The document provides guidelines from the American Cancer Society and US Preventive Services Task Force for cancer screening in average-risk asymptomatic individuals. It discusses screening recommendations for breast, colorectal, cervical, lung and prostate cancer. For each cancer, it summarizes the guidelines from both organizations, noting areas of agreement and differences in their recommendations for when to begin screening, screening intervals, and when to stop screening.

1. TITLE
Speaker
CANCER SCREENING in the
NORMAL RISK
ASYMPTOMATIC FILIPINO
Mary Ondinee Manalo-Igot, MD, MSCM, FPCP, FPSO, FPSMO
Medical Oncologist / Neuro-Oncologist
DLSUMC – Department of Internal Medicine
Acacia Hotel Manila / September 20, 2018

2. OUTLINE
• Cancer Situation in the Philippines
• Principles of Cancer Screening
• 2018 Screening Guidelines from ACS and
USPSTF
• Screening in a Resource Limited-Setting
• DOH Cancer Control Program
• Summary

3. CLINICAL SCENARIO in the clinic:
• 69/M, office executive
• good functional capacity
• healthy lifestyle
• no comorbids
• no vices
• no personal or family history of cancer

4. “Doc, magpapa-cancer screening po ako
kasi di ko nagagamit ang HMO ko,
sayang naman.”

5. Cancer Situation in the Philippines
• Cancer is an epidemic.
• Cancer is the third leading cause of morbidity
and mortality in the country.
• 189 of every 100,000 Filipinos are afflicted
with cancer while four Filipinos die of cancer
every hour or 96 cancer patients every day.
Department of Health web portal:
https://portal2.doh.gov.ph/philippine-cancer-control-program
Philippine Health Statistics, 2009

6. Estimated Leading New Cancer Cases,
Both Sexes, 2015
CANCER
SITES
NUMBER %
Breast 20267 19
Lung 13679 13
Colon/Rect
um
9625 9
Liver 8649 8
Cervix 7289 7
Prostate 5526 5
Leukemia 4270 4
Thyroid 3288 3
Stomach 2715 3
Ovary 2657 2
2015 Philippine Cancer Society Facts and Estimates (Manila Cancer
Registry and Rizal Cancer Registry)

7. Estimated Leading New Cancer Cases in
the Philippines, Both Sexes, 2015
CANCER
SITES
NUMBER %
Breast 20267 19
Lung 13679 13
Colon/Rec
tum
9625 9
Liver 8649 8
Cervix 7289 7
Prostate 5526 5
Leukemia 4270 4
Thyroid 3288 3
Stomach 2715 3
Ovary 2657 2
2015 Philippine Cancer Society Facts and Estimates (Manila Cancer
Registry and Rizal Cancer Registry)

8. SCREENING

9. CANCER SCREENING
• Refers to a test or examination performed on
an asymptomatic individual.
• Goal of cancer screening is to prevent death
and suffering from the disease in question
through early intervention.
• Screening is a public health intervention.
• Opportunistic or programmatic
De Vita, Hellman, and Rosenberg’s Cancer: Principles & Practice of
Oncology, 10th edition.

10. Benefits and limitations of regular
cancer screening?
BENEFITS
• Getting screened reassures you if the
result is normal.
• Cancer screening may help prevent
cancer by finding changes in your
body that would become cancer if
left untreated.
• The earlier a cancer is detected, the
better your chance of survival.
LIMITATIONS
• Sometimes test results suggest
you have cancer even though
you don't (called a false
positive).
• The test may not detect cancer
even though it is present (called
a false negative).
• Some cancers would not
necessarily lead to death or
decreased quality of life
(overdiagnosis).
• Having screening tests may lead
to more tests and procedures
that may be harmful.
http://www.cancer.ca/en/prevention-and-screening

11. Principles of Cancer Screening
• Disease should have a high incidence
• Biological behavior and natural history of the disease
should be known
• Test should have high sensitivity, specificity, and
positive predictive value
• Test should be rapid, inexpensive, non-invasive, and
acceptable to patients
• An acceptable and efficacious method of treatment
must exist for patients diagnosed with disease
• Screening should lower the disease-specific morbidity
and increase survival
De Vita, Hellman, and Rosenberg’s Cancer: Principles & Practice of
Oncology, 10th edition.

