W-Pratiksha Hospital had launched a Women’s Cancer Prevention Drive in October, in which they had pledged to screen 1000 ladies for Breast & Cervical cancer free of cost. In addition, regular camps and health talks were planned over a period of 6 months.
The latest health talk was organized at W Pratiksha Hospital and it featured talks on Breast & Cervical Cancer. Women of all age groups attended the talk in huge numbers. I had the privilege of talking about Breast Cancer and the reasons why India is seeing a boom in the incidence of this cancer. This was followed by a lively question and answer session, in which ladies addressed their concerns about Breast Cancer and their apprehensions to get screened.
Similar talks are going to be organized at regular intervals at the hospital and in nearby schools & colleges.
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.
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:
- 115,000 new cases of breast cancer are diagnosed each year and this number will double by 2030.
- 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.
- 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.
- 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.
- 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.
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:
- Age: The risk increases with increasing age and male breast cancer usually presents in the 6th or the 7th decade of life
- 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
- 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.
- Radiation exposure
- Exposure to estrogen: Excessive exposure to estrogen increases the chances of male breast cancer.
- Liver disease
- 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
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 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
“Sometimes your joy is the source of your smile, but sometimes your smile can be the source of your joy.” – Thich Nhat Hanh
I clicked this picture during my visit to a resort. It was fascinating to capture the water sprinkler spreading drops of water (joy for the grass and plants) all over the place.
As a Breast Cancer Surgeon, I have realised that we might not be able to treat a patient’s problem always but a simple smile and some words of encouragement can go a long way in helping the patient tackle her problems.
Spreading Joy by Counselling Cancer Patients
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.
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.”
Thanks to public health messages, everyone pretty much knows that breastfeeding is beneficial for baby. But it also benefits the mother in more than one way. Somebody has rightly said that “Breastfeeding is nature’s health plan.” One of the benefits of breastfeeding to the mother is the reduction in the risk of breast cancer.
The major study that supports breastfeeding as a protective factor against breast cancer was published in Lancet in 2002. The study authors found that the rate of breast cancer diagnoses was slightly lower among women who had breastfed and among women who had breastfed for longer periods of time.
For every 12 months of breastfeeding (either with only 1 child, or as the total period of time for several children), the risk of breast cancer decreased by 4.3%, compared to women who did not breastfeed. Risk decreased by a further 3.4% for each child breastfed, compared to women who did not breastfeed.
Although a 4% lowering of risk does not sound much but with the increasing incidence of breast cancer, if new mothers adhere to the recommended guidelines of breastfeeding their children for one year, they could theoretically prevent up to 5000 cases of breast cancer each year.
In India, where breast cancer incidence is on the rise (especially in the urban areas), breastfeeding could have a greater impact in prevention of breast cancer. Currently, WHO is celebrating the World Breastfeeding Week and educating mothers about the advantages of breastfeeding, not only to the children but to the mothers as well and all of us should make an effort to spread this word around.
Prevention is better than cure!!