SECONDARY PREVENTION

Secondary prevention strategies relate to the discovery and control of cancerous or pre-cancerous lesions.

Early detection of cancer greatly increases the chances for successful treatment. It comprises of:

  • Early diagnosis in symptomatic populations
  • Screening in asymptomatic high risk populations


Screening refers to the use of simple tests across a healthy population in order to identify individuals who have disease, but do not yet have symptoms.

Based on existing evidence, mass population screening is advocated for breast and cervical cancer. Other cancers that are commonly screened for include prostate and colon.

Screening for Breast Cancer

Screening for breast cancer involves:

  • Breast Self Examination (BSE): a simple, quick examination done by the client herself, aimed at early
    detection of lumps. Regular and correct technique of breast examination is important and easy to teach and
    administer
  • Clinical Breast Examination (CBE): performed by a trained and skilled health care provider from HC3
    • Take a detailed history and conduct a physical examination
    • All breast quadrants must be examined in detail plus the armpits for lymph nodes
    • Inspect the skin for changes and swellings, for tethering of the breast on the chest wall, palpate for lumps, check for nipple discharge
    • A suspicious lump or bloody nipple discharge MUST BE REFERRED for evaluation by mammography or
      ultrasonography as well as core needle biopsy
  • Mammography: a low-dose x-ray of the breast. It is the test of choice for screening of early breast cancer but it is available only at national referral hospital level
  • Breast Ultrasound: not used as a screening test, but is useful as an additional tool in characterizing palpable
    tumors and taking of image-directed biopsies. It may be used as a screening tool in lactating women, smallbreasted women and in males.

Screening for Cervical Cancer

This aims to detect pre-cancerous lesions that are then treated to prevent progression to invasive cancer. The
following methods are recommended:

  • Visual Inspection with Acetic Acid (VIA): involves applying 3-5% freshly prepared acetic acid to the cervix
    and observing results after one minute.

    • The VIA results are generally categorized into 3 subsets: suspicious for cancer, VIA negative and VIA positive
    • It uses readily available equipment, does not require a laboratory and provides an immediate result.
    • Positive cases can be treated with cryotherapy by adequately trained providers.

      Consider the following if using VIA as a screening method:

    • Women <25 years of age should be screened only if they are at high risk for disease: HIV positive, early sexual exposure, multiple partners, previous abnormal screening results, cervical intraepithelial neoplasia (CIN)
    • VIA is not appropriate for women >50 years
    • Screening is advised every 3-5 years in case of normal results, but after 1 years in case of abnormal results and treatment (cryotherapy) nd every year in HIV positive women.
  • Visual Inspection with Lugol’s Iodine (VILI): it involves looking at the cervix with the naked eye or low
    magnification after swabbing with Lugol’s iodine. VILI has a sensitivity and specificity of about 92% and 85%,
    respectively. Test results are available immediately thereby decreasing loss to follow-up. Recommendations
    and timings of VIA outlined above also apply to VILI.
  • Cytology Testing by Pap Smear: it is a microscopic examination of cells scraped from the opening of the
    cervix. The PAP smear is best taken around mid-cycle. It should be postponed in case of cervicitis until after
    treatment; otherwise, the pus cells obscure clarity of the smear and affect interpretation. It requires histocytology services so it is available only at referral facilities.