Cancer. The word is derived from “crab” and conjures up visions of multiple tentacles insidiously spreading all over the body. Unfortunately, the vision includes undiagnosed, undetected, untreated versions of the dreaded disease.
Women in India are prone to cervical (lower end of the uterus) and breast cancer. A vaccine (HPV or human papillovirus vaccine) was recently introduced to reduce the incidence of cancer of the cervix. However, there is no vaccine to prevent breast cancer. One in 22 women in India are projected to be diagnosed with breast cancer in the course of their lifetime. The incidence varies from eight per 1,00,000 women in rural India to 27 per 1,00,000 women in urban areas. Breast cancer is not a disease confined to women; in rare occasions, it can occur in men too.
Lumps in the breast can be felt when they are pea sized. The tissue feels different, and is firmer and harder than in the surrounding areas. Later the skin over the lump may be discoloured or thickened (resembling an orange peel). Also, there may be retraction (pulling inward) of the nipple.
Many lumps are harmless non-cancerous fibroadenomas. Others are not real lumps but nodular breasts reflecting the hormonal changes that occur during the course of a normal menstrual cycle. All lumps, however, must be taken seriously and evaluated as soon as they appear.
Evaluation of a breast lump is usually done with a mammogram or an ultrasound examination. Once the position has been accurately localised, the lump is aspirated with a fine needle. Cells obtained during the procedure are used to diagnose the nature of the lump. Depending on the diagnosis, the breast is operated. This is followed by chemotherapy, radiotherapy, hormone therapy and immunotherapy.
Breast cancer can occur at any age, though it is less common under the age of 25 years. The exact mechanism which sets in motion the changes responsible for breast cancer is not known. Certain environmental and genetic factors are associated with an increased risk of breast cancer.
• Long years of menstruation with early menarche (less than 12) and late menopause (over 55)
• Delayed childbirth
• Failure to breast-feed children
• Breast or ovarian cancer in first degree relatives
• Smoking and drinking alcohol
• Cancer elsewhere and exposure to radiation
• Post menopausal hormone replacement therapy for more than four years.
In developed countries, the majority of cases is discovered by routine screening, even before a lump is palpable. In India, by the time the patient arrives for an evaluation, the cancer has usually spread locally. This is unfortunate as a 20-year survival is found in 90 per cent of patients if the tumour diameter is less than 1cm. Early detection and diagnosis are therefore of paramount importance.
One of the most useful tools for early detection is breast self examination. It is simple, easy and sensitive. It can be done in five steps, preferably on the same day every month. This is to negate any changes in consistency because of hormonal effects.
Step 1: Begin by looking at your breasts in the mirror, uncovered, with your shoulders straight and arms on your hips. Check that the breasts are their usual size, shape and colour. There should be no visible distortion or swelling. The danger signs are dimpling, puckering, bulging of the skin, redness, soreness, rash or swelling, or a nipple that has changed position.
Step 2: Look for the same changes with raised arms.
Step 3: Gently squeeze each nipple between your finger and thumb and check for nipple discharge.
Step 4: Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few fingers of your hand, keeping the fingers flat and together. Cover the entire breast from top to bottom, side to side from the armpit to the cleavage. Follow a pattern to be sure that you cover the whole breast.
5. Begin examining each area with a very soft touch, and then increase pressure so that you can feel the deeper tissue, down to your ribcage.
Step 5: Finally, feel your breasts while you are standing or sitting.:-
Mammograms can detect tumours before they are felt with the hand. After the age of 45 years, they should ideally be done every two years. In case of any abnormality, see a competent surgeon immediately. The process may be expensive, but is well worth the cost.
A few lifestyle changes can reduce your risk of developing breast cancer.
• Maintain a BMI (weight in kg / height in metre squared) of around 23
• Reduce the intake of fat
• Eat five helpings of fruits or vegetables a day
• Regular exercise (jogging, cycling swimming, running) for 45 minutes at least four times a week has a positive effect on the immune system.
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Source: The Telegraph (Kolkata, India)
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