HEALTHWATCH
Prevent breast cancer
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October is Breast Cancer Awareness Month and, rather than using mammography alone as a preventive measure, campaigns are needed to foster and protect breast health, writes Dr. UMA KRISHNASWAMY.
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AFP
Creating awareness about breast cancer in October.
IN 1993, President Clinton named October as Breast Cancer Awareness Month and the third Friday in October as National Mammography Day in the U.S.
The rest of the world was quick to adopt this new American tradition. India too is no exception to this.
Rising incidence
There is a rising incidence of breast cancer in India. According to The International Agency for Research on Cancer, which is part of the World Health Organisation, there were approximately 79,000 women per year affected by breast cancer in India in 2001 and over 80,000 women in 2002.
But, there are no comprehensive national, regional or local level statistics about the incidence of breast cancer in Indian women. The figures in this article are from the National Cancer Registry.
October is now the month of strident commercial voices in the healthcare sector advocating free or cut price mammography with self-styled experts generating what amounts to "breast cancer phobia". Can a mammogram done as a knee jerk reaction to media hype and publicity prevent breast cancer?
While extremely useful as a diagnostic and a secondary level preventive tool, the mammogram is not perfect, with an average sensitivity of 80 per cent.
Even in large-scale quality controlled programmes, screening mammograms miss approximately 20 per cent of breast cancers present at the time of screening (false negatives). The National Cancer Institute, the US., estimates that a negative screening mammogram misses 1 in 5 cancers. One must also note that the vast majority of abnormal tests (false positives) are not cancers. Women with abnormal results must have additional evaluation procedures to determine whether or not the mammographic finding is a cancer. Since many women have false positive tests, psychological distress is a real problem even if subsequent tests rule out cancer.
Preventive factors
In the justifiable fear about cancer, it is forgotten that the vast majority of breast problems are not cancers. Over 75 per cent of lumps are benign. Thus, rather than campaigning for mammography alone as a preventive measure, breast health campaigns are needed throughout the year, around the world, to foster breast health and consequent protection against cancer.
What habits do women need to cultivate to ensure breast health? To prevent a disease, one needs to mitigate the risk factors that may lead to breast disease and breast cancer.
The mere presence of risk factors is not synonymous with the occurrence of breast cancer nor can all risk factors for breast cancer be mitigated or modified. The following universal suggestions may be made for all Indian women:
A diet low in fat and rich in vitamins, minerals and antioxidants (through fresh fruits and vegetables).
Regular exercise and weight reduction.
Alcohol consumption must be avoided or minimised.
Avoid use of tobacco. While tobacco does not lead directly to breast cancer, it can lead to certain benign breast diseases.
Oral contraceptive pills and Hormone Replacement Treatment must be undertaken under the close supervision of a health care provider.
Self-breast examination must be practiced monthly from teenage onwards by all women.
Clinical breast examination may be undertaken annually with one's health care provider.
In women who are at higher risk, one's doctor may advocate mammographic surveillance usually from age 35 onwards. Currently screening mammography is not advocated for all Indian women.
In women with a significant family history of breast cancer, a specialist surgeon may need to be consulted for statistical assessment of one's individual breast cancer risk or for undertaking genetic testing.
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Facts and figures in India
BREAST cancer is the second most common cancer in Indian women. The incidence is more in urban than rural women. It is more prevalent in the higher socio-economic groups. Women of the Parsi community face a higher risk. The average incidence rate varies from 22-28 per 100,000 women per year in urban settings to 6 per 100,000 women per year in rural areas.
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