12. Who’s Right When it Comes to Screening?

13. American Cancer Society (ACS) versus
U.S. Preventive Services Task Force (USPSTF)
Cancer Screening Guidelines

14. 5 Cancers with Guidelines for
Screening
• Breast Cancer
• Colorectal Cancer
• Cervical Cancer
• Lung Cancer
• Prostate Cancer

15. BREAST CANCER SCREENING

16. 5-YEAR SURVIVAL RATE FOR BREAST
CANCER BY STAGE
Stage 5-Year Survival, %
0 99
I 92
IIA 82
IIB 65
IIIA 47
IIIB 44
IV 14
Modified from data of the National Cancer Institute:
Surveillance, Epidemiology and End Results (SEER).

17. Not the average risk
• Have a known BRCA1 or BRCA2 mutation
• Have a first-degree relative with breast cancer,
and have not had genetic testing themselves
• Had radiation therapy to the chest when they
were between the ages of 10 and 30 years
• Have Li-Fraumeni syndrome, Cowden
syndrome, or Bannayan-Riley-Ruvalcaba
syndrome, or have first-degree relatives with
one of these syndromes
• Have a lifetime risk of breast cancer of about
20% to 25% or greater, according to risk
assessment tools that are based mainly on
family history
Li-Fraumeni Syndrome: caused
by mutation in TP53. Cancers
include soft tissue & bone
sarcomas, breast cancer, brain
cancer, adrenocortical adenoCA,
& leukemia.
Cowden syndrome: caused by a
PTEN mutation characterized by
multiple hamartomas & an
increased risk of developing
cancers of the breast, thyroid,
endometrium, CRC, kidney and
melanoma.
Bannayan-Riley-Ruvalcaba
syndrome: caused by a PTEN
mutation characterized by
macrocephaly, multiple
hamartomas and dark freckles
on the penis of males. More
than half will have
developmental delays,
hypotonia, hyperextensibility,
scoliosis and pectus excavatum.

18. Breast Cancer Risk Assessment Tool
(Gail Model)
• It uses 7 key risk factors for breast cancer.
– Age
– Age at first period
– Age at the time of the birth of a first child (or has not given
birth)
– Family history of breast cancer (mother, sister or
daughter)
– Number of past breast biopsies
– Number of breast biopsies showing atypical hyperplasia
– Race/ethnicity
• Women with a 5-year risk of 1.67 percent or higher are
classified as "high-risk."
https://bcrisktool.cancer.gov/calculator.html

19. Who’s Right When it Comes to Screening?

20. Previous Screening Recommendations for Breast Cancer
Test or Procedure American Cancer Society U.S. Preventive Services Task Force
Breast self
examination
Women ≥ 20 years: Breast
self-exam is an option
“D” = AGAINST
Clinical examination Women 20–39 years:
Perform every 3 years
Women ≥40 years: Perform
annually
Women ≥40 years: “I” =
INSUFFICIENT EVIDENCE
Mammography Women ≥40 years: Screen
annually for as long as the
woman is in good health
Women 50–74 years: Every 2 years
(“B”)
Women ≥75 years: “I”
“A”: The USPSTF recommends the service, because there is high certainty that the net benefit is
substantial.
“B”: The USPSTF recommends the service, because there is high certainty that the net benefit is
moderate or moderate certainty that the net benefit is moderate to substantial.
“C”: The USPSTF recommends selectively offering this service to individual patients based on
professional judgment. There is at least moderate certainty that the net benefit is small.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty that the
service has no net benefit or that the harms outweigh the benefits.
“I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and
harms of the service.

