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Panel discussion on Cancer Screening

Kerala Cancer Crusade and Cancer Literacy Mission and IRIA Preventive Radiology National Program conducted a Webinar Series on “Kerala Cancer Crusade and Cancer Literacy Mission” in association with IRIA Kerala, Swasthi Foundation and Community Oncology, Regional Cancer Centre, Journo Med. The seventh-day webinar discussed “Early Cancer Detection and Scientific Evidence for Cancer Concept.” The event was held on 21st October 2022.

Dr Ramdas Kunnambath, Director of Clinical Operations and Allied Services, Karkinos spoke about the Early Detection of Cancer which could be performed through screening or early clinical diagnosis. India currently can’t afford to organize screening programs in most places. It must be highly resource-intensive in terms of cost, organization and manpower. The easiest way is to attain an awareness and approach for the clinical diagnosis. The topics that need to be stressed are signals of cancer and the identification of early warning signals of cancer. So, the best way is to address the issue at the same time. But the adequate infrastructure should be robustly available. The main motto of the recently conducted Kerala onco-summit is to enhance literacy and motivate diagnosis in the centres. There are cancers, oral as well as breast cancers, prostate cancer and lung cancers also need to be discussed.  

Highlighting the studies of Lung Cancer Screening, it was identified that. ⅔ rd of smoking was observed in developing countries. The common cancers are lung cancers and oral cancers. So, the policy initiative must be taken by experienced professionals. The policy initiatives are taken as a part of the policymakers to bring down lung cancer. Observing the population-based registry information, a lot of activities were performed against tobacco. Similarly, many lung cancers are identified among females who are non-smokers and passive smokers. Low-dose CT among the high dose people with heavy narco dependents and Lung cancer incidences are on increase. Even, a large number of patients are being observed without any habits. If one concentrates on better uses, a lot of lung cancers can be detected at a very early age and can be treated. 

In the case of lung cancer screening, Primary prevention is very important. Tobacco sensation should be done. Handling passive smokers is very difficult and it is one disadvantage. Here also, the signs and symptoms of lung cancer must be learnt in detail. So, approaching the doctor gives a better solution. Low note CT scan especially after the covid pandemic, one can observe a lot of indeterminate nodules in the lung. The handling of models i.e., 3D and polymetric must be learned. If one starts investigating the nodule, all the resources would be channelled. It is not cost-effective. But in the long-term perspective, much more important would be the prevalence of tuberculosis. If there is a presence of disease, a biomarker study can be performed. The only way to show aggressiveness is biology which is cost intensive unless there are facilities in place where biomarker study is aggressive or not. 

Dr Babu Mathew, Former Professor and Head of Community Oncology discussed the primary and secondary prevention of cancers at easily accessible sites. After the record pie and world tobacco control initiative, the governments have initiated a policy. There was no governmental policy for tobacco control.  The tobacco industry and tobacco agricultural ministry have controlled a lot of subsidies. There was a lot of funding available even if to control the tobacco funding program. In the years 1980-85 and 90, there was no tobacco control. The tobacco industry and tobacco agricultural ministry attracted a lot of subsidies and there was enough funding for tobacco control. 

Also, there was an extension of chemoprevention for tobacco control, and one needs to try beta-keratin, vitamin A and vitamin A + beta keratin and carotenoids. It is problem when one detects cancer, the efficacy of chemoprevention can be accessed only as the cancerous endpoint. The usage of the intermediate endpoints is to test the chemoprevention in oral cancer. Then another point is the self-examination of the oral cavity. The chemo-cancer survey was performed. Several researchers have studied the efficacy of oral cancers. When examining the survey, 0.1% population observed the enormous survey. It is only the performance of a high-risk examination and the oral examination. Considering the clinical examination of cancer, painless non-healing ulcer in the leukoplakia or multiple exophytic growths, a patient suffering from malignant fibrosis should invest their valuable time in doctor treatment.  There is a patient with oral supplement fibrosis. If there is proper treatment and protocol for cancerous and precancerous lesions. The screening methodologies have both pros and cons there are different modalities in treating precancer and cancerous lesions. They may be simple, proven evidence-based treatments or methods potentially malignant or deciduous.

