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9.PCH.1.3, page 1

Essential Standard Clarifying Objective 9.PCH.1

Analyze wellness, disease prevention, and recognition of symptoms.

9.PCH.1.3 Explain the procedures for health screenings, checkups, and other early detection measures

in terms of their health-‐related benefits. Materials Needed: Appendix 1a, b, c, d – Early Detection (signs and cards on colorful paper and laminated) Appendix 2 – copy of Early Detection Teacher’s Key Appendix 3 – copies of Do It NOW! The Importance of Early Detection Appendix 4a, b, c – copies of Young Athlete, Unsung Hero, Fights Melanoma Appendix 5 – copies of Early Detection Can Save Lives Appendix 6 – copies of ACS’s Seven Warning Signs of Cancer Models for breast and testicular self-‐examination Appendix 7 – copies of Whatcha Going to Say? Statement of Objectives: In Healthful Living Education, we have studied various health risks. Usually we focus on the primary prevention of risks. That is, what we do in the first place to keep from becoming ill or injured. Secondary control is early detection and that practice will be the basis of today’s lesson. By the end of the class, we will know the importance of medical examinations and self-‐examination to detect conditions early and improve effectiveness of intervention. Review: Option 1 Ask these questions:

• How many of you have heard about someone who “waited too late” to go to the doctor?

• What do you think that means?

• With which diseases could someone wait too long and not get the care needed to save

their lives?

Option 2 There are three levels of disease and injury control: primary prevention, secondary control, and tertiary control. Primary prevention includes eating nutritiously, exercising regularly, and avoiding harmful substances such as tobacco. Secondary control is early detection: medical exams and self-‐examination. Tertiary is the treatment level. With some diseases, such as cancer, the greatest hope for a cure is detecting the problem early enough to get treatment that is lifesaving. Having regular physical exams and learning techniques of self-‐examinations are skills and habits that need to start during adolescence.

NC School Health Training Center NC Association for the Advancement of Health Education

9.PCH.1.3, page 2

In our first activity, we will see if we can distinguish between practices that are primary prevention, early detection, and treatment. Post the signs and distribute cards from Early Detection (Appendix 1). Ask students to decide or consult with their classmates about whether the health practice represents primary prevention, secondary or early detection, or treatment (tertiary) and place the cards under the appropriate sign. Have all students remain at the front of the room to process the answers and correct incorrect responses. Use Appendix 2, Early Detection Teacher’s Guide, to rearrange cards that were placed in the wrong category. Say, There are many practices that can improve a person’s health. Some health risks can be prevented, others can be detected early enough to receive effective treatment, and others must be treated. Focus: Option 1 To emphasize the concept of the importance of early detection, read the poem, Do It Now! (Appendix 3) Ask these questions.

• Why does the author of the poem believe procrastination is natural?

• When people experience symptoms, what are they hoping for?

• Whose help and advice should we seek if we notice a symptom?

Option 2 Provide a copy of Young Athlete, Unsung Hero, Fights Melanoma (Appendix 4a, b, c). Give students time to read the article. This is one of dozens of stories of cancer survival that can be found at the website for the American Cancer Society (ACS), www.cancer.org. In almost every story, the cancer is detected early either through a medical examination, self-‐examination, or noticing a sign or symptom. In this story, there could have been an easier outcome (less difficult and invasive treatment) if the boy or his parent had sought medical attention for the mole earlier. Thankfully they acted soon enough to save his life. Skin cancer is one of the cancers that can be detected early. There are several others. At this point in the lesson plan, the class may be divided by gender so that boys are hearing the lesson about testicular self-‐examinations and girls are hearing the lesson on breast self-‐examinations. Explain to each group what the other class (gender) is learning and that these methods of self-‐examination may be life-‐saving.


