Common Cancers

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This executive summary highlights the key recommendations from the main text of the guidelines.

Main Recommendations

Breast cancer

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

of screening; breast magnetic resonance imaging (MRI) may be used in selected high-

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.

Cervical cancer

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.

Colorectal cancer

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.

Oral cancers

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.

Oesophageal cancer

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

Prostate cancer

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.

Childhood cancers

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

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

 

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