This executive summary highlights the key recommendations from the main text of the guidelines.
Promotion of breast awareness and education of women on breast health are important
aspects in early detection of breast cancer. Mammography is the recommended mode
risk populations. Breast Self-Examination (BSE), clinical breast examination (CBE) and
ultrasound are not screening modalities but are complementary to mammography and
aid in early diagnosis of breast cancer. Age of starting screening as well as frequency will
depend on risk assessment and stratification.
The target population for screening is women aged 25 to 49 years. Testing for the human
papilloma virus (HPV) is recommended as the primary screening method; visual inspection
with acetic acid (VIA) alone, or combined with visual inspection with Lugol’s iodine (VILI)
can also be used as primary screening methods where facilities for HPV testing are not yet
available, while pap smear may be used in some specified circumstances. Ideally, a same
day’screen & treat’approach is recommended, with cryotherapy and/or Loop Electrosurgical
Excision Procedure (LEEP) as part of the screening programme.
On average, Screening should start at 45 years; the recommended screening tests are
fecal occult blood test (FOBT) for people with average risk and colonoscopy for high risk
groups. Frequency of screening is 5 years; high risk groups may require more frequent
screening. Genetic testing is recommended for familial colorectal cancer.
The most effective approach to ensure early diagnosis of oral cancers in Kenya is to offer
opportunistic screening, targeting all individuals at risk of developing oral cancer.
Recommended screening/early diagnosis methods are visual inspection, imaging,
exfoliative cytology and incisional biopsy.
The goal is to detect precancerous lesions and early cancerous lesions. Screening
modality of choice is endoscopy (white light endoscopy, Lugol’s chromoendoscopy
or narrow band imaging endoscopy). Targeted screening is advised for people with
first degree relatives with biopsy proven oesophageal cancer, asymptomatic people
living in high-risk areas, patients treated for head and neck squamous cell carcinoma
and patients with history of caustic acid ingestion.
14 I KENYA NATIONAL CANCER SCREENING GUIDELINES
There is no role for mass screening for prostate cancer. Screening for prostate cancer
should be a highly individualized decision between a client and his caregiver, bearing
in mind the client’s values and preferences. The client should be well informed about
the benefits and harms of screening. Screening should target men aged 40 years and
above of African descent; SS years and above of Caucasian or Asian origin. Men with
a family history of prostate cancer should begin screening at 40 years of age. Patients
with a PSA >4ng/ml regardless of other parameters, should be referred to a urologist for
further management. The final diagnosis of prostate cancer must be histological based
on a biopsy report.
The majority of childhood cancers are not amenable to screening, apart from
retinoblastoma and other rarer heritable conditions. Furthermore, unlike some
adult cancers, childhood cancers are not associated with lifestyle. The emphasis
therefore, in childhood cancers is early detection as there is high potential for cure.
Screening of childhood cancers is recommended mainly for hereditary retinoblasto-
ma, certain genetic syndromes and in childhood cancer survivors.
Tumor markers are produced by cancers or by the body in response to cancer.
This therefore means that most tumor markers have no role in cancer screening
in the general population. However, tumor markers have a very restricted use
in early detection of some cancers. PSA & CA 12S are useful for screening high
risk individuals with either a strong family history or with specific risk factors for
prostate and ovarian cancers respectively.
This Guideline provides evidence-based recommendations for cancer screening in Kenya. In all instances, a patient-centered approach should be employed in the imple- mentation of the stated recommendations.
……………………………………………………………………. Dr Kioko Jackson K., OGW, MBS
Director of Medical Services
Ministry of Health
KENYA NATIONAL CANCER SCREENING GUIDELINES I 1S