Dr Nirmal C, Consultant, Community Oncology Department, MVR Cancer Centre spoke about cancer screening which is not possible and the steps to opt for early detection. The main target was breast and cervical cancer screening. Breast cancer screening and awareness activities need to be examined. After lung cancers, colorectal cancers are quite common and a little more focus should rely on gastrointestinal cancers. There are limitations involved with lung cancer screening. He also spoke about the lung cancer issues that need to be targeted and taken care of. 

Dr Rijo Mathew, President of IRIA spoke about the importance of cancer awareness and masking the ownership of health. The oral examination can be done with the help of screening programs, how can one attain the ownership of screening programs, when the cancer term is utilized, stigmas involved with the ownership of cancers, and the cancer camps were all studied.  The establishment of eco-friendly NCD clinics and even the usage of digital apps, social media or groups that promote the activities and the major problem is dealing with the risks involved in high-risk groups don’t know whether they belong to high-risk groups with the help of new age technologies. Once an awareness is created of the modification of services and the screening services involved in it. There are new thoughts that need to be developed at a new age. This is termed the information age, unlike the industrial age. Now obesity is developing a crucial role and how to detect their role among the leadership in lifestyle diseases, screening and understanding of risk factors. 

Dr Krishnanda Pai, Member of Community Oncology and Founder of Malabar Cancer Society discussed the Regional Cancer Centre (RCC) Prime program, a breast self-examination which is practised by women once every month. The own examinations were showcased, and the incidents were brought down by 30-40%. If breast self-examination was documented visually, it creates a great impact. There is one avenue to utilize social media. The inhibition fear is persistent in community volunteer training and a house-to-house awareness program are excellent working ideas where one experiences a successful community. Local volunteers were identified among both men and women, an intensive training program was scheduled for a day. Even a small group of people visit a group, and they provide cancer awareness, lifestyle modulations, and tips for early detection of cancer especially breast, oral, cervix, colorectal, and skin cancers. Once the awareness program is completed, screened data is obtained from patients’ families and the problems with oral cancer are detected. Even problems with cervical and breast cancer were detected. The Screening programs were conducted by medical experts. Follow-up services are provided for treatment cases. For eg: In a population of 30,000-40,000 panchayats, 15000 volunteers were recognized. Both men and women are Aasha workers, Kutumba Shree workers, retired persons, unemployed persons, anyone can be a volunteer. In the Malabar area, the potential for volunteers is very rich. Once the volunteers are convinced of a Nobel cause and people initiate to provide voluntary service. How volunteers are mobilized in the Malabar area without any mobilization is studied deeply. 

Dr Ramdas, Director of Clinical Operations and Allied Services, Karkinos spoke about the things to be implemented to have a clear-cut plan for the Kerala cancer crusade. A proper plan needs to be made and addresses need to be challenged. There should be a collective effort and responsibility.

Conclusion

The importance of breast cancer teaching, and cancer self-examination was revealed by Dr Rijo Mathew. The panel discussions create awareness about cancer examinations. These discussions create a network between the individuals, the organizations, and service providers, to create awareness and to motivate people, skilled navigators or service providers. Recently, a program for self-breast examination has been introduced in many cooperate hospitals. Many people were trained and 10% of people are provided with mammogram services. So, a lot of service providers are coming up along with a lot of stakeholders and even Larkin’s, the application needs to be promoted, and it serves a purpose. The digital Aasha workers work in association with the breast self-examination, Swasthi foundation. This was how a network is created and different entities were promoted. So, within the framework, a collaboration with Kerala Cancer Crusade with multiple stake holders works together as a platform. 

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