Mammography

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Mammography is a low-dose x-ray examination of the breast that is used to detect breast cancer in its early stages. It is the most effective screening tool for breast cancer, and it can reduce the risk of death from breast cancer by up to 40%.

In India, mammography is recommended for women aged 45 and above. However, women with a family history of breast cancer or other risk factors may be advised to start getting mammograms earlier.

Mammograms are available in most major cities in India. You can find a list of mammography centers in your area by searching online or by contacting your local hospital or clinic

The incidence of breast cancer in India is rising at an alarming rate. According to the World Health Organization (WHO), India is now the second most affected country in the world by breast cancer, after China. In 2020, an estimated 1.3 lakh women in India were diagnosed with breast cancer, and 70,000 died from the disease. The incidence rate is expected to increase to 2.2 million new cases by 2040.

There are a number of factors that have contributed to the rising incidence of breast cancer in India, including:

  • Women who have family history of breast cancer: Women who have a family history of breast cancer are at an increased risk of developing the disease themselves. The risk is highest for women who have a first-degree relative (mother, sister, or daughter) with breast cancer. Breast cancers are due to inherited genetic mutations. These mutations can be passed down from parent to child, and they can increase the risk of breast cancer by a significant amount.
  • Obesity: Obesity increases the risk of breast cancer.
  • Women who never breast fed: Women who never breastfed are at an increased risk of developing breast cancer. The risk is about 20% higher than women who have breastfed.
  • Women who never had child: Women who have never had children tend to have higher levels of circulating estrogen than women who have had children. The more menstrual cycles a woman has, the higher her risk of breast cancer. This is because each menstrual cycle exposes the breast tissue to estrogen and progesterone, which are hormones that can promote the growth of cancer cells.
  • Women working late hours: Women who worked night shifts had a 30% higher risk of breast cancer than women who worked day shifts.
  • Prolonged use of contractive pills: There is a slightly increased risk of breast cancer in women who use oral contraceptives (OCs) for prolonged periods of time.
  • The changing diet: The Indian diet is becoming more Westernized, with an increased intake of processed foods and red meat. These foods are high in saturated fat and cholesterol, which are known risk factors for breast cancer.
  • The growing population: The Indian population is growing rapidly, and with it the number of women who are at risk of developing breast cancer.
  • The lack of awareness about breast cancer: Many women in India are not aware of the symptoms of breast cancer, or they do not seek medical attention until the disease is in advanced stages.

The rising incidence of breast cancer in India is a major public health concern. There is an urgent need to raise awareness about the disease and to improve access to early detection and treatment services.

Here are some tips for reducing your risk of breast cancer:

  • Eat a healthy diet: Choose plenty of fruits, vegetables, and whole grains. Limit your intake of processed foods, red meat, and saturated fat.
  • Exercise regularly: Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
  • Maintain a healthy weight: If you are overweight or obese, losing even a small amount of weight can help reduce your risk of breast cancer.
  • Don’t smoke: Smoking increases your risk of breast cancer, as well as many other types of cancer.
  • Limit alcohol intake: Drinking too much alcohol increases your risk of breast cancer.
  • Get regular mammograms: Starting at age 45, women should get a mammogram every year.
  • Be aware of the symptoms of breast cancer: The most common symptoms of breast cancer are a lump in the breast, changes in the size, shape, or texture of the breast, dimpling of the skin, nipple discharge, and changes in the skin of the nipple or areola. If you notice any of these symptoms, see your doctor right away.

Breast Cancer Awareness

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Breast cancer is the most common type of cancer in women worldwide. According to a report of World Health Organization (WHO), there are about 162,500 new breast cancer registrations and 87,090 reported deaths in India in 2018. The number is quite alarming. But more scary statistics comes from Cancer India Society. For every 2 women newly diagnosed with breast cancer, one woman dies of it in India as per cancer statistics. One among 28 woman in India develops breast cancer. So there is immediate requirement to bring awareness about deadly breast cancer to Indians.

October is Breast Cancer Awareness Month every year. This year it begins on Friday, 1 October and ends on Sunday, 31 October. It is an annual international campaign to bring awareness about the impact of breast cancer, raise funds for research and lifesaving support. Many hospitals and organizations aim to promote and develop awareness in the public. They emphasize the importance of early detection for the treatment and prevention of deaths. Cancer awareness can also help people in changing to healthier lifestyles.

In 1992, it was Evelyn Lauder and Self magazine which introduced the pink ribbon as their official symbol for breast cancer awareness during Breast Cancer Awareness Month. They chose color pink to symbolize the virtuous and blameless aspects of breast cancer and the femininity the disease threatened. It stands for fear of breast cancer and hope for the future. It also represents the charitable people and businesses who publicly support the breast cancer awareness campaign. During this period, people all over the world show their support for everyone affected by breast cancer.

This is the first of a series of blog post in breast cancer awareness. I will be discussing the breast cancer symptoms, who is at risks, diagnosis and prevention of early death. What are the medical technologies available for testing so that people can gain easy access? What is holding back in Indians for lack of awareness or early detection?

With awareness of the different testing options, more people will gain access to screening, and fewer people will die from the disease. Breast cancer awareness can also help people to make healthier lifestyle choices

In 2018, the World Health Organization (WHO) estimated that breast cancer accounted for 15% of all cancer deaths in women. On the positive note, the enormous research and development happening in the field of breast cancer has brought a ray of hope in the treatment of the disease. The death rate can be reduced, if the cancer can be detected early.

