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Breast cancer awareness

Disease Awareness

October 28th, 2016 - 0 Comments

The Breast Cancer Awareness Month, marked in countries across the world every October, increases attention and support, contributing to early detection and treatment as well as palliative care for the disease. There are about 1.38 million new cases and 458,000 deaths from breast cancer each year, making it by far the most common cancer in women worldwide.

At phamax, as an Initiative to support for Pink October, the team wore pink to work. Apart from this, we engaged with a cancer survivor, a leading medical oncologist and a caregiver to bring out their perspectives on breast cancer.

“I’m gonna kill you and eradicate you. I will be tough with you.”

Malavika Harita, CEO of advertizing and communications company Saatchi & Saatchi Focus, went for her regular check-up when lumps were discovered in her breasts. What followed was a harrowing and an overwhelming experience.

On April 2015, breast cancer came to Malavika like a sudden jolt, almost threatening to change everything she held dear to her. After each test, where she hoped that the outcome would be negative, things didn’t turn out the way she planned. What kept her going were her son and cousin, who are doctors themselves, her doctor who kept reassuring her that all was not lost, many people whose livelihood was dependent on her, and the organization that she was heading. Without their support overcoming cancer would have been an unbelievable feat.

When she was diagnosed with HER2 +ve, second stage of cancer with nineteen affected lymph nodes, it took her one year to recover from that. She underwent two surgeries, sixteen chemo sessions and thirty seven dots of radiation with ten injections after every chemo. There was no sign of swelling in her arms and in addition to that her breast was also intact during the surgery. She was under very costly medication.

But she was determined unlike most cancer patients. She wanted to fight cancer with great confidence. She says, “I made it very clear to my son that only if I like the doctor will I get treated. Chemistry with the doctor is very important. Only that can lead to trust.” During her checkups, she asked her doctors what to expect during treatment. Her doctors answered all her questions but recommended to not ‘google it’. She headed a health care agency and so understood that the internet was misleading and incorrect sometimes.

She was an asymptomatic patient, but her level of awareness was higher than the rest suffering from the same disease as she has participated in many awareness campaigns in her health agency. Once she was diagnosed, she read more about it and spoke to two of her friends who are also survivors.

During the first few weeks she tried putting all her financial assets and work in place to keep her mind away from her predicament. The constant support from her son and cousin kept her fighting.

The worst part about cancer is the ignorance and fear which patients live with, making their life unbearable. Patients do not realize that cancer is curable, if detected early. Often, relatives make the condition worse by not communicating effectively. Malavika was a very strong woman and she did not see the treatment as a problem. Rather, she was skeptical about the aggression associated with the treatment.

She revealed that if patients are aware about their upcoming treatment, the fear of the unknown will not be there anymore. Malavika shared the mental turmoil inside her as a patient. She says, “When you are a patient you need to think about yourself all the time.” This is not easy for one who is not a self-centered person. Only women can understand the pain of other women, and Malavika is very thankful to her nurse who was always beside her when she underwent her chemo and dressing.

Malavika, being a strong woman, regularly went to her office except when she visited the hospital for chemo. She went back to her normal work life as soon as her chemo sessions got over. She lost all her hair by the second chemo, yet she was never ashamed for her shaven head. Looking at it optimistically, she turned it into a style statement with colorful caps!

She never changed her doctor. She trusted her doctor and followed his instructions with discipline. The doctor assigned a chemo team for her and continuously reassured her.  Malavika was advised to control her diet and weight but was not allowed to go out of her house for a walk. So she walked inside the confines of her house and changed her diet to keep her weight under control.

The total treatment cost was INR 1.5 million, but she was reimbursed as she was covered by insurance. She was treated in HCG Bio by Dr. Gopinath.

Malavika is still a little apprehensive. She doesn’t want to go through it again. Nevertheless, she added: if ever diagnosed again, she will be very tough and will battle the disease. She never calls herself a victim – she is a survivor instead.  Currently Malavika is helping people by giving tips, sharing her personal experience and asking them to trust their doctor.

The awareness on breast cancer in India is increasing, yet, it is going to take time. Still there is a lack of information available online. The right support and care are imperative in cancer, especially breast cancer. Trust your doctor and have a plan. Battling a disease like cancer needs a lot of preparation. It is also important to find survivors who are willing to share their experience and guide you through the initial treatment phase, which is the toughest part of the battle.

The critical part of the fight against breast cancer is being aware.

Dr Poonam Patil, a leading Consultant Oncologist is sharing the following advice on self examination and getting screened.

Breast cancer awareness and screening

Women in general are now encouraged to be more aware of how their breasts normally look and feel. So, it becomes easier to spot any suspicious changes. Identifying a change early gives the best chance of effective treatment if a cancer is diagnosed. Screening is looking for cancer before a person has any symptoms, hence it is done by women who do not have any symptoms.

Most breast lumps are benign (not cancerous). If a persistent lump in breast or any changes in breast tissue is discovered, it is very important to see a physician immediately. Many times, fear keeps women from relevant health care. Sometimes women stay away from medical care because they fear what they might find. Take charge of your own health by monthly self-exams, regular visits to the doctor, and regularly scheduled mammograms.

Essential to all this is first understanding your normal breast structure. Hence, detecting abnormalities yourself would be easier.

