Community cancer awareness programs: symptom awareness alone doesn’t suffice

Background: Although cancer is a global public health problem, maximum impact is on developing economies. In India, socio-cultural factors also operate to add the burden. Aim of the study was to delineate factors causing late presentation of cancers to the point of care.Methods: We gave cancer awareness classes to a village community, preceded by a campaign to attend the classes with the help of a local trustee organisation and primary health center. Data was collected from the attendees using a structured questionnaire prepared to dissect out the awareness about cancer symptoms and concerns about treatment.Results: Only 1.8% of the total population of the area under study attended the classes. Out of the 411 attendees, 323 (78.6%) responded to the questionnaire and of them, 294 (91%) identified the site wise symptoms of cancer clearly and 40 (12.4%) detected their own symptoms warranting cancer screening. Commonest concern was the cost of treatment (40.9%). There were people thinking that cancer is not a life-style disease (3.1%), it is genetic (7.7%), it may be due to fate alone (6.2%), it is contagious (5%), and it cannot be cured (3.7%).Conclusions: Despite high health status indices, literacy rate and high knowledge about cancer symptoms, there are still a lot of superstitions about cancer in Kerala. The most common reason preventing people from approaching health care system with early symptoms of cancer is the fear of cost of treatment. Apart from teaching symptoms of cancer, cancer awareness programs should include familiarisation of various financial aids available for cancer treatment.

Imaging features in Hirayama disease.

Purpose: To evaluate the MR findings in clinically suspected cases of Hirayama disease. Materials and Methods: The pre and post contrast neutral and flexion position cervical MR images of eight patients of clinically suspected Hirayama disease were evaluated for the following findings: localized lower cervical cord atrophy, asymmetric cord flattening, abnormal cervical curvature, loss of attachment between the posterior dural sac and subjacent lamina, anterior shifting of the posterior wall of the cervical dural canal and enhancing epidural component with flow voids. The distribution of the above features in our patient population was noted and correlated with their clinical presentation and electromyography findings. Observations: Although lower cervical cord atrophy was noted in all eight cases of suspected Hirayama disease, the rest of the findings were variably distributed with asymmetric cord flattening, abnormal cervical curvature, anterior shifting of the posterior wall of the cervical dural canal and enhancing epidural component seen in six out of eight (75%) cases. An additional finding of thoracic extension of the enhancing epidural component was also noted in five out of eight cases. Conclusion: Dynamic post contrast MRI evaluation of cervicothoracic spine is an accurate method for the diagnosis of Hirayama disease.

Co-occurrence of radiological features of progressive supranuclear palsy and corticobasal degeneration.

We report an interesting case demonstrating co-occurrence of radiological features of progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). The clinical features were typical of PSP but magnetic resonance imaging (MRI) showed both typical brainstem changes of PSP and an atypical pattern of cortical atrophy. While the MRI had markers of CBD, the clinical features were not classical of CBD.