Chemicals in shampoos may increase risk of breast cancer

Estrogen-mimicking chemicals called parabens, which are commonly found in an array of personal care products like shampoos, may be more dangerous than previously thought, according to a new study. The findings, published online October 27 in Environmental Health Perspectives, could have implications for the development of breast cancer and other diseases that are influenced by estrogens. The study also raises questions about current safety testing methods that may not predict the true potency of parabens and their effects on human health.

Parabens are a class of preservatives widely-used in consumer products like shampoos, cosmetics, body lotions, and sunscreens. The chemicals are considered estrogenic because they activate the same estrogen receptor as the natural hormone estradiol. Studies have linked exposure to estradiol and related estrogens with an increased risk of breast cancer, as well as reproductive problems. As a result, the use of parabens in consumer products increasingly has become a public health concern.

How much parabens might contribute to breast cancer risk is unclear. “Although parabens are known to mimic the growth effects of estrogens on breast cancer cells, some consider their effect too weak to cause harm,” says lead investigator Dale Leitman, a gynecologist and molecular biologist at University California, Berkeley. “But this might not be true when parabens are combined with other agents that regulate cell growth.”

However, existing chemical safety tests, which measure the effects of chemicals on human cells, look only at parabens in isolation and fail to take into account that parabens could interact with other types of signaling molecules in the cells to increase breast cancer risk. “Scientists and regulators are using potency estimates from these kinds of tests and are assuming they are relevant to what goes on in real life. But if you don’t design the right test, you can be off by a lot,” says co-author Ruthann Rudel, a toxicologist at Silent Spring Institute.

To better reflect what goes on in real life, the researchers looked at breast cancer cells expressing two types of receptors: estrogen receptors and HER2. Approximately 25 percent of breast cancers produce an abundance of HER2, or human epidermal growth factor receptor 2. HER2-positive tumors tend to grow and spread more aggressively than other types of breast cancer.

The researchers activated the HER2 receptors in breast cancer cells with a growth factor called heregulin that is naturally made in breast cells, while exposing the cells to parabens. Not only did the parabens trigger the estrogen receptors by turning on genes that caused the cells to proliferate, the effect was significant: The parabens in the HER2-activated cells were able to stimulate breast cancer cell growth at concentrations 100 times lower than in cells that were deprived of heregulin.

The study demonstrates that parabens may be more potent at lower doses than previous studies have suggested, which may spur scientists and regulators to rethink the potential impacts of parabens on the development of breast cancer, particularly on HER2 and estrogen receptor positive breast cells.

Since people come into contact with multiple chemicals every day through consumer products, understanding how mixtures of hormone-mimicking chemicals and growth factors interact to promote cell growth might better reflect a person’s potential cancer risk from exposure. In particular, one area of increasing concern is how exposure to multiple chemicals during critical periods of development including puberty and pregnancy increases a person’s susceptibility to breast cancer later in life.

This brings us to the all important question: Do we stop using products like shampoos, sun-screen? 

Few points:

1. Paraben free products are freely available in the market. Though a bit expensive, they are a good alternate to products which contain these harmful products
2. Authorities should lay down more stringent guidelines to detect these harmful chemicals in daily use products and determine the minimum tolerable dose of these chemicals in these products
3. More studies should be carried out to assess the role of parabens in the development of breast cancer 

Breast Cancer Awareness Drive

During my training in America, doctors there used to ask me “Why doesn’t India have a Breast Cancer Screening Program?”
Well today, I can proudly say that we are working towards it. You always have to take small steps to fulfill big dreams and that is what we did yesterday by launching the W Pratiksha Hospital Cancer Awareness Drive.
I was happy to see the media supporting the project and giving it the importance it deserves.
We are going to having regular camps in the surrounding villages for the next six months and anyone who would like to volunteer is most welcome.

It was heartening to see one of my treated patients (a breast cancer conqueror) being felicitated during the event. She shared her thoughts with the media as well and told them about the importance of early detection and management.

Twitter chat on Stigma associated with Breast Cancer In India

We are starting a series of twitter chats, which will focus on the issues faced by breast cancer patients and survivors in India. This is a first of its kind initiative, which will highlight the ‘Indian scenario.’ This chat is going to be hosted by @realtalkies on twitter.