21. 2018 Screening Recommendations for Breast Cancer
Test or Procedure American Cancer Society U.S. Preventive Services
Task Force
Breast self
examination
No recommendation “D”
Clinical examination No recommendation Women ≥40 years: “I”
INSUFFICIENT EVIDENCE
Mammography Women 40-44 years: Should
be able to start screening if they
want to
Women ≥45 years: Screen
annually for as long as the woman is
in good health and is expected to
live for 10 years or more
Women ≥55 years: Can
continue yearly or every 2 years
Women 40–49 years: The
decision should be an
individual one, and take
patient context/values into
account (“C”)
Women 50–74
years: Every 2 years (“B”)
Women ≥75 years: “I”
“B”: The USPSTF recommends the service, because there is high certainty that the net benefit is
moderate or moderate certainty that the net benefit is moderate to substantial.
“C”: The USPSTF recommends selectively offering this service to individual patients based on
professional judgment. There is at least moderate certainty that the net benefit is small.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty that the
service has no net benefit or that the harms outweigh the benefits.
“I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and
harms of the service.

22. American Society of Clinical Oncology (ASCO)
(counterpart of the Philippine Society of Medical Oncology)
• Recommends
annual
screening
starting age
40 years
• Greatest reduction
in breast cancer
deaths, with nearly
40% reduction in
breast cancer
related deaths

23. COLORECTAL CANCER SCREENING

24. Who’s Right When it Comes to Screening?

25. Stage 5-Year Survival, % Stage 5-Year Survival, %
I 92 I 88
IIA 90 IIA 83
IIB 87 IIB 81
IIIA 72 IIIA 72
IIIB 65 IIIB 58
IIIC 53 IIIC 50
IV 12 IV 13
Modified from data of the National Cancer Institute: Surveillance,
Epidemiology and End Results (SEER).
American Cancer Society. Colorectal Cancer Facts and Figures 2017-
2019. Atlanta, Ga: American Cancer Society; 2017.
5-YEAR SURVIVAL RATE
FOR COLON CANCER BY
STAGE
5-YEAR SURVIVAL RATE
FOR RECTAL CANCER
BY STAGE

26. AVERAGE RISK
• No personal history of:
– adenomatous polyps
– colorectal cancer
– inflammatory bowel disease
– confirmed or suspected hereditary colorectal
cancer syndrome (FAP or Lynch syndrome)
• No family history of colorectal cancer

27. 2008 Screening Recommendations for Colorectal Cancer
Test or
Procedure
American Cancer Society U.S. Preventive Services Task Force
Sigmoidoscopy Adults ≥50 years: Screen every 5 years
Note: For all CRC screening tests, stop
screening when benefits are unlikely
due to life-limiting comorbidity.
Adults 50–75 years: Every 5 years in
combination with high-sensitivity fecal
occult blood testing (FOBT) every 3
years (“A”)a
Adults 76–85 years: “C”
Adults ≥85 years: “D”
Fecal occult
blood testing
(FOBT)
Adults ≥50 years: Screen every year
with high sensitivity guaiac based FOBT
or fecal immunochemical test (FIT) only
Adults 50–75 years: Annually, for high-
sensitivity FOBT (“A”)
Adults 76–85 years: “C”
Adults ≥85 years: “D”
Colonoscopy Adults ≥50 years: Screen every 10 years Adults 50–75 years: every 10 years (“A”)
Adults 76–85 years: “C”
Adults ≥85 years: “D”
“A”: The USPSTF recommends the service, because there is high certainty that the net benefit is
substantial.
“C”: The USPSTF recommends selectively offering this service to individual patients based on
professional judgment. There is at least moderate certainty that the net benefit is small.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty that the
service has no net benefit or that the harms outweigh the benefits.
“I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and
harms of the service.