9.PCH.1.3, page 3

Teacher Input: Provide copies of Early Detection Can Save Lives (Appendix 5). With cancer, the greatest hope for a cure is early detection. These types of cancer in particular can be found early and treated, thereby saving lives and reducing suffering. If all Americans practiced early detection testing according to ACS recommendations, the five-‐year survival rate for people with these cancers would increase to about 95%. The American Cancer Society has identified and publicized Seven Warning Signs of Cancer. Knowing these and asking for medical diagnosis and care are extremely important health practices. Most Americans can name only one of the seven signs. How many can you name? Distribute copies of Appendix 6, ACS’s Seven Warning Signs of Cancer. We have divided our class today so that the males and females in the class are hearing about the kind of cancer that is specific to their gender. One caution though: It is possible for a male to develop breast cancer. One in every 100 cases of breast cancer affects a man. If a man notices a lump developing under or near his nipple, he should see a physician to rule out breast cancer. Option 1 Download copies of materials on breast and testicular self-‐examination from the American Cancer Society. http://www.cancer.org/Cancer/BreastCancer/MoreInformation/BreastCancerEarlyDetection/breast-‐cancer-‐early-‐detection-‐acs-‐recs-‐bse. http://www.cancer.org/Cancer/TesticularCancer/MoreInformation/DoIHaveTesticularCancer/do-‐i-‐have-‐testicular-‐cancer-‐self-‐exam Go over the information and directions in the handouts. Option 2 Invite a guest speaker or speakers from the local health department to teach or co-‐teach the lesson on self-‐examination and early detection. The public health department may have models and instructional materials, which can be utilized in the lesson. Guided Practice: Self-‐examination is a skill that can be learned in adolescence that should be practiced throughout one’s lifetime. The high school Healthful Living Education class is often the last health education that young people receive and includes learning about healthy habits that can result in the early detection of life-‐threatening conditions. Distribute the handout Whatcha Going to Say? (Appendix 7) Have students work in pairs to develop a response to a classmate who expresses a barrier or obstacle to practicing early


9.PCH.1.3, page 4

detection strategies. Call on students to share responses and reinforce the decision to incorporate early detection strategies into the healthy habits they practice. Independent Practice: Place students in small groups to practice the skills of self-‐examination on a model. Make certain students have washed hands or used cleansing cloths before they handle the models. Have each student practice the skill and the others observe and critique the skill. The teacher should monitor skill practice to be certain students are on task and they receive feedback on their ability to implement the skill. Closure: Today we learned about early detection of health problems that can be serious if left untreated. Some of these health problems can occur at young ages and need to be reported to an adult such as a parent or health care provider. Others may occur later in life. Young people should begin practicing healthy habits and incorporate these behaviors

9.PCH.1.3, Appendix 1a

Primary Prevention

Secondary Control of Disease

Tertiary Control of Disease

9.PCH.1.3, Appendix 1b

exercising 2-3 X/week

eating a low-fat diet

practicing regular breast

self-exam

practicing regular

testicular self-exam

getting a physical

examination

taking an antibiotic for an

infection bypass surgery for cardiovascular

disease

noticing one of the 7 warning signs of cancer

flossing your teeth

maintaining a desired weight

using a condom during sexual

intercourse

having blood cholesterol level

checked

9.PCH.1.3, Appendix 1c

taking calcium supplementation

avoiding all tobacco

products chemotherapy using sunscreen

taking the AIDS “cocktail”

taking an aspirin each day

mammography CPR having a

chest x-ray practicing meditation

getting 7-8 hours of sleep

nightly

direct pressure for severe bleeding

having a cancerous

tumor removed

applying a cast to a broken

bone washing

hands often eating

breakfast

9.PCH.1.3, Appendix 1d

checking pulse & respiration

wearing a seatbelt

wearing a helmet when

riding a bicycle

having a pelvic exam + Pap

smear manual thrusts

for choking anti-depressant

medication practicing abstinence

getting tested for STDs

9.PCH.1.3, Appendix 2

Teacher Key Primary Prevention Secondary Control of Disease Tertiary Control of Disease

exercising 2-3 X/week eating a low-fat diet flossing your teeth maintaining a desired weight avoiding all tobacco products practicing meditation taking calcium supplementation eating breakfast washing hands often getting 7-8 hours of sleep nightly taking an aspirin each day wearing a bicycle helmet using sunscreen

practicing regular breast self-examination noticing one of the 7 warning signs of cancer having blood level cholesterol checked getting a physical examination practicing regular testicular self-examination having a pelvic exam + Pap smear having a chest x-ray mammography

bypass surgery for cardiovascular disease chemotherapy having a cancerous tumor removed abdominal thrusts for choking anti-depressant medication applying a cast to a broken bone direct pressure for severe bleeding taking the AIDS “cocktail” CPR taking an antibiotic for an infection


Do It NOW! The Importance of Early Detection

Sometimes we are frightened to learn the truth,

So we postpone to another day

Having a screening or a health exam.