The details of the chat are mentioned in the images. Feel free to join in and contribute in this important discussion.
Follow me during this chat on Twitter: @docrohan

I will be discussing some the issues raised by me in the blog post – “Is cancer diagnosis a social death sentence in India”

Details of #BCIndia Twitter chat

AIIMS study reveals a link between OCP’s and Breast Cancer

The use of oral contraceptive pills (OCP’s) especially emergency contraceptive pills (morning after pills) is increasing rapidly among young women and this might be one of the factors responsible for the rise in the incidence of Breast Cancer in our country. Many studies conducted on this issue have failed to indicate a clear link between OCP’s and breast cancer. However, a recent study conducted by AIIMS, which was published in Indian Journal of Cancer has revealed a higher chance of breast cancer among regular users of OCP’s.

According to the study, breast cancer risk was found to be 9.5 times more in women with a history of consuming such pills regularly. The study included 640 women, out of which 320 were breast cancer patients. 11.9% breast cancer patients in the study had a history of using long term OCP’s as compared to 1.2% healthy individuals.

It is a well known fact that breast cancer is a hormone dependent cancer (mainly dependent of on estrogen) and the regular use of OCP’s leads to a disturbance in the normal hormonal status. Morning after pills (emergency contraceptive pills), which contain a higher dose of estrogen lead to a sudden surge in the levels of these hormones and are thought to be more harmful. The problem is that these pills are being consumed on a daily basis by many youngsters. The users of morning after pills were not included in this study.

Women should realize the importance of this study and more awareness needs to be created among young women regarding excessive use of emergency contraceptives. At the same point, more studies (prospective trials) are required on this issue to firmly establish a link between OCP’s and breast cancer.

 

Source: http://timesofindia.indiatimes.com/city/delhi/The-pill-can-kill-AIIMS-study/articleshow/28251469.cms

 

IT city (Bangalore) is also India’s Breast Cancer Capital

Bangalore is India’s breast cancer capital – Dr. Anita Khokhar’s Blog

Bangalore now has the dubious distinction of being India’s Breast Cancer Capital. In a recently concluded population based study, the IT city has registered the highest incidence of Breast Cancer cases in the country (36.6 new cases for every one lakh population). (Source: PBCR data)

This data compiled from 11 cities across India revealed Thiruvananthapuram to have the second highest incidence of Breast Cancer at 35.1 followed by Chennai (32.6) and Nagpur (32.5).

Although the study has revealed these numbers, the actual incidence of Breast Cancer in these cities is much higher. This is due to the fact that many cases go un-reported.

The reasons for such a high incidence of breast cancer in Bangalore are quite obvious:

• Increased incidence of smoking and alcohol consumption among women
• Early menarche (age at which menstrual periods start) due to obesity and Western lifestyle habits
• Late marriages and children
• Lack of breastfeeding
• Increased use of estrogen based contraceptives
• Late menopause and the use of hormone replacement therapy following menopause

All these factors are known risk factors for breast cancer and are quite prevalent in Bangalore.

This study should serve as an eye opener for women not only in Bangalore but also other metropolitan cities of the country.

 

Breast cancer cases in India to double by 2030

Currently, one in 23 Indian women develop breast cancer, but a recently concluded study states that the numbers are going to double by 2030 –Breast cancer cases to double by 2030: Study – Times Of India.

India is on the brink of a breast cancer epidemic and the question is that is it really prepared to handle this epidemic?

This study highlights some important facts:

1. 115,000 new cases of breast cancer are diagnosed each year and this number will double by 2030.
2. Indian breast cancer presents a decade earlier than the Western world. This means Indian women in their thirties and forties will bear the brunt of this epidemic. As screening mammograms are not very useful in this age group, it cannot be used as an effective screening modality.
3. Increasing longevity and lifestyle changes have been attributed to this sudden rise in the number of breast cancer cases.

There are some more shocking facts about Breast Cancer in India, which have been highlighted by other studies.