29. 2018 Screening Recommendations for Colorectal Cancer
Test or Procedure American Cancer Society U.S. Preventive Services Task Force
Stool-Based Tests
Fecal occult blood
testing (FOBT)
Adults ≥45 years: Screen
every year with high sensitivity
guaiac based FOBT or fecal
immunochemical test (FIT) only
Adults 50–75 years: Annually,
for high-sensitivity FOBT (“A”)
Adults 76–85 years: “C”
Adults ≥85 years: “D”
Fecal
immunochemical
testing (FIT)
Adults ≥45 years: Screen
every year
“I”
Fecal DNA testing Adults ≥45 years: Screen,
but interval uncertain
“I”
“A”: The USPSTF recommends the service, because there is high certainty that the net benefit is
substantial.
“C”: The USPSTF recommends selectively offering this service to individual patients based on
professional judgment. There is at least moderate certainty that the net benefit is small.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty that the
service has no net benefit or that the harms outweigh the benefits.
“I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and
harms of the service.

30. 2018 Screening Recommendations for Colorectal Cancer
Test or
Procedure
American Cancer Society U.S. Preventive Services Task Force
Direct Visualization Tests
Colonoscopy Adults ≥45 years:
Screen every 10 years
Adults 50–75 years: every 10 years
(“A”)
Adults 76–85 years: “C”
Adults ≥85 years: “D”
Sigmoidoscopy Adults ≥45 years: Screen
every 5 years
Adults 50–75 years: Every 5 years in
combination with high-sensitivity fecal occult
blood testing (FOBT) every 3 years (“A”)a
Adults 76–85 years: “C”
Adults ≥85 years: “D”
CT
colonography
Adults ≥45 years: Screen
every 5 years
“I”
“A”: The USPSTF recommends the service, because there is high certainty that the net benefit is
substantial.
“C”: The USPSTF recommends selectively offering this service to individual patients based on
professional judgment. There is at least moderate certainty that the net benefit is small.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty that the
service has no net benefit or that the harms outweigh the benefits.
“I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and
harms of the service.

31. Which test to choose for screening?
• “The ACS and USPSTF found no head-to-head studies
demonstrating that any of the screening strategies are
more effective than others, although the tests have
varying levels of evidence supporting their effectiveness,
as well as different strengths and limitations.”
• “Offering choice in colorectal cancer screening strategies
may increase the proportion of patients who will actually
do the screening.”

32. CERVICAL CANCER SCREENING

33. Stage 5-Year Survival, %
0 93
IA 93
IB 80
IIA 63
IIB 58
IIIA 35
IIIB 32
IVA 16
IVB 15
Modified from data of the National Cancer Institute: Surveillance,
Epidemiology and End Results (SEER).
American Cancer Society. Cancer Facts and Figures 2018. Atlanta, Ga:
American Cancer Society; 2018
5-YEAR SURVIVAL RATE FOR CERVICAL
CANCER BY STAGE

34. Who’s Right When it Comes to Screening?

35. 2012-2018 Screening Recommendations for Cervical Cancer
Test or
Procedure
American Cancer Society (2012) U.S. Preventive Services Task Force
Pap test
(cytology)
Women <21 years: No screening
Women ages 21–29 years: Screen
every 3 years
Women 30–65 years: Acceptable approach to
screen with cytology every 3 years (see HPV test)
Women >65 years: No screening following
adequate negative prior screening
Women after total hysterectomy for
noncancerous causes: Do not screen
Women ages 21–65 years: Screen
every 3 years (“A”)
Women <21 years: “D”
Women >65 years, with adequate, normal
prior Pap screenings: “D”
Women after total hysterectomy for
noncancerous causes: “D”
HPV test Women <30 years: Do not use HPV testing
Women ages 30–65 years: Preferred approach
to screen with HPV and cytology cotesting every
5 years (see Pap test)
Women >65 years: No screening following
adequate negative prior screening
Women after total hysterectomy for
noncancerous causes: Do not screen
Women ages 30–65 years: Screen in
combination with cytology every 5 years if
woman desires to lengthen the screening
interval (see Pap test) (“A”)
Women <30 years: “D”
Women >65 years, with adequate, normal
prior Pap screenings: “D”
Women after total hysterectomy for
noncancerous causes: “D”
“A”: The USPSTF recommends the service, because there is high certainty that the net benefit is substantial.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty that the service has no net
benefit or that the harms outweigh the benefits.