We’re hoping it will just “go away.”

Denial is a natural reaction.

It is human instinct to not want to know.

Yet our best defense against serious disease

Is to get up the courage and go.

If we notice a change in our bodies,

Our parents are the first we should tell.

Then going to the doctor is next, because

Early detection’s our best chance to get well.

9.PCH.1.3, Appendix 4a

Young Athlete, Unsung Hero, Fights Melanoma (Source: www.cancer.org)

Mother Cautions: Parents, Be Vigilant You look at Brian and all he's going through, and he never ever complains about anything. He's my hero. I look at him and I see what he can do. He gives me strength. Since he was born, Brian Green has always been the picture of health. Now 18, the blue-eyed, fair-skinned Florida youth has spent his growing up years participating in sports, from Little League baseball to high school football, weight training, soccer, track, and pole vaulting. Rarely has he ever been sick. But there was this mole on his ear since he was two or three years old. Three years ago, the mole grew to the size of a dime, became irregular in shape, and changed color. "It wasn't in a place where I could see it," said Brian, "because it was on back of my ear. And the only time I remember noticing it was after a baseball game." Brian would often participate in all-day tournaments with no sun protection; his baseball cap didn't cover his ears. His mother, Joy, remarked, "Back then, I didn't pay attention to moles. He grew and the mole grew. But then I guess it grew more, and I didn't notice." There had been warnings from others, like the hairdresser, who told them they should really have it checked. "When it did change color, it got kind of light in the center and started to have jagged edges, and when he would comb his hair, he would nick it, and it would bleed. That's when I took him to the doctor to have it diagnosed," said Joy. Have It Checked In April 1999, they saw a dermatologist, who was suspicious right away. A biopsy was performed. Two different labs confirmed it was melanoma. "Needless to say," said Joy. "I won't forgive myself for not having it checked [earlier]." She cautions parents, "Take your child right away. Do not wait. If I could do it all over again, believe me, I would. But I can't go backwards. I can only go forwards and try to do everything I can to fight this disease." In May that same year, Joy took Brian to the H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida in Tampa. The doctor removed the mole, and also agreed with the diagnosis, even though melanoma is very rare in young people. The next step was to inject a radioactive dye into Brian's ear to trace where the cancer may have spread. As a result, surgery was performed to remove five lymph nodes in his neck, and skin was grafted from his thigh onto his ear.

9.PCH.1.3, Appendix 4b

The doctors found a microscopic melanoma in one lymph node, placing Brian at Stage III of the disease. In June, Brian started the immunotherapy treatment called interferon for nine months. At first the dosage was too high, affecting his liver. He lost weight. It made him feel like he had the flu. But that didn't stop him. He'd get a fever, take Tylenol, then go practice football. Scores High Academically, Too Throughout his treatment, Brian remained a high achiever in academics, making excellent grades in college prep subjects. That fall, Brian made the varsity football team as a freshman. He was able to finish both the football and soccer seasons. But his sophomore track program was cut short in the spring of 2000, because he had to have surgery. In February 2000, when Brian found a lump on his neck, he stopped taking interferon. In March when the lump was removed, it was found to contain melanoma. In April a modified radical neck dissection was performed. They removed 68 lymph nodes out of his neck. All nodes came back negative for cancer. The saliva gland was removed under the chin, and they worked around his facial and shoulder nerves. Five treatments of radiation to the neck followed. "My spirits were up," said Brian. "It didn't bother me, I just went through it and did what I had to do." Even though his right shoulder was a little weaker and at first drooped, Brian soon healed from his surgery. In the summer he went right back to weight lifting and running in preparation for the fall football season. "Even when I couldn't play," said Brian, "the coaches always welcomed me at practice. They always reminded me I was part of the team. When I got older, they asked me to assist coaching." But in his junior year, he couldn't play football — after a whole summer of practice — because he had lung surgery. In July on their way to the movies, Joy had spotted a large lump behind Brian's ear, which he thought was scar tissue. She said, "We have to get it checked out." Back-to-Back Surgeries Performed In addition to the CT scans, Joy insisted on a PET scan. The scan showed a mass behind the ear and a spot in his lung, where the melanoma had spread. Two back-to-back surgeries were scheduled in August and September 2000. The small nodule was removed from his lung; it tested positive for melanoma. The disease had progressed to Stage IV. One week later the mass behind his ear, the salivary gland in his cheek, and another lymph node were removed. Surgery was followed by radiation in the neck area.

