Cancer screening & prevention

• Mammogram (a low-dose breast X-ray) every 1 to 2 years from 40 to 74.
• It finds cancers too small to feel. It takes a few minutes; pressing the breast is uncomfortable for a few seconds.
• Young women have denser breasts; an ultrasound is sometimes added.
• From 30, a breast examination by a doctor during your yearly check-up.
• Know what is normal for you. See a doctor for a new lump in the breast or armpit, a change in shape, skin dimpling, a nipple turning inwards, or bloody discharge.
• Most lumps are not cancer, but every new lump should be checked.

Breast cancer

• Cervical cancer is caused by long-lasting infection with HPV, a common virus. It is one of the most preventable cancers.
• From 25 to 65: an HPV test every 5 years (the best test), or a Pap smear every 3 years.
• Both are done in a few minutes during a gynaecological examination.
• If a test is abnormal, a closer look (colposcopy) and simple treatment of the early changes stop cancer from forming.
• After 65, you can stop if your recent tests were normal.
• Still needed if you have had the HPV vaccine.

HPV vaccine · Cervical cancer

• Bowel (colorectal) cancer usually starts as a polyp, a small growth that takes years to turn into cancer.
• From 45 to 75, one of:
  • Stool test (FIT) every year: checks for hidden blood. Done at home.
  • Colonoscopy every 10 years: a camera test that also removes polyps there and then.
• If the stool test is positive, a colonoscopy is needed.
• Do not wait for screening if you have blood in the stools, a change in bowel habit lasting weeks, or anaemia.

Bowel cancer

• Low-dose CT scan of the chest every year, for people aged 50 to 80 who:
• have smoked about 20 pack-years or more (for example 1 packet a day for 20 years, or 2 packets a day for 10 years; beedis count too), and
• still smoke, or stopped in the last 15 years.
• Small spots are common and are usually not cancer; old TB scars often show up. Most need only a repeat scan.
• The most important step is to stop smoking: Tobacco

Lung cancer

• Mouth cancer is one of the commonest cancers in India, mostly from tobacco, gutka, khaini, paan and areca nut.
• A doctor or dentist looks inside the mouth: it takes 2 minutes and needs no tests.
• Every year if you use or have used tobacco or areca nut; and from 30 for everyone.
• Check your own mouth once a month in a mirror. See a doctor for a white or red patch, an ulcer that does not heal in 2 weeks, or difficulty opening the mouth.

Mouth cancer

• The PSA blood test can find prostate cancer early, but it is not a simple yes or no test.
• Many prostate cancers grow so slowly that they would never cause harm. PSA can find these too, leading to biopsies and treatment that were not needed.
• So for men 50 to 69, the choice to test is made together with your doctor, after talking about the benefits and downsides.
• Talk about it earlier, from 40 to 45, if your father or brother had prostate cancer, or you carry a BRCA2 mutation.

Prostate cancer

• Screening is for people with cirrhosis (from any cause: alcohol, fatty liver, hepatitis) or long-term hepatitis B.
• Ultrasound every 6 months, often with an AFP blood test.
• Treating hepatitis B or C, and stopping alcohol, lowers the risk.

Liver cancer

• There is no reliable screening test for ovarian, stomach, pancreatic, kidney or most other cancers in people at average risk.
• For these, know the warning signs and see a doctor early.
• Ovary: bloating, early fullness, tummy pain or passing urine often, on most days for 3 weeks or more.
• Women with a BRCA mutation can lower their ovarian cancer risk with surgery: BRCA1 and BRCA2.

• Screening may start earlier if a parent, brother, sister or child had cancer, especially at a young age.
• Breast: mother or sister with breast cancer: earlier mammograms, sometimes MRI.
• Bowel: a parent, brother or sister with bowel cancer: colonoscopy from 40, or 10 years before their age at diagnosis, every 5 years.
• Prostate: father or brother with prostate cancer: talk about PSA from 40 to 45.
• Bring a list of relatives with cancer, the type and their age at diagnosis.

Family members and screening

• People who carry a mutation such as BRCA1, BRCA2 or Lynch syndrome need a special plan, often from their 20s or 30s.
• If several relatives on one side had breast, ovarian, bowel, womb, pancreatic or prostate cancer, ask whether genetic testing is right for your family.

Genetic testing · BRCA1 and BRCA2 · Lynch syndrome

• Tobacco or areca nut in any form: mouth, lung, throat and bladder.
• Hepatitis B or C, cirrhosis: liver.
• Radiation to the chest before 30 (for example for lymphoma): breast screening from 8 years after treatment.
• Long-standing ulcerative colitis or Crohn's disease: regular colonoscopy.
• Having had cancer before: follow-up is planned by your oncologist.

• Tobacco in any form (cigarettes, beedis, gutka, khaini, paan with tobacco, hookah) causes cancers of the mouth, throat, lungs, food pipe, bladder, pancreas and more.
• Areca nut (supari) causes mouth cancer even without tobacco.
• Stopping at any age helps; the risk falls year by year.
• Medicines and counselling double the chance of stopping. Ask us, or call the free national quitline: 1800-11-2356.

• HPV vaccine: prevents most cervical cancers, and some throat, anal and genital cancers. Best at 9 to 14 years (girls and boys), before any sexual contact; can be given up to 26, and to some adults up to 45 after discussion.
• Hepatitis B vaccine: prevents liver infection that can lead to liver cancer. For all babies, and adults who were never vaccinated.
• Get tested for hepatitis B and C at least once; both can be treated.

• Extra weight raises the risk of at least 13 cancers, including breast (after menopause), womb, bowel, kidney, liver and pancreas.
• Aim for 150 minutes of activity a week: a brisk 30-minute walk on 5 days.
• Less sitting: stand or walk for a few minutes every hour.

• Plenty of vegetables, fruit, dal and whole grains: fibre lowers bowel cancer risk.
• Less red and processed meat (sausages, salami, ham).
• Alcohol raises the risk of mouth, throat, food pipe, liver, bowel and breast cancer. There is no fully safe amount; less is better.
• No supplement or 'anti-cancer' product has been shown to prevent cancer.