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Representing Pink

Dr.Zeeshan Khan

Breast cancer is cancer that develops from breast tissue.Cancer is a family of diseases and breast cancer is a single disease. Breast tissues are made up of milk production glands, which called lobules and the ducts, which connect the lobules to the nipple. The remaining part of the breast is composed of with lymphatic, connective and fatty tissues. Signs of breast cancer may include a lump in the breast,thickening different from the other breast tissue, one breast becoming larger or lower, a change in breast shape, dimpling of the skin, fluid coming from the nipple, or a red scaly patch of skin. In those with distant spread of the disease, there may be bone pain, swollen lymph nodes, shortness of breath, or yellow skin.Breast cancer is the most prevalent type of cancer in the world. Throughout worldwide breast cancer poses a major health risk for women.

In Pakistan,Illiteracy is also a major cause of breast cancer among women because women have no awareness about personal hygienic conditions. Most of the Pakistani women have no proper access to the medical facilities due to gender-based discrimination.Sexually transmitted diseases and breast cancer has become very common disease among women in Pakistan. In rural areas of Pakistan, socio-economic conditions are responsible for the poor health of the women. At some stage of life, 1 in 9 Pakistani women has become the patient of breast cancer.

In Asia, Pakistan has the highest rate of breast cancer. Young women also present at advanced stage of breast cancer, which has negative effect on prognosis. In rural areas, rural women are developing a great number of breast cancers every year because it is an inherited disease, which is transmitted from mother to daughter. Pakistani rural as well as urban women are facing cervical, ovarian and uterine cancers. Screening centers are not available in Pakistan to diagnose various type of cancer and every year a great number of women are dying due to breast cancer and Hepatitis-C.

About 1 in 8 U.S. women (about 12%) will develop invasive breast cancer over the course of her lifetime. In 2017, an estimated 252,710 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S., along with 63,410 new cases of non-invasive (in situ) breast cancer.

Mammogram is a screening program, which is very helpful and effective in the detection of the disease. Most of the population cannot afford this screening program because it is very expensive. The simplest technique is Breast self-examination (BSE) to check one-self monthly. Trained medical practitioners and nurses at health centers teach the women, how to use Breast self-examination technique once a month.

Risk factors include being female,obesity, lack of exercise, alcohol, hormone replacement therapy during menopause, ionizing radiation, early age at first menstruation, having children late or not at all, older age, family history, Klinefelter syndrome,lack of breastfeeding,higher levels of certain hormones and certain dietary patterns. Recent studies have indicated that exposure to light pollution is a risk factor for the development of breast cancer.

About 5–10% of cases are due to genes inherited from a person’s parents,including BRCA1 and BRCA2 among others.Breast cancer most commonly develops in cells from the lining of milk ducts and the lobules that supply the ducts with milk.Cancers developing from the ducts are known as ductal carcinomas, while those developing from lobules are known as lobular carcinomas.In addition, there are more than 18 other sub-types of breast cancer.The diagnosis of breast cancer is confirmed by taking a biopsy of the concerning lump.

The balance of benefits versus harms of breast cancer screening is controversial.Surgical removal of both breasts is another preventative measure in some high risk women.In those who have been diagnosed with cancer, a number of treatments may be used, including surgery, radiation therapy, chemotherapy, hormonal therapy and targeted therapy.Types of surgery vary from breast-conserving surgery to mastectomy.Breast reconstruction may take place at the time of surgery or at a later date.In those in whom the cancer has spread to other parts of the body, treatments are mostly aimed at improving quality of life and comfort.

Outcomes for breast cancer vary depending on the cancer type, extent of disease, and person’s age.Survival rates in the developed world are high,with between 80% and 90%.Worldwide, breast cancer is the leading type of cancer in women, accounting for 25% of all cases.

Inflammatory breast cancer is a particular type of breast cancer which can pose a substantial diagnostic challenge. Symptoms may resemble a breast inflammation and may include itching, pain, swelling, nipple inversion, warmth and redness throughout the breast, as well as an orange-peel texture to the skin referred to as peau d’orange.As inflammatory breast cancer does not present as a lump there can sometimes be a delay in diagnosis.

Occasionally, breast cancer presents as metastatic disease—that is, cancer that has spread beyond the original organ. The symptoms caused by metastatic breast cancer will depend on the location of metastasis. Common sites of metastasis include bone, liver, lung and brain.Unexplained weight loss can occasionally signal breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are called non-specific, meaning they could be manifestations of many other illnesses.

Smoking tobacco appears to increase the risk of breast cancer, with the greater the amount smoked and the earlier in life that smoking began, the higher the risk.In those who are long-term smokers, the risk is increased 35% to 50%.A lack of physical activity has been linked to about 10% of cases.Sitting regularly for prolonged periods is associated with higher mortality from breast cancer. The risk is not negated by regular exercise, though it is lowered.