1. Lack of awareness about this disease compounded by the lack of screening guidelines in the country, leads to majority of the patients presenting with locally advanced breast cancer. A study which I published in the Journal of Royal Society of Medicine, couple of years back, highlights this problem – Patient and provider delays in breast cancer patients attending a tertiary care centre: a prospective study.
   
2. The above mentioned study also highlights the lack of preparedness of the medical system to tackle with this epidemic. There are very few centres in India, which are providing dedicated Breast Cancer Services. These facts should trigger a positive change in the medical system and more emphasis should be paid to develop dedicated breast cancer units across the country.

As it is extremely difficult to develop screening guidelines for breast cancer in our country, I feel increasing awareness about this disease is the first thing which we should focus on, in addition to developing a more comprehensive breast cancer service in our country.

Male Breast Cancer

Although breast cancer is predominantly a female disease, males are not immune to this cancer. Male breast cancer comprises 1% of all breast cancer diagnosis.

Risk factors for Male Breast Cancer:

1. Age: The risk increases with increasing age and male breast cancer usually presents in the 6th or the 7th decade of life
2. Family history of breast cancer/ Inherited gene mutations: The chances of male breast cancer are higher in people with BRCA 2 mutation and a positive family history of breast cancer
3. Alcohol
4. Klinefelter’s syndrome: Men with Klinefelter syndrome have small testicles (smaller than usual). Often, they are unable to produce functioning sperm cells, making them infertile. Compared with other men, they have lower levels of androgens (male hormones) and more estrogens (female hormones). For this reason, they often develop gynecomastia (benign enlargement of the male breast), which is also a differential diagnosis of male breast cancer.Patients with this syndrome have a higher incidence of Male Breast Cancer.
5. Radiation exposure
6. Exposure to estrogen: Excessive exposure to estrogen increases the chances of male breast cancer.
7. Liver disease
8. Obestiy
9. Testicular problems: Undescended testis, mumps and Klinefelter’s syndrome increases the chances of male breast cancer.

A common differential diagnosis of Male Breast Cancer is Gynecomastia (benign enlargement of the male breast). Gynecomastia usually results from an imbalance between androgen and estrogen production. This is commonly seen in adolescents or in elderly patients because testosterone levels increase during puberty and decrease with age. Besides these causes, many drugs—including steroids, antidepressants, diuretics, and antihypertensive medications—have also been implicated in the development of gynecomastia, although as many as 50% of cases have no known identifiable cause.

Certain risk factors are common to both gynecomastia and carcinoma: breast irradiation, mumps orchitis, and bilateral cryptorchidism (undescended testis), Klinefelter’s syndrome.

Male Breast Cancer

Gynecomastia

Symptoms:

Lack of awareness is the major cause which prevents early diagnosis of this condition in males. Following are the danger signs, which can point towards a male breast cancer:

If you notice any persistent changes to your breasts, you should contact your doctor. Here are some signs to watch for:

• a lump in the breast
• nipple pain
• an inverted nipple
• nipple discharge (clear or bloody)
• enlarged lymph nodes under the arm

Diagnosis: 

Diagnosis of male breast cancer is achieved on the same lines as female breast cancer. Patient is usually subjected to an imaging test followed by histo-pathological confirmation of the diagnosis.

Some patients also require extensive work-up to rule out metastasis to other parts of the body.

Management & Prognosis:

Management of male breast cancer is similar to female breast cancer.

By virtue of the proximity between most male breast cancers and the skin and chest wall, extension to or invasion of these structures is more commonly observed than in women but the prognosis of male breast cancer remains the same as female breast cancer.

For more information regarding the management of this condition, click here

Our Breast Cancer Counsellor – The Pink Crusader

Our Pink Crusader

Her true name is Mrs. Meera Raj, an English professor (ma’am – please forgive me for any grammatical errors 😉 ), breast cancer survivor and more importantly, a Breast Cancer Counsellor.

Her battle with cancer started 3 years back, when she was detected with breast cancer. She noticed a lump in her breast and got it evaluated from a surgeon, who confirmed her worst fears after conducting a biopsy. All of a sudden, her perfect life was jolted by this diagnosis and she was clueless about what the future had in store for her. After the initial shock, she came to terms with her diagnosis and outlined a plan for the future.