Cancer starts when cells of our bodies begin to grow out of control in a short period of time. Cancers occurring in the breast tissues are referred to as Breast Cancer.
Breast cancer is an abnormal, uncontrollable growth of cells that originate from the breast tissue. The cancer cells typically form a tumor that can be seen on an x-ray or felt as a lump. Breast cancer occurs mostly in women, but a small percentage of men can get. Breast cancers can start from different parts of the breast like the ducts that carry milk to the nipple or in the glands that make milk. It can spread to other parts when the cancerous cells enter the blood stream or lymph system and get carried away.

Prevention of breast cancer is far away but there are risk factors which can help in reducing the chances of breast cancer. The risk factors for breast cancer may include

i) genetics and heredity: mutations of genes BRCA1 and BRCA2 can inhibit the body’s ability to safeguard and repair DNA. These genes can be passed on genetically to future generations, leading to a genetically-inherited increased risk of breast cancer. Women who has inherited such genes have higher risk.

ii) early start to menstruation before 11 years,

iii) no pregnancy or after 35 years of age,

iv) use of oral contraception,

v) late menopause after 55 years,

vi) lifestyle: excessive intake of alcohol, smoking, obesity, sedentary lifestyle, stress and poor dietary intake

vii) never breast fed or never had children

viii) a close relative who has had breast cancer or has a family history

ix) medical treatment: chemotherapy, radiation, or immunosuppressive drugs can also cause damage to healthy cells.

These are some of the factors that have been attributed to increase in the risk of breast cancer among the young women.

Breast cancer symptoms vary from person to another.

i) A painless lump in the breast or armpit is the most common and the first symptom of breast cancer.

ii) Skin changes: redness, skin thickening, skin nodules, like a flat or indented area of breast or feels like it is being pulled inwards

iii) Breast changes such as a difference in the size, shape, texture, or temperature of the breast

iv) Changes in nipple: feels like flat or pulled inward, dimpled, burns, itches or develops sores

v) Unusual discharge from nipple, it could be blood red, clear or any other colour.

However, some people do not have any signs or symptoms at all.

If there are any of these signs and symptoms of breast cancer, consult the breast cancer experts.

Early detection of breast cancer offers the best outcome for survival and quality of life after a person is devastated by getting to know about her illness. A doctor can help in providing to detailed risk assessment and genetic screening for women with family history of breast cancer.

Mammograms are X-rays of the breast that can detect cancer at a very early stage even before they are be felt or noticed. The X-rays capture black-and-white images of the breasts. These images are displayed on a computer screen and examined by a radiologist for signs of cancer.

The Magnetic Resonance Imaging (MRI) uses magnets and radio waves to create detailed 3D images of the breast tissue. Just before testing, patients are injected with an intravenous dye solution to distinguish cancerous tissue by colour. The contrast in the MRI image tends to be more concentrated in areas of cancer growth and can be detected by radiologists

Doctors may recommend ultrasound to identify fluid-filled cysts that are not cancerous. Ultrasound may be used for routine screening tests in some women who are at a higher risk of developing breast cancer.

Other methods such as Genetic Screening and Biomarker testing may be required for very risky persons with history of hereditary breast cancer. Counselling for patients with history of familial/hereditary breast cancer is also required.

The easiest way to breast cancer prevention is by doing a self-breast examination. This is highly recommended for women above 30 years of age.

A breast cancer self-examination is a way to check the breasts for changes such as lumps or thickenings by a woman. It is recommended that women be aware of their breasts and notice any changes, rather than performing checks on a regular schedule. Any unusual changes discovered during the breast self-examination should be reported to the expert doctor. It may be lumps in the breasts or armpits, any signs of fluid coming out of one or both nipples. Doctors will be able to correctly diagnosis when reported. Breast cancer experts believe that performing breast self-exam along with other screening methods can help in early detection. You can conveniently do breast self-exam free of cost on a regular basis and at any age.

According to According to the American Cancer Society, almost all women who were diagnosed with stage 1 of breast cancer have survived for more than 5 years. So are 93% of those diagnosed with stage 2, the survival rate decreased to 72% of those with stage 3, and 22% of those with stage 4.  With higher stages of cancer growth, the survival rate decreases and more than 50% of Indian women suffer from stage 3 and 4 of breast cancer. It is about 60% survival rate post breast cancer women in India, as compared to 80% in the U.S.

According to some research, there are cultural and religious issues regarding breast cancer awareness like women don’t access health services, are hesitant to consult male doctors, overlook their health due to household commitments and are over-dependent on other family members to seek medical help. All these factors lead to a delay in diagnosis.

In India, even when women are in responsible positions and earning for their families, it’s the men who are generally the head of the household. Even educated professional women do not discuss private matters about their health with the male members of their family. So the health messages of breast cancer should be directed towards men to increase their awareness which may help women open up their problems. Their understanding is essential to enable the female family members to access medical help at the earliest stage.

In India, the survival rates of breast cancer in India are low because the detection takes place late in the 3rd or 4th stage. By increasing awareness there are chances of increasing the survival rate. Please should know that breast cancer is a treatable disease and chances of survival are higher if it’s detected well in time.

Dr. Monica Mehrotra, MBBS, MD in Radiology is a renowned Radiologist in Kanpur. She is the founder and Director of Mehrotra Diagnostic located in Harsh Nagar, Kanpur, Uttar Pradesh. Dr. Monica Mehrotra is highly skilled and experienced in Digital X Ray, Mammography, HSG, and CT Scan. she can be reached at mehrotradiagnostics@gmail.com or www.mehrotradiagnostics.com