36. Simplified Cervical Cancer Screening
Woman’s Age How often should a woman have a
Pap Test?
<21 years old No testing needed
21-30 years old Pap test every 3 years
30-65 years old Pap test every 3 years, or
Pap test and HPV cotesting every 5
years
>65 years old No testing needed if no abnormal
results for the past 10 years

37. LUNG CANCER SCREENING

38. Stage 5-Year Survival, %
IA1 92
IA2 83
IA3 77
IB 68
IIA 60
IIIA 36
IIIB 26
IIIC 13
IVA 10
IVB <1
Modified from data of the National Cancer Institute: Surveillance, Epidemiology
and End Results (SEER).
Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project:
Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth)
Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2016;11(1):39-
51.
5-YEAR SURVIVAL RATE FOR NON
SMALL CELL CANCER BY STAGE

39. 2002 03 04 05 06 07 08 09 10
T0
NLST Design and Time Posts
• RCT
• 1:1 randomization to CT or
CXR
• Launched across ~ 33 sites
FinalAnalysis
CXR
CT
53,476
High-
Risk
Subjects
T2
T1
Follow up
Interim analyses
National Lung
Screening Trial
National Cancer
Institute
TSLN

40. NLST Summary
• CT scan detects more lung cancers than CXR by 2.3 folds
• 20% lung cancer mortality reduction CT vs CXR
− Absolute risk reduction = 0.4% (AR CT= 1.3% | CXR = 1.7%)
• Few major complications
• NNS (Number needed to screen) : 320
− NNS (Breast Cancer): US: 238, NZ: 781
• NCI_2012 and J med Screen, 2001;8(3):114-5
• Need for diagnostic algorithm to decrease false positives

41. SCREENING CRITERIA
•Currently smoke or have quit within the past 15
years, and
•Have at least a 30-pack-year smoking history, and
•Receive smoking cessation counseling if they are
current smokers, and
•Have been involved in informed/shared decision
making about the benefits, limitations, and harms
of screening with LDCT scans, and
•Have access to a high-volume, high quality lung
cancer screening and treatment center.

43. 2018 Screening Recommendations for Lung Cancer
Test or Procedure American Cancer Society U.S. Preventive Services Task Force
Low dose helical CT
scan
Current or former smokers
aged 55-74 years in
good health: Screen every
year
Adults aged 55-80 years with a
history of smoking: Screen every
year, “B”
• Screening should be discontinued once:
• a person has not smoked for 15 years, or
• develops a health problem that substantially limits life expectancy
or the ability or willingness to have curative lung surgery
“A”: The USPSTF recommends the service, because there is high certainty that the net benefit is
substantial.
“B”: The USPSTF recommends the service, because there is high certainty that the net benefit is
moderate or moderate certainty that the net benefit is moderate to substantial.
“C”: The USPSTF recommends selectively offering this service to individual patients based on
professional judgment. There is at least moderate certainty that the net benefit is small.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty that the
service has no net benefit or that the harms outweigh the benefits.
“I”: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and
harms of the service.

44. PROSTATE CANCER SCREENING

45. Stage 5-Year Survival, %
I Local Stage 100
II 100
IIIA Nearly 100
IIIB Regional Stage Nearly 100
IVA Nearly 100
IVB Distant Stage 29
Howlader N, Noone AM, Krapcho M, et al (eds). SEER Cancer Statistics
Review, 1975-2014, National Cancer Institute. Bethesda, MD,
bhttps://seer.cancer.gov/csr/1975_2014/, based on November 2016
SEER data submission, posted to the SEER web site, April 2017.
5-YEAR SURVIVAL RATE FOR PROSTATE
CANCER BY STAGE