9.PCH.1.3, Appendix 4c

The worse part for Brian was not being able to play football. After lung surgery he couldn't lift anything, and wasn't able to participate in athletics for three months. Missing an entire season made him depressed. "But every time I had surgery, and it messed up a season, I remembered I had next year," said Brian. His schoolbooks weighed at least 30 pounds, and being forbidden to lift anything heavier than five pounds, he had to wheel them in a luggage carrier and take the elevator. In March 2001, another mass was discovered in the left lung, higher up. The oncologist wanted to wait and see. The surgeon said it was big enough to operate, so the Greens opted for surgery. The mass proved to be malignant. In June, Brian started a new immunotherapy that wasn't available when he first started, GM-CSF. Brian continues to give himself shots as a preventative measure, two weeks on and two weeks off, in the stomach. The best news of all: no recurrence since his last lung surgery. Brian's been cancer free for a year now. "We thank the dear lord every day that it hasn't come back," said Joy. Brian's indomitable spirit keeps him going. Even after lung surgery, when he couldn't play football, he went on to play soccer and pole vault that year, despite a fall and a chipped ankle bone. The senior kept his grade point average high, maintaining a 4.1, weighted for his honors courses. He's also earned his school's Student of the Month and Unsung Hero (football) awards and was a nominee for Wendy's Heisman for Seniors, where the nation's top high school seniors are honored who best exemplify a supreme scholar, citizen, and athlete. Brian was also recognized as one of the Disney Dreamers and Doers, because of his courage in defying adversity and exerting a positive influence on the people around him. Aims High In the fall Brian plans to attend University of Central Florida in Orlando, where he will study aerospace engineering. His dream is to design spacecraft for NASA. "No matter what, you've got to keep positive," said Brian. "Don't let it [cancer] keep you from what you love to do, or let it change your life or your goals. Joy joined in, "Keep that outlook. You're going to beat this, no matter what." "You look at Brian and all he's going through, and he never ever complains about anything. He's my hero," said Joy. "I look at him and I see what he can do. He gives me strength."


Early Detection Can Save Lives

The American Cancer Society believes that early detection examinations and tests can help save lives and reduce suffering from cancers of the:

Breast Colon

Rectum Cervix

Prostate Testis (testicles)

Oral cavity (mouth) Skin


American Cancer Society’s Seven Warning Signs of Cancer

Change in bowel or bladder

habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or

elsewhere Indigestion or difficulty in

swallowing Obvious change in wart or mole Nagging cough or hoarseness

Source: American Cancer Society


Whatcha Going to Say? You have just completed your study of early detection in Healthful Living class. As you leave the class one of your classmates makes the statement in the left-hand column. What do you say back to correct his or her misconception? [Fill in the right-hand column with well-educated responses.]

Classmate’s Comment about Lesson

Your Response to Encourage Healthy Habits

“I’m too young to get cancer. I won’t need to practice self-examination until I’m in my 40s or 50s.”

“No way I’m going to do self-exam. That’s gross!”

“There’s no history of skin cancer in my family. I don’t need to check my moles.”

“I don’t have time and I don’t know how. Besides, my doctor will notice if something is really wrong.”

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