Prevention as primary prophylaxis.
Prophylaxis of tumour diseases has an enormous meaning in health protection and its equally important as a medical treatment. ”Prevention is better than cure”, says an old saying. Prophylaxis of malignant tumours includes all activities that minimize the risk of developing cancer.It is an influence on a life style of a society and an attempt of prohealthy modification its ordinary day as well as capability to recognize premalignant conditions or a cancer at early stage, with the possibility of radical treatment. This global persuit to improve people's awareness about the influence of their life style on the risk of cancer development is called the primary prophylaxis.
How can we shelter our self from this fatal influence of wrong life style?
Firstly: the change of daily diet.
The diet and quantity of food should be modified to a life style. It is recommended to eat great amount of fruits and vegetables (5 times daily),with the restriction of animal fats at the same time. The exception here are Omega 3 and Omega7 fats, because of positive effect on prophylaxis of cancer diseases. Great amount of this fats contain olive oil and fish. Our food should include right amount of fibre (30mg/daily),calcium (1mg/daily) as well as vitamins and minerals. Especially vitamins C,A and E (antioxidants) are significant in prevention of malignant cancers. With correct diet, using dietary supplements are not necessary, but in populations with deficiency of this ingredients, complementation is recommended. It is advisable to avoid contaminated products with carcinogenic substances like aflatoxins, pesticides, aromatic hydrocarbons or heavy metals.
Secondly: ban on smoking and restriction on alcohol consuming.
Its a fact, that people who don’t smoke, very rarely are to develop malignant lung cancer and the risk of falling ill is reduced consistently from the moment of quiting smoking. But only after 15 years, the risk of developing cancer is approaching the level of non smokers. Only total rejection of smoking can prevent several types of tumours. American population researches shows, that Mormons death rate caused by cancer is 40% less than rest of the nation. But Mormons do not smoke or drink alcohol! Condense ethyl alcohol is carcinogenic substance. The relation between consuming it and incidence of mouth, throat and gullet cancers is evident. There are scientific proofs that consuming hard alcohol by young women increase the risk of breast cancer. Even some kinds of beer can increase the risk of developing colonic carcinoma. Only red wine with lot of antioxidants in its chemical composition, can help preventing cancer.
Thirdly: sexual aspects.
Increasing risk of cervical carcinoma is in a group of women who commenced early sexual life and were often changing sexual partners, which is correlated with increasing number of cases with HPV virus. Using condoms during the intercourse or one sexual partner and personal hygiene, can shelter from getting infected and developing a cancer.
Other influential factors are certain medical agents. Its known that chronic use of medicines like Phenacetin or Chloramphenicol raise the risk of cancer. Elimination of this drugs or change to safer medicines, should protect from forming some types of tumours. Some researches shows that overuse of hormonotherapy, especially estrogen, may increase the risk of breast cancer. The therapy should always be provided with care and under doctor's supervision as well as compulsory periodic tests ( gynecological and cytological examinations, mammography ). Hormonotherapy should not be administrated on women with oncological family history.
The risk factor in developing skin cancer and malignant melanoma is ultraviolet radiation as a geographic agent. It is advisable for children and adults to avoid sunbathing in most intensive hours of sun radiation, especially persons with tendency for developing pigmented moles. Important is the use of sunscreens with UVA /UVB protective filters.
Tumour detection at early stage as the secondary prophylaxis.
Primary aims of cancers prophylaxis and screening programs are to disclose the highest number of cases with premalignant tumour as well as cancer at early stage. The base for detection rules are cancer datas in big human populations. Authors of many scientific publications believe that detecting malignant tumour at early stage increase the chance of recovery of a patient even in 25%. The sooner the tumour is detected, the less invasive, costly and shorter treatment.
Conducting on a large scale, prophylactic investigations are useful only if the tests are easily available and the tumour curable. Deciding factor of the treatment result is early cancer detection. Screening programs that are known and largely available, allows detection at precancer stage or a tumour without remote metastasis.
The most frequent early detection screening tests are conducted for breast cancer, cervix cancer, prostate cancer and colon cancer.
Breast cancer: the standard test is mammography and ultrasonography with possible biopsy. Global screening investigations are including geographic sub-populations and defined group of women. Most of the specialists and cancer centers in the world recommend mammography once in 2 years for women of 40-49 years old, after 50 - once in a year. In group of women below 40 years of age, mammography should be performed in case of high risk factor, like family load (family history) as well as suspicion of breast cancer. The standard test for this group of women is ultrasonography. Women with genetic load require a special recommendation. Free of charge mammography tests are available at health care departments with NFZ approval.
Cervix cancer: is the second important type of cancer in the early detection program. Cytological examination- Papanicolau test- is the most suitable method of the screening program for women of 25-59 years old, that in last 3 years did not have a cytological examination performed. The exception are women above 60 years old with correct test results. Cytological examination should be performed every 2 years (among women with correct test results).
Prostate cancer: the standard test is per rectum examination. In case of prostate hypertrophy, testing of PSA level ( prostate antigen ) is necessary which is the most sensitive indicator of cancer cells. Another test is TRUS ( per rectum ultrasonography examination) with possible biopsy. In large number of countries, screening tests are introduced to all man above the age of 50.
Colon cancer: the standard investigation is colonoscopic examination with biopsy specimen. There is no scientific proofs in effectiveness of tests for hidden blood in colon cancer detection. However, it can be performed as a first screening test, but it can not be consider as a cancer diagnosis. In case of 2 positive test results for hidden blood, the colonoscopic examination with diagnostic investigation should be performed. Screening program for colonic cancer is available for people above the age of 50.
Lung cancer: screening test for this type of tumour is chest radiogram in two projections. The screening is to be performed in specific group of people, especially in group of chain smokers. In this particular group of people, screening tests are extremely important and advisable, because of high detection of lung cancer in smokers.
Skin cancer and malignant melanoma: this type of cancers can be detected during visual examination by a general practitioner. Every skin lump or hypodermic nodule, enlargement or changes in color or shape of pigmented moles as well as superficial or deep ulceration, should be a reason to consult specialist oncologist.
Screening tests require massive engagement of administrative system, medical workers of cancer centers as well as finances. To see good results of this efforts, the involving of doctors and potential patients in prophylaxis and early cancer diagnostic, seem to be inevitable. General practitioner, suspecting a tumour should be checking the family history in search of factors which, in case of some patients, could increase the risk of cancer developing. General health investigation is a necessity. The better cooperation between the general practitioner and the specialist oncologist, the greater part of a society will receive the proper and effective oncological care. Effective care, where detection of precancer stage will be possible, as well as full recovery with the use of sparing treatment.