46. Who’s Right When it Comes to Screening?

47. 2008-2016 Screening Recommendations for Prostate Cancer
Test or Procedure American Cancer Society U.S. Preventive Services Task
Force
Prostate Specific
Antigen (PSA)
Men ≥50 years: should talk to a doctor
about the pros and cons of testing so
they can decide if testing is the right
choice for them.
Men ≥45 years: should talk to a doctor
about the pros and cons of testing if
African American or have a father or
brother who had prostate cancer before
age 65.
How often they are tested will depend
on their PSA level.
Men 55-69 years: “D”
Men ≥70 years:
recommends against PSA
testing “D”
Digital rectal
examination
As for PSA; if men decide to be tested, they
should have the PSA blood test with or
without a rectal exam.
No individual recommendation
“C”: The USPSTF recommends selectively offering this service to individual patients based on
professional judgment. There is at least moderate certainty that the net benefit is small.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty
that the service has no net benefit or that the harms outweigh the benefits.

49. 2018 Screening Recommendations for Prostate Cancer
Test or Procedure American Cancer Society U.S. Preventive Services Task
Force
Prostate Specific
Antigen (PSA)
Men ≥50 years: should talk to a
doctor about the pros and cons of testing
so they can decide if testing is the right
choice for them.
Men ≥45 years: should talk to a doctor
about the pros and cons of testing if
African American or have a father or
brother who had prostate cancer before
age 65.
How often they are tested will depend
on their PSA level.
Men 55-69 years:
make an individual
decision about whether to
be screened after a
conversation with their
clinician about potential
benefits and harm “C”
Men ≥70 years:
recommends against PSA
testing “D”
Digital rectal
examination
As for PSA; if men decide to be tested, they
should have the PSA blood test with or
without a rectal exam.
No individual recommendation
“C”: The USPSTF recommends selectively offering this service to individual patients based on
professional judgment. There is at least moderate certainty that the net benefit is small.
“D”: The USPSTF recommends against the service, because there is moderate or high certainty
that the service has no net benefit or that the harms outweigh the benefits.

50. WHERE ARE WE RIGHT NOW IN
TERMS OF CANCER SCREENING?

51. CLINICAL SCENARIO at Service OPD:
• IM resident during Cancer Consciousness Week
• Giving a lecture to 30-50 people from low to no
income families on the benefits of cancer
screening
• What will you offer them?

52. Philippine Cancer Control Program
Administrative Order No. 89-A s. 1990, amending A.O. No. 188-A s. 1973
• National Cancer Prevention and Control Action Plan
(NCPCAP) 2015-2020:
1. POLICY AND STANDARDS DEVELOPMENT
– Development of “National Policy on the Integration of Palliative
and Hospice Care into the Philippine Health Care System”
– Development and Operationalization of National Cancer
Prevention and Control Website and Social Media Sites
– Development of “Comprehensive National Policy on Cancer
Prevention and Control”
– Establishment of National Cancer Center and Strategic Satellite
Cancer Centers
– Expansion of Philhealth Z Benefit Package Coverage to Other
Cancers

53. The reality is that more than 80% of Philippine families cannot
afford out-of- pocket expenses needed for basic medical care.
• Contrary to the continuing
misperception that most
Filipinos lack awareness that
certain common cancers are
curable when detected and
treated early, it could be that
due to socio-economic
realities, majority actually
have no choice.

54. Combined monthly income of those in the
poverty line : ≤ P9,000 / MONTH
• According to a controversial statement from
NEDA, a family of 5 would need around
P42,000 / month to live comfortably.

