Every nurse has an opportunity to assist in the community effort to control cancer. The very nature of her work with all ages and all groups makes her a potential force in cancer control. For the nurse to be fully effective in the cancer-control program, she should understand present-day methods of diagnosis and treatment.

The nurse has an active part in the case-finding aspects of a cancer-control program. She exercises this function in her role of an alert informed observer and teacher; uses her skills to motivate individuals to seek prompt medical supervision for any deviation from normal health, and, in the absence of symptoms, promotes maintenance of optimum health by encouraging periodic physical examinations. To do so she must be well informed about cancer and be sure in her own mind that she accepts the scientific facts about cancer; that many patients will survive this illness; that cancer like other long-term illnesses can and does persist for varying periods of time without acute episodes or recurrence if it is treated early and adequately.

Age and sex in cancer case finding are important since the incidence of cancer in certain sites tends to be related to these factors. For example, cancer of the lung is more common in men over 45 and cancer of the breast is more common in women over 40. A nurse should take these facts into consideration in providing health supervision to patients and their families.

She should also know that the incidence of cancer of the digestive system is increased in men over 40-that lung cancer is more frequently diagnosed in men who are heavy smokers. Men with signs or symptoms which might indicate these conditions should be referred to their physicians. In her daily contacts with patients and their families the nurse should be alert to any precancerous condition she observes-recognition of these signs is a signal for referral for medical investigation. A nurse who listens with discrimination to discussions concerning a patient's or a family's health problems may learn of conditions that require a physician's evaluation.

It is important for the nurse to realize that cancer has become the second leading cause of death in children in the United States and the leading cause of death in this group if one excludes accidents. Certain forms of cancer, e.g., leukemia and Hodgkin's Disease, account for approximately 50 percent of the cancer deaths in children of all races and sexes. The nurse should be alert to the possible significance of undue or prolonged fatigue, and marked changes in personality, vision, motion, or digestion in an apparently well child.

The nurse in industry has opportunities to encourage preemploy-ment and periodic physical examinations by which precancerous conditions may be detected and treated.

Thus, no matter where the public health nurse may be functioning she will find many opportunities to participate in case-finding activities in her daily contacts with people.

The most important single weapon in detecting cancer before any symptoms appear is the periodic health examination of the presumably well individual. A periodic dental examination may be of equal importance in the detection of oral cancer. Since cancer can develop in individuals of all ages regular health and dental examinations are essential for everyone.

Health examinations for adults should be regular and thorough. Nurses should explain this at the time they are encouraging the individual to establish the habit of having periodic physical examination. Patients should understand that a complete examination requires sufficient time for careful history taking before the examination. The basic components of cancer detection in physical examination include a thorough inspection and palpation of accessible sites-skin, head and neck, breast, abdomen, colon and rectum, female genitalia or male genitalia, including prostate.

Every visit to a maternity patient provides the opportunity for the nurse to discuss regular, periodic physical examinations throughout life. Since the patient is generally willing to accept a pelvic examination in the post partum period the nurse can build on this attitude by explaining uterine cytology and its importance as a method of early cancer detection.

Another way in which the nurse may contribute to cancer control is to encourage the patient to follow through on the physician's recommendations for repair of cervical lacerations or treatment of cervical infections.

The nurse also participates in the early detection of cancer, specifically cancer of the uterus, by interpreting the cytologic examination (the Papanicolaou smear) to all women. It is important that women understand the need for periodic pelvic examinations which include the Papanicolaou smear. It should be explained that the specimen for cytologic examination is obtained by a simple, quick, painless procedure. Cellular changes which occur and which may require medical care can be detected in a smear from even a normal-appearing cervix. Cancer which is diagnosed in the symptomless stage offers the highest potential for cure. The nurse who is discussing the cytologic examination and preparing the woman for the Papanicolaou smear instructs her not to douche for 24 hours prior to going to her physician for the examination. Many physicians also prefer that a tub bath be omitted on the day of the examination. If the woman has been using any medication in the genital tract she should douche prior to the 24-hour period preceding examination and not use the medication again until after she has been to her physician for the smear. The above instruction applies to coitus.

The nurse also advises the woman that smears are not usually taken during a normal menstrual period. If there is spotting or an abnormal menstrual flow it is important for the woman to see her physician. Repeat examinations are frequently requested when cells are obtained during pregnancy or menopause because cellular changes which require medical evaluation can occur during these periods or immediately following delivery.

The nurse can be helpful in interpreting the importance of returning for repeat smears. She will be able to speak with authority if she herself has carried out the health practice she is advocating.

The teaching of breast self-examination to women is another well-defined method by which the nurse may participate in the early detection of cancer. Many physicians include a breast examination in a physical examination of their women patients; however, most physicians are willing to have their patients taught a method by which a systematic and thorough self-examination may be done periodically by the woman.

The woman is taught to do the breast self-examination after her menstrual period because an examination done during a menstrual period is unreliable due to temporary changes which normally occur in breast tissue at this time.

It is important that the woman be instructed to stop the examination whenever she finds an abnormal condition, and to make an appointment with her physician as soon as possible. The nurse should recognize that most women who find a lump will be anxious about this. The nurse may be very helpful to the patient in the period of time between discovery of the lump and the physician's decision as to what must be done.

The technique of breast self-examination is not discussed in this book since both a movie and separate pamphlets describing the technique are available from the American Cancer Society and some State health departments.