Saturday, November 8, 2014

Understanding Breast Cancer - The Sunday Tribune by Dr Pawan Gupta

The Sunday Tribune (Spectrum) - 26 October 2014 - National - Understanding breast cancer 

HEALTHUnderstanding breast cancerMost breast cancers can be detected by self-examination and save many lives
Dr Pawan Gupta
BREAST cancer is the most common cancer in women in India and accounts for 25 per cent to 31 per cent of all cancers in women in Indian cities. (Source: PBCR 2009 2011). According to Indian figures for 2012, around 144,937 women were newly detected with breast cancer and 70,218 women died of breast cancer. For every 2 women newly diagnosed with breast cancer, one woman is dying of it.
We are witnessing an age shift, and the average age of developing breast cancer has shifted from 50-70 years to 30-50 years; and cancers in the young tend to be more aggressive.
Breast cancer happen in men too. The number of cases is around 1 per cent.
In India 1 in 28 women will develop invasive breast cancer during their lifetime. As India becomes westernised, the incidence rate for breast cancer increases. A 2005 study conducted by the International Association of Cancer Research, Lyon, projected that there would be 2,50,000 cases of breast cancer in India by 2015, a 3 per cent increase per year. Currently, India reports roughly 1,00,000 new cases annually.
About 40 per cent of women will discover a breast lump at some point in their lives. Although a lump doesn't necessarily mean cancer, what women do immediately after that discovery can mean the difference between. It is important to see a doctor if you detect any lumps or other abnormalities in your breast.
A diet rich in vegetables, fruit, poultry, fish, and low-fat dairy products has been linked with a lower risk of breast cancer
A diet rich in vegetables, fruit, poultry, fish, and low-fat dairy products has been linked with a lower risk of breast cancer
Lumps and bumps are normal in every breast. You need to know 'what is normal' for you and be aware of changes. In India, approximately 40 per cent of breast cancers are first diagnosed at stage IV. In the USA, approximately 6 per cent of all cases are first diagnosed at stage IV.
Stage IV means the cancer has already spread from the breast to other organs such as the bones or lungs. While there is currently no cure for stage IV breast cancer, in many cases it can be manageable with treatment for many years.
Early detection can improve the prognosis for survival in most cases. With early detection not only survival improves but the woman can preserve her breast also and avoid chemotherapy too.
3 minutes, 3 fingers once in 30 days
Women should be familiar with the look and feel of their breast. Early detection is a woman's best protection. It just takes 3 minutes to examine each breast.
n 3 steps: Look, feel and check
n 3 fingers: Feel your breast with 3 fingers.
n 30 days: You need to check your breast only once a month.
Most breast cancers are detected by a woman herself. The 3 minute-3 finger campaign intends to empower every woman to practice self-breast awareness from the age of 20 onwards to notice any new abnormality in the breast which needs to be treated at the earliest.
Symptoms to look for
n Development of a lump or swelling.
n Skin irritation or dimpling.
n Nipple pain or retraction (turning inward).
n Redness or scaling of the nipple or breast skin.
Discharge from nipple other than breast milk (you may observe staining on your sheets or bra). Clear fluid is more concerning than bloody, green or blackish fluid.
Dilation of the pores in only one area of skin on the breast that may have an orange peel appearance.
At the onset of any of these changes, contact your doctor as soon as possible.
If you find even a small change, call your doctor. Remember, most of the time, these changes in the breast may not be cancer.
Your doctor may arrange for you to visit her/him first for a clinical breast exam or have you go directly for diagnostic evaluation in a breast-imaging facility prior to seeing you.
Risk factors
A woman is at an increased risk of breast cancer.
n As a woman ages, risk increases across all ages until approximately age of 80.
n If she has certain inherited genetic mutations for breast cancer (BRCA1 and/or BRCA2).
n If a woman has dense breast tissue as determined by a radiologist when reading her mammogram.
n Has two or more first-degree relatives (mother, sister, daughter, father or brother) diagnosed with breast cancer at an early age.
Minor factors
n Has had no biological children.
n Had her first child after age 30.
n Never breastfed a child.
n Reached menopause after age 55.
n Had her first period before age 12.
n Drinks more than one alcoholic beverage per day.
Gained significant weight after menopause.
Used menopausal hormone replacement therapy (HRT, in particular HRT containing both estrogen/progestin hormones) recently or for a long time to treat symptoms of menopause.
While you can't change many known risk factors for breast cancer (being female, one's age, family history, etc.), you can modify your lifestyle to reduce at least some of the risks, including:
n Postmenopausal obesity.
n Weight gain as an adult (especially in your forties and fifties).
n Use of hormone replacement therapy (HRT) containing both estrogen/progestin hormones.
n Maintaining a sedentary lifestyle.
n Cigarette smoking.
n Alcohol consumption.
Can breast cancer be prevented?
There is no sure way to prevent breast cancer. But there are things all women can do that might reduce their risk and help increase the odds that if cancer does occur, it is found at an early, more treatable stage.
You can lower your risk of breast cancer by changing those risk factors that can be changed. Body weight, physical activity, and diet have all been linked to breast cancer, so these might be areas where you can take action.
Both increased body weight and weight gain as an adult are linked with a higher risk of breast cancer after menopause. Alcohol, even low levels, also increases risk of breast cancer.
Many studies have shown that moderate to vigorous physical activity is linked with lower breast cancer risk.
A diet that is rich in vegetables, fruit, poultry, fish, and low-fat dairy products has also been linked with a lower risk of breast cancer. Most studies have not found that lowering fat intake has much of an effect on breast cancer risk.
It's not clear at this time if environmental chemicals that have estrogen-like properties (like those found in some plastic bottles or certain cosmetics and personal care products) increase breast cancer risk. If there is an increased risk, it is likely to be very small. Still, women who are concerned may choose to avoid products that contain these substances when possible.
— The writer is associate director, surgical oncology,
Jaypee Hospital, Noida
Some helpful tips
n Get regular, intentional physical activity.
n Reduce your lifetime weight gain by limiting your calories and getting regular physical activity.
n Avoid or limit your alcohol intake.
n Women who choose to breastfeed for at least several months may also get an added benefit of reducing their breast cancer risk.
n Not using hormone therapy after menopause can help you avoid raising your risk.
n After 40, get a mammogram done every year.

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