During her treatment, she felt the need for a person whom she could share her fears and apprehensions with but at that time she had no one to counsel her except her oncologist. Following her treatment, she took it as a challenge to help others suffering from Breast Cancer. She quit her job and did a course in Cancer Counselling in an effort to make a difference in the lives of others. Ever since that, she has not looked back. She joined the Department of Breast Oncology at Mazumdar Shaw Cancer Center as a Breast Counsellor and has been helping out patients suffering from this dreaded disease.

Her routine starts with interacting with the OPD and in-patients and telling them more about the disease and what to expect in the future. She shares her experience with them and that gives the patients strength to prepare for the battle ahead. She routinely visits the chemotherapy ward to give pep talk to the patients undergoing chemotherapy and also runs a Breast Cancer support group, which is growing day by day.

At Workin

We had carried out a study at Safdarjang Hospital on “The correlation of anxiety and depression levels with response to neoadjuvant chemotherapy in patients with breast cancer”, which was published in a reputed scientific journal and we had concluded that counselling and family support plays an important role in alleviating the anxiety & depression associated with cancer diagnosis in these patients. After joining the Breast Cancer Unit at Mazumdar Shaw Cancer Center and observing Meera ma’am dealing with the patients, I have come to the conclusion that it makes a huge difference in the patients attitude towards the disease if proper counselling is carried out. Breast counsellors (or Navigators) are a routine part of a Breast Unit in USA and UK but this is relatively new trend in India and only a couple of Breast Units in India currently have dedicated Breast Cancer Counsellors.

Mrs. Meera is an inspiration not only for the patients but also for all the doctors in the Breast Unit. Her enthusiasm towards the patients and her job pushes us further each day to help patients suffering from breast cancer. She is truly a “Pink Crusader.”

 

Is Cancer Diagnosis a Social Death Sentence in India?

Being a cancer surgeon it really hurts me when I see patients suffering from cancer but it hurts me even more, when the people around them desert them during their time of need. Instead of only fighting the cancer growing within them, they also end up fighting the “social cancer”.

Consider these scenarios:

• Being a breast surgeon, I have seen many breast cancer patients having marital problems after being diagnosed with cancer. Their husbands leave them because of financial reasons and due to their physical appearance after cancer treatment.

• One patient was made a social outcast in her own home and was not allowed to sleep and eat with her children and other family members because they thought that cancer was a communicable disease.

• I know of a distant relative, who was diagnosed with leukemia when he was very young. He was completely cured with chemotherapy but then had a tough time finding a suitable match. Every time he revealed his story to the girl’s family, they rejected him immediately. One family even got all his reports verified from multiple experts, who were of the opinion that the cancer was treated, but still the family rejected him. Although he was able to win the battle against cancer but could not fight the social cancer and landed up with depression.

These problems arise because of the lack of awareness about cancer in our country. With the incidence of communicable diseases reducing in our country, cancer is going to become the next epidemic. If the same social stigma continues to haunt these patients, their lives would become miserable.

Some months back I saw a matrimonial column specifically for patients with AIDS (for which no cure is present). If the society can accept AIDS, then why not have a separate matrimonial column for cancer survivors, a disease which is curable, if diagnosed early.

A cancer patient does not need sympathy but needs support, not only from the immediate family members but also the society. Let us help create awareness about cancer and also educate relatives of cancer survivors about their disease and their needs.

Cancer awareness is the only chemotherapy against this social stigma.

Multifocal vs. Multicentric Breast Cancer

Multifocal breast cancer is defined as the presence of two or more tumor foci within a single quadrant of the breast or tumor foci within 5 cms of each other.

Multicentric breast cancer is defined as the presence of two or more tumor foci within different quadrants of the same breast or tumor foci separated by more than 5 cms.

With the advent of better imaging modalities, these tumors are being detected more frequently and it is important to understand their impact on the surgical management.

Patients with multifocal breast cancer are eligible for breast conservation surgery (BCS; provided no other contraindications for this procedure are present) whereas BCS is avoided in patients with multicentric tumors. 

Another point of interest to both the patients and the doctors is that the diagnosis of a multicentric or a multifocal tumor does not affect the overall survival of the patient.