The association between breast feeding and breast cancer has not been clearly determined; some studies have found support for an association while others have not.
A number of dietary factors have been linked to the risk for breast cancer. Dietary factors which may increase risk include a high fat diet,high alcohol intake,and obesity-related high cholesterol levels.Dietary iodine deficiency may also play a role.Evidence for fiber is unclear.

Other risk factors include radiations and shift-work.A number of chemicals have also been linked, including polychlorinated biphenyls, polycyclic aromatic hydrocarbons, and organic solvents.Although the radiation from mammography is a low dose, it is estimated that yearly screening from 40 to 80 years of age will cause approximately 225 cases of fatal breast cancer per million women screened.

Genetics is believed to be the primary cause of 5–10% of all cases.
Breast changes like atypical ductal hyperplasia and lobular carcinoma in situ,found in benign breast conditions such as fibrocystic breast changes, are correlated with an increased breast cancer risk. Diabetes mellitus might also increase the risk of breast cancer.Autoimmune diseases such as lupus erythematosus seem also to increase the risk for the acquisition of breast cancer.
Mutations leading to loss of this ability can lead to cancer formation.
Breast cancer, like other cancers, occurs because of an interaction between an environmental (external) factor and a genetically susceptible host.

Breast cancer staging using the TNM system is based on the size of the tumor (T), whether or not the tumor has spread to the lymph nodes (N) in the armpits, and whether the tumor has metastasized (M) (i.e. spread to a more distant part of the body). Larger size, nodal spread, and metastasis have a larger stage number and a worse prognosis.

The main stages are:Stage 0 is a pre-cancerous or marker condition, either ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS).
Stages 1–3 are within the breast or regional lymph nodes.
Stage 4 is ‘metastatic’ cancer that has a less favorable prognosis since it has spread beyond the breast and regional lymph nodes.Breast cancer cells may or may not have three important receptors: estrogen receptor (ER), progesterone receptor (PR), and HER2.

Women may reduce their risk of breast cancer by maintaining a healthy weight, drinking less alcohol, being physically active and breastfeeding their children.The benefits with moderate exercise such as brisk walking are seen at all age groups including postmenopausal women.High levels of physical activity reduce the risk of breast cancer by about 14%.Strategies that encourage regular physical activity and reduce obesity could also have other benefits, such as reduced risks of cardiovascular disease and diabetes.

High intake of citrus fruit has been associated with a 10% reduction in the risk of breast cancer.
Marine omega-3 polyunsaturated fatty acids appear to reduce the risk.High consumption of soy-based foods may reduce risk.

The selective estrogen receptor modulators (such as tamoxifen) reduce the risk of breast cancer but increase the risk of thromboembolism and endometrial cancer.There is no overall change in the risk of death.They are thus not recommended.The benefit of breast cancer reduction continues for at least five years after stopping a course of treatment with these medications.The management of breast cancer depends on various factors, including the stage of the cancer and the age of the patient.

The pink ribbon is a symbol to show support for breast cancer awareness
A pink ribbon is the most prominent symbol of breast cancer awareness.The pink ribbon is associated with individual generosity, faith in scientific progress, and a “can-do” attitude. It encourages consumers to focus on the emotionally appealing ultimate vision of a cure for breast cancer, rather than on the fraught path between current knowledge and any future cures.

Ten diet and lifestyle changes to help reduce your breast cancer risk are:

1. Eat cruciferous vegetables every day
This includes cauliflower, broccoli, kale, cabbage and Brussels sprouts — which are all great for breast health.
2. Eat antioxidant-rich berries
Strawberries, blueberries, raspberries and blackberries are all rich in antioxidants and phytonutrients.These things are free-radical scavengers so, believe it or not, berries make cancer cells commit suicide,you blend a cup a day into a shake.
3. Eat more turmeric
Turmeric, which is activated by black pepper, is a breast health “superfood,”. I recommend adding it to a smoothie.
4. Eat more Indian Gooseberry
Indian gooseberry, often sold as “AMLA powder,” has the highest concentration of antioxidants on earth.
5. Eat more mushrooms
Common button mushrooms are also a great source for nutrients when it comes to breast cancer prevention.
6. Eat more soy
For years, doctors, told breast cancer patients to avoid soy. Since 2009, however, newer studies have shown benefits of soy products, including tempeh, tofu, edamame and soy milk.
7. Stick to regular bar soaps
Using old-fashioned bar soap instead of antibacterial soap can lessen the risk of toxins you are exposed to.
8. Buy organic when eating the skin of produce
Oncologists recommend eating organic as often as you can but said it is most important when you’re eating a fruit or vegetable where you’re actually eating its skin, which may have absorbed toxins.
9. Dust and vacuum your home regularly
Dusting and vacuuming is a great way to lessen the number of toxins in the air.
10. Fill your home with household plants
Many house plants naturally absorb toxins.

Dr. Zeeshan Khan works at CMH Hospital Lahore.

He can be reached at:dr.zeeshan.alias.ghazikhan@gmail.com

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