Understanding your breast

The breast is made up of a mass of fatty connective tissue resting on the major chest muscle, and surrounded by skin [which includes the nipple]. The breast has milk lobules which make breast milk for nursing mothers, and milk ducts which carry the milk to the nipple.  Interspersed are blood vessels and lymph vessels.  Lymph vessels lead to small bean shaped lymph nodes, clusters of which are found in the armpit, chest and above collar bone.

Most breast cancers form from rapid and uncontrolled growth of either duct cells or lobular cells. When cancer spreads away from the breast, it is frequently to these nodes, and through the blood into other parts of the body.

Male breasts contain much less fatty tissue than female breasts but are structured similarly and can still be affected by breast cancer.

 

Physical examination

The list below shows changes suggestive of breast cancer:

  • Lump or thickening –feels different from the rest of the breast tissue
  • Change in shape or size – one breast may have become noticeably larger or lower
  • Nipple change –becomes inverted [pulled in] or change its position or shape
  • Rash – on or around the nipple
  • Discharge – from one or both nipples
  • Puckering or dimpling – breast or around nipple
  • Swelling, redness or warmth for some time – of the lymph nodes under your armpit or around your collarbone
  • Constant pain – in one part of your breast or in your armpit

Once a lump or other suspicious change is discovered, an urgent appointment should be requested with your doctor. A thorough physical examination is usually the first step before any other tests are performed.

 

The following points act as a guide to breast awareness:

  • Become familiar with the normal appearance of your breasts
  • Know what changes to look and feel for
  • Self-examine regularly
  • Report any changes to your doctor without delay
  • Always attend routine breast screening when requested

Risk factors identified in breast cancer are:

  • Age: chance of developing breast cancer increases with age.
  • A personal history of breast cancer: if you have had breast cancer in one breast, you have an increased risk of developing cancer in the other breast
  • Family history: an immediate relative such as mother, sister or daughter with breast or ovarian cancer or both, especially if they were diagnosed at a younger age/ before menopause, or a male relative with breast cancer, carries a greater chance for a woman of developing breast cancer
  • Genetic predisposition: between 5 percent and 10 percent of breast cancers are inherited. Defects in one of several genes, especially BRCA1 or BRCA2, increase risk of developing breast, ovarian and colon cancers
  • Radiation exposure: exposure to radiation treatments to the chest during childhood or adolescence increases risk of developing breast cancer later in life
  • Excess weight: obesity increases risk of breast cancer
  • Early onset of menstrual cycles: early menarche, especially before age 12, carries a greater risk of developing breast cancer
  • Late menopause: menopause after age 55, increases likelihood of breast cancer
  • First pregnancy at older age: first full-term pregnancy occurring after age 30, or never becoming pregnant increases chance of developing breast cancer
  • Hormone therapy: treating menopausal symptoms with the hormone combination of estrogen and progesterone hormones for four or more years increases your risk of breast cancer. In addition, use of birth control pills which are also hormonal in nature, also increases the risk
  • Smoking: there are clear health benefits – other than minimizing breast cancer risk – to quitting smoking and limiting exposure to second hand smoke
  • Precancerous breast changes (atypical hyperplasia, lobular carcinoma in situ): a prior breast lesion biopsy revealing precancerous changes increases subsequent risk of cancer development

The tools for screening breast cancer are:

  • Breast self-examination
  • Clinical breast examination (done by a physician)
  • Imaging -Mammography; Magnetic Resonance Imaging (MRI)of breast may be required in some cases

Breast self-examination: it is a very vital check in our country as women do not go for regular health checks.  However, awareness on breast health and self-check can help them detect a problem and take corrective measures early. This should be done in the first week after menstrual periods.  In pregnant women and post-menopausal women, it should be around the same time every month.  If any abnormality is noted, immediately see a doctor.  There may be many benign causes which would be picked up, but let the doctor decide if it requires further tests or not.

 

Preferably, see a doctor before going for a mammogram, and then show them the results.

As Dr Poonam Patil puts it, it is vital to be breast aware. And if there are any changes from normal or in case of doubt, it is better to consult a doctor.

Moving on, we have heard from a survivor and an expert. The vital component in the battle against cancer for the patient is the caregiver or the family. As this is the time when the caregiver will need to support the patient morally, physically, emotionally, socially and sometimes financially as well.

Breast Cancer and Comorbidities

Sakshi Mittal, a clinical research associate in Focus Scientific Research Center saw her aunt from close quarters suffer and battle breast cancer. She believes it is very important to understand the other comorbidities that the patient might have. Diseases like hypertension, diabetes, Hepatitis C and others are some comorbid conditions that make the management of cancer tricky. Comorbidities have been shown to influence cancer treatment decisions. There was one patient (diagnosed with carcinoma left breast with lung metastasis, Stage IV) who seemed an eligible candidate for personalized medicine but failed to receive the treatment because of complications associated with her chronic illness.

Collaborative effort to tackle all issues

The duration and treatment of comorbidities, stage at diagnosis and treatment for breast cancer can be some points to explore the potential adverse effects of comorbidities on survival.

In the present scenario of breast cancer, it becomes very important to have a collaborative approach in treating patients very accurately. Ignorance can lead to a huge cost to one’s life and pain for the family members.

It is very important to be aware not just about the disease, but also the options available to identify, prevent and manage the disease. A little help from the community goes a long way in supporting the patient in terms of surviving the battle.

Stay informed, stay aware, stay healthy!

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