruits and less of processed food
  3. Get vaccinated. Vaccine for hepatitis B can help prevent liver cancer and against HPV can protect from cervical and oral cancer
  4. Avoid sun exposure for long time or wear sunscreen

Thus, keeping cancer away demands a multi pronged strategy, so make these changes and take these steps today