🛡️ Cancer Prevention & Screening
The three levels of prevention, the warning signs mnemonic, and what screening actually does.
🧭 The three levels — get these straight
Exam questions constantly ask you to classify an action rather than perform it. The classification is the mark.
| Level | Goal | Examples |
|---|---|---|
| Primary | Stop it ever happening | HPV and hepatitis B vaccination, smoking cessation, sunscreen, limiting alcohol, healthy weight and diet, avoiding occupational carcinogens |
| Secondary | Find it early, before symptoms | Mammogram, Pap and HPV test, colonoscopy, PSA discussion, low-dose CT for smokers, skin checks |
| Tertiary | Limit damage and disability once it exists | Treatment, rehabilitation, lymphedema management, palliative and survivorship care |
Primary prevents. Secondary detects. Tertiary manages. Three words. A mammogram in a woman with no symptoms is secondary — it does not prevent cancer, it finds it. The HPV vaccine is primary — it prevents the infection that causes it. That pair is a favorite.
⚠️ CAUTION — the seven warning signs
An old mnemonic that still earns its place, because every letter is something a patient can notice at home.
- C — Change in bowel or bladder habits
- A — A sore that does not heal
- U — Unusual bleeding or discharge
- T — Thickening or lump in the breast or elsewhere
- I — Indigestion or difficulty swallowing
- O — Obvious change in a wart or mole
- N — Nagging cough or hoarseness
Add the two general ones that are always significant: unexplained weight loss and unexplained persistent fatigue.
🌞 ABCDE — assessing a mole
- Asymmetry — one half does not match the other
- Border — irregular, ragged, blurred
- Colour — uneven; several shades; black, blue, red or white within it
- Diameter — larger than about
6 mm, roughly a pencil eraser - Evolving — changing in any way. This is the most important letter.
A mole that is changing needs assessment even if it fails every other letter.
🩺 What you actually teach
Tobacco is the single largest preventable cause of cancer. If you can only address one thing, address that. Quitting reduces risk at any age, and the risk keeps falling for years afterwards — a fact worth telling a patient who thinks it is too late.
Modifiable risk, in rough order of impact
- Do not smoke, and avoid second-hand smoke. Also no chewing tobacco — oral cancer.
- Limit alcohol. It raises risk of mouth, throat, esophagus, liver, colon and breast cancer, and less is genuinely better.
- Protect from the sun. Broad-spectrum SPF 30 or higher, reapplied every 2 hours; shade between 10 a.m. and 4 p.m.; clothing and a hat. No tanning beds — ever.
- Keep a healthy weight and move. Obesity is linked to at least a dozen cancers.
- Eat mostly plants. Vegetables, fruit, whole grains; limit red meat and cut processed meat.
- Get vaccinated. HPV prevents cervical and several other cancers; hepatitis B prevents liver cancer.
- Practice safer sex and do not share needles — HPV, HIV, hepatitis B and C are all oncogenic routes.
💬 Talking about screening honestly
- Screening finds cancer. It does not prevent it. The exception is colonoscopy and Pap testing, which remove pre-cancerous lesions and so do both.
- A normal result is not a promise. Teach patients to report new symptoms between screenings rather than waiting for the next appointment.
- Ask why someone is not attending. Cost, transport, childcare, fear of the result, fear of pain, past bad experience, or nobody ever explained it. Each has a different fix, and none is fixed by repeating the recommendation.
- Screening intervals change. Use current national guidance for the individual patient rather than a number learned years ago — and teach patients that a changed recommendation is not a mistake being corrected.
The most useful question is not "do you attend screening" but "what has got in the way".
Know who is higher risk. A strong family history, a known BRCA or Lynch mutation, previous radiation, chronic hepatitis, or long-standing inflammatory bowel disease all mean earlier and more frequent screening than the general population, and sometimes genetic counseling. Recognizing that a patient is not average-risk is often the whole of the nursing judgment.