Hold close the knowledge

THE GROWING GLOOM

While breast cancer kills women more often than anything else and globally, over 5 lakh women succumb to it every year, it is also something that can be controlled if discovered in time.

Among Indians, breast cancers are more aggressive and they are discovered in advanced stages 8212; thanks to the low priority that women accord to their health in general and their inhibitions and embarrassment regarding a breast examination in particular.

Most women in India go to a doctor when breast cancer has reached an advanced stage and treatment options offer a dismal outlook. What few consider is that an early detection of the disease offers an 80 per cent chance of recovery.

Almost 56 per cent of our women come with large sized, Grade III cancers and in 42 per cent, it spreads to the armpit before women consult a doctor. Urban and rural India writes off more than 39,000 women 8212; within the 35-60 yrs age group 8212; every year to breast cancer.

That the United States, Belgium, Canada, Denmark and the United Kingdom lead the incidence charts in breast cancer and we fare better than even China, is no consolation. Particularly when we are showing a steep upward trend in the disease while the incidence of breast cancer in the West is on the decline. Worse, our patients are a decade younger than elsewhere 8212; 61 per cent of patients in India are within the 35-60 age group.

WHO8217;S AT RISK

8216;Know your enemy8217; is a logical first step for the just-initiated survivor.

Genetics and lifestyle cancer is an oft-quoted second name for this disease nowadays. For 15 per cent of breast cancers are hereditary and run in the family. It means an increased risk for women who have one or more than one first degree maternal mother, sister, daughter or aunt relative having encountered this disease.

Young women in this category can avail of BRCA1, BRCA2 gene testing to further elucidate their risk of actually suffering from this disease. A sample of blood dispatched to a laboratory equipped with FISH technology will predict or negate with 85 per cent accuracy the subsequent development of breast cancer.

There is also the 8216;Cancer family syndrome8217; 8212; a loose association of breast, ovarian, uterine, stomach and pancreatic cancer in a cluster of distantly related families.

Before anyone throws up their arms in helplessness, it should be remembered that 85 per cent of breast cancer arises sporadically, mostly due to factors well within human control. Hardly anyone these days have been prescribed radiation therapy in chest when they were children, to suffer from breast cancer later in life. The only exception is children suffering from indolent lymphatic system cancers.

Community practices and individual lifestyles are potent yet malleable factors.

Intracommunity or ethnic group attitudes to marriage, childbirth and inbreeding are held responsible for the highest breast cancer attack rates among Parsis, followed by Sindhis, Christians and Moslems in that order. Late childbirth 8212; after the age of 35 yrs 8212; and intracommunity wedlock, usually between cousins, amplifies the genetic risk manifold.

This is the Indian version of the story that leads to high rates of breast cancer in Ashknazi Jews in USA.

Changing lifestyle in metropolitan cities have brought in its wake a situation where girls begin menstruating at the age of 12 yrs on an average rather than 14 yrs, plan marriage not before 30 yrs and usually do not contemplate pregnancy before 30-35 yrs. Many become sexually active at an early age and are on long-term oral contraceptive use. Others become victims of unsupervised hormone replacement therapy.

Usage of estrogen-alone oral contraceptives continuously for more than 4 years and estrogen-alone hormone replacement therapy for over 10 years are scientifically proven offenders.

Normally, annual checkups, comprising Pap smear testing and Mammograms are a must, so the development of a cancer from induced pre-cancerous states can be inhibited in time by terminating hormonal medicine forthwith. Little reason why the bad female hormones 8212; estrone and 8-estradiol 8212; should not kick off carcinogenesis given enough time and a conducive environment.

Obesity, apart from being a disease in itself, predisposes women to breast and uterine cancer. So does alcohol, when consumed in excess of 3 to 7 drinks a week.

WHAT TO LOOK FOR

A simple three-pronged strategy comprising a monthly 8220;Breast Self Examination8221;, clinical examination every 3 years and mammography every year is extremely helpful.

Breast Self Examination is also an opportunity for the woman to get to know her body and become psychologically comfortable with it.

This should be undertaken by every woman after she turns 20. Feel the breast and the armpits once every month 8212; preferably a week after periods. Women who have attained menopause should do this once a month as well 8212; preferably on the same date.

Take your time, not less than 20 minutes in fact, and don8217;t leave out even an inch 8212; please remember, your life depends on it. What you are looking for is: A change in the size or shape of breast, nipple discharge or lumps in the breast. And remember, these are the signs of relatively advanced stage. So any subtle change deserves immediate reporting to a doctor.

Every woman above the age of 35 must undergo a breast examination by a doctor or a trained nurse practitioner once every three years. If one happens to be at a higher than normal risk by dint of factors mentioned earlier, this practice needs to be conducted annually.

The third cardinal life saver is a special type of X-Ray of the breast called mammography, which is known to discover a lump 2 years before it is big enough to be felt by touch.

Since mammography can detect 90 per cent of breast cancer in older women, it is advisable to have it once a year after the age of 35 yrs.

A word of caution! Subtle architectural distortions below the age of 35 yrs can play hide and seek with this modality. Breast ultrasound is the investigation of choice in this setting, if one is not to go wrong.

A little knowledge this is not and appropriate response is anticipated in the form of declining trends of breast cancer incidence and mortality in India.

The author is Senior Consultant, Oncology, at Indraprastha Apollo hospital, Delhi.

All statistics are courtesy IARC Lyons, WHO, 2002 international agency for research in cancer