Preventive Oncology

Preventive Oncology is a special discipline in oncology that focuses on key measures that can prevent cancer development or delay the progression of the malignant process. Cancer prevention measures can be taken on three major levels:

• 1. Primary Cancer Prevention: Primary cancer prevention focuses on identifying the cancer-causing factors and reducing the risk of cancer formation. This is achieved through alcohol and tobacco cessation, obesity management, vaccination, practising a healthy lifestyle, etc.
• 2. Secondary Cancer Prevention: Secondary cancer prevention focuses on detecting cancer before the onset of symptoms when the cancers are likely to be treated successfully. Screening is one of the major secondary cancer prevention measures.
• 3. Tertiary Cancer Prevention: Tertiary cancer prevention focuses on delaying the progression and preventing the complications like secondary malignancies, once the disease has become symptomatic.

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Services Offered By HCG Preventive Oncology Clinic

1. Cancer Screening

Cancer Screening is a collective term given to a series of medical tests performed on asymptomatic individuals to check for the presence of precancerous lesions. At HCG’s Preventive Oncology OPD, screening is done for the cancers of breast, colon, rectum, prostate and cervix.

a. Breast Cancer Screening

It is the evaluation of symptom-free, apparently healthy females aged between 20-70 years for early detection of breast cancer. Breast cancer screening is done through clinical examination and mammography.

• Clinical Breast Examination (CBE): It involves a detailed evaluation of history, physical examination of breasts and under-arm regions, palpation of breasts in different positions and examination of lymph nodes.
• Mammography: Mammography uses low-dose X-ray radiation to detect precancerous and cancerous growth in the breasts. It detects the smallest tumours and other abnormalities that are missed during clinical breast examinations.

b. Colorectal Cancer Screening

Colorectal cancer screening is performed to detect abnormal growths called polyps, which protrude from the inner walls of the colon and rectum. Colorectal cancers become symptomatic only in the advanced stages. Therefore, regular screening becomes extremely important. Colorectal cancer screening is done through a faecal occult blood test and upper/lower gastrointestinal endoscopy.

• Faecal Occult Blood Test (FOBT): It is performed to check for tiny amounts of blood in the faecal matter, which is a sign of a polyp or early-stage colorectal cancer.
• Upper/Lower Gastrointestinal Endoscopy: Upper and lower GI endoscopies act as extremely sensitive cancer screening tools and help doctors in detecting precancerous lesions or polyps that could be signs of early-stage colorectal cancer.

c. Prostate Cancer Screening

Prostate cancer progresses at a slower rate; therefore, regular screening may help in catching cancer even before it starts showing symptoms. Common screening tests for prostate cancer are the PSA test and digital rectal examination.

• PSA test (Biomarker Assessment): It is a simple blood test performed to assess the levels of Prostate-Specific Antigen (PSA), which is a special protein biomarker produced by both malignant and benign prostate tissue. High PSA levels in the blood may indicate the risk of prostate cancer.
• Digital Rectal Examination (DRE): A physical examination conducted by the doctor to examine for lumps, hard regions or any other abnormalities in the prostate gland.

d. Cervical Cancer Screening

Cervical cancer screening is performed to detect any abnormalities in the cervical cells that could lead to cervical cancer. It usually takes 3-7 years for any high-grade changes in the cervical tissues to present themselves as tumours, and regular screening helps in the early detection. Pap test is an effective cervical cancer screening method.

• Pap test: During a Pap test or Pap smear, samples of cervical cells are collected and checked for irregularities. Precancerous cellular changes can be addressed with appropriate treatment. All women should begin cervical cancer screening at age 21.

e. Whole-Body MRI Scan:

Whole-body MRI is a valuable tool in cancer screening with the ability to detect tumours that measure less than one centimetre. With excellent sensitivity and specificity, these scans can provide accurate information on precancerous lesions in lesser time. In some cases, whole-body MRI scans can help avoid invasive screening and diagnostic procedures.

2. Tobacco and Alcohol Cessation Clinic

Tobacco and alcohol are the causes of several preventable diseases, including cancer. Abstaining from tobacco and alcohol consumption is proven to reduce the risk of crucial diseases like cancer.

Through psychological (behavioural) and medical intervention, successful tobacco and alcohol cessation can be achieved.

Psychological therapy identifies specific triggers like stress, anxiety, depression, issues in professional and personal life, loneliness, etc., that lead to smoking and drinking. Later, patients are taught to recognise them, build healthier coping mechanisms and replace their smoking or drinking habits with the new healthy habits.

Medications also help in quitting tobacco and alcohol by controlling the urge to smoke or drink.

3. Obesity Clinic

Obesity is associated with inflammation, hormone imbalance and hampered fat metabolism; these factors can increase cancer risks.

Healthy weight management helps in bringing down the risks of various cancer types. Carefully planned diet regimens can help obese individuals maintain a healthy weight and reduce the risk of various chronic diseases. Along with dietary advice, medicines can also help in obesity management by suppressing the appetite or altering calorie absorption.

4. Primary Prevention Measures for Cancer through Vaccination

Vaccinations may help in preventing the cancers caused due to oncoviral infection. Currently, vaccinations are available for the oncoviruses – Human papillomavirus (HPV) and Hepatitis B Virus (HBV). However, these vaccines are to be taken before getting infected by the viruses.

• Human papillomavirus (HPV) vaccination:
  • HPV vaccine helps prevent cervical, vaginal, vulvar, penile and anal cancers along with oropharyngeal cancers.
  • HPV vaccines are recommended for individuals aged 9-26 years.
  • It must be noted that the HPV vaccine is not a substitute for cervical cancer screening; all women, including those who are vaccinated, should undergo cervical cancer screening regularly.
  • Hepatitis B Virus (HBV) vaccination:
    • HBV causes Hepatitis B, which if left untreated, may cause liver cancer. Individuals of all age groups can take HBV vaccines.

    5. Counselling on Lifestyle Modification

    According to many studies, cancer is a lifestyle disease that a healthier and active lifestyle can prevent. Factors like sedentary lifestyle, unhealthy diet and chronic stress can trigger tumour formation. These factors also aggravate the tumour growth in patients with stage 1 and stage 2 cancers.

    Lifestyle modification counselling sessions at HCG, focus on creating awareness on the importance of having an active lifestyle, prudent diet and effective stress management strategies.

    6. Research

    Through extensive research carried out in recent years, the development of cancer and the factors that contribute to the formation of cancer are clearly defined. The data from these studies have paved the way for the development of several novel cancer prevention strategies. Some of the approaches adopted at HCG include:

    • Identifying biological mechanisms by which obesity and diabetes are associated with the risk of cancer
    • Studying the mechanisms that stimulate the immune system to attack the cancer cells
    • Developing novel drugs for cancer prevention
    • Assessing the strategies that can be used to address the socioeconomic and biological factors that contribute to higher cancer rates among specific population groups
    • Studying the impact of environmental exposure on cancer risk and intervening to downgrade those exposures.

    7. Neo-Preventive Strategies

    Neo-preventive strategies are novel prevention measures that help individuals prevent cancer development. Neo-preventive strategies are extremely helpful in assessing one’s cancer risk at a molecular level and providing accurate insights. The key neo-preventive strategies adopted at HCG are primary and secondary cancer prevention through the administration of anti-inflammatory medication and nutritional therapy, genetic testing and counselling to assess the cancer risks and devising immunotherapy and nanotechnology-based cancer prevention strategies.