55. I
ESTIMATED PRICES OF SCREENING TESTS
(as of September 2018, c/o front desk personnel)
SCREENING
TEST
Private Hospital in
Alabang
De La Salle – UMC DLS-UMC Charity Rate
(with Social Service Help)
BREAST CANCER
Mammogram P3,594.00 P1,393.00 P1,114.00
COLORECTAL CANCER
Colonoscopy P16,000.00 plus PF P9,000.00 plus PF P9,000.00
Sigmoidoscopy P13,000.00 plus PF P9,000.00 plus PF P9,000.00
CT colography P24,552.00 None None
FOBT P480.00 P220.00 P180.00
CERVICAL CANCER
Pap smear (conventional) P1,600.00 plus PF P400.00 plus PF P200.00
Pap smear (cytology) P2,800.00 plus PF None None
HPV test P7,000.00 None None
Pap smear with HPV cotesting P8,600.00 plus PF None None
LUNG CANCER
Low dose helical CT scan P9,277.00 P6,550.00 P6,550.00
PROSTATE CANCER
PSA P4,780.00 P1,820.00 P1,456.00
* Philhealth coverage still deductible where applicable.

56. Philippine Cancer Control Program
Administrative Order No. 89-A s. 1990, amending A.O. No. 188-A s. 1973
• National Cancer Prevention and Control Action Plan
(NCPCAP) 2015-2020:
2. ADVOCACY AND PROMOTIONS
• National Cancer Consciousness Week
• Colon and Rectal Cancer Awareness Month
• Cancer in Children Awareness Month
• Cervical Cancer Awareness Month
• Prostate Cancer Awareness Month
• Lung Cancer Awareness Month
• Liver Cancer Awareness Month
• Breast Cancer Awareness Month
• Cancer Pain Awareness Month
In the Philippines, in
spite of nearly two
decades of
“Awareness
Campaigns”
conducted by the
public and private
sectors, such as those
on breast, cervix and
colorectal cancers,
majority of these
cancers are still not
diagnosed and treated
at an earlier, more
curable stage.

59. Philippine Cancer Control Program
Administrative Order No. 89-A s. 1990, amending A.O. No. 188-A s. 1973
• National Cancer Prevention and Control Action
Plan (NCPCAP) 2015-2020:
3. SERVICE DELIVERY
• Availability of Free Cervical Cancer Screening in all trained
RHUs
• Availability of cryotherapy equipment in every province (81
provinces)
• Availability and accessibility of screenings for selected
cancers in all trained RHUs
• School-based HPV vaccination of 9-13 year old females
• Hepatitis B vaccination for all health workers nationwide

60. Philippine Cancer Control Program
Administrative Order No. 89-A s. 1990, amending A.O. No. 188-A s. 1973
• Availability of Free Cervical Cancer Sceening in all
trained RHUs via Visual Inspection with Acetic Acid
(VIA)
– VIA:
• Uses bright white light to visualize the cervix with unaided eye
• Clean cervix with dilute 3-5% acetic acid solution
• Wait at least 1 minute
• Abnormal tissue temporarily appears white (acetowhite)
• Get IMMEDIATE results
• Alternative to cytology in screening for cervical cancer in poorly-
resourced locations
• Can be done by nurses/midwives/BHW trained to deliver the
service
– SERVICE OPD of OB at the DE LA SALLE – UMC:
• Service is FREE
• Pay P50.00 for the speculum to be used
• Additional ≈P500 for biopsy if with abnormal findings
VIA NEGATIVE
VIA POSITIVE

61. IN SUMMARY
• HIGH – MODERATE
INCOME SETTING
– Screen patient if
average risk / falls
under the screening
criteria
– Discuss risks and
benefits of cancer
screening
– Use ACS or USPSTF
Guidelines
• RESOURCE LIMITED
– Take advantage of
AWARENESS WEEKS to
score some freebies 
– Refer to Service OPD
CANCER TEST
Breast (October) Mammogram
Colorectal
(March)
FOBT
Cervical (May) VIA c/o service OPD or
RHU
Prostate (June) -
Lung (November) -

62. Whose responsibility is cancer
screening?

63. Whose responsibility is cancer
screening?
ALL PHYSICIANS.
The more cancer we catch early,
the more lives we save.

64. TITLE
Speaker