Power of Pink

Dr Deepak Bharti
Breast cancer is the most dreaded disease which has spread its roots among women of all ages and has become a major problem both in developed and developing countries.It is found mostly in women, but men can get breast cancer, too. The peak occurrence of breast cancer in developed countries is above the age of 50 whereas in India it is above the age of 40.
HISTORY: Breast Cancer Awareness Month (BCAM) was launched in 1985. It started as a weeklong event which was started by Betty Ford who was a Breast cancer survivor and was the wife of then president of United States Gerald Ford, as a partnership between the American Cancer Society and the pharmaceutical division of Imperial Chemical Industries (now part of AstraZeneca). The early goal of Breast Cancer Awareness Month was to educate women about breast cancer and early detection tests so that they could take care of their breast health. One of their key goals that they wanted to achieve was to promote mammograms as an important tool to be used in the fight against breast cancer. The first nation-wide campaign that utilized the pink ribbon was back in 1992 by Evelyn Lauder, who established Breast Cancer Research Foundation and solidified the pink ribbon as a universal symbol for the disease.
RISK FACTORS: Studies have found a number of risk factors that increase chance of getting breast cancer.
Lifestyle: Breast cancer risk increases with increased consumption of alcohol/tobacco, smoking, increased intake of dietary fats, low intake of fruits and vegetables, decreased physical activity.
Menstruation: Early menses before the age of 12yrs increases the risk of breast cancer and late menopause after the age of 55yrs also increases the risk of breast cancer.
Estrogen: If its level increases in the body it adds up to the risk of having breast cancer in women’s lifetime.
Body weight: Obesity or adult weight gain especially just before and after menopause increases the risk of breast cancer.
Birth control pills: Prolonged use of oral contraceptives may increase breast cancer risk.
Breastfeeding: women avoiding breastfeed enhances the chance of getting breast cancer in later stages of their life.
Nulliparity (having no child) and Late pregnancy (after the age of 30)
Use of hormonal replacement therapy (more than five years)
Family history of breast and ovarian cancer
Low levels of vitamin D in the body.
BRCA1 and BRCA 2 gene mutations having been identifies as the major genetic causes. If someone inherits such a gene, the chances of developing breast cancer are 80% and ovarian cancer is 40% in lifetime.
Radiation Exposure
DETECTION: Breast cancer detection involves clinical examination by Doctor, breast self examination (BSE) and by using Mammogram.
Clinical examination should be performed by doctor or trained nurse practitioner annually for women over 40 years, after three years for women between 20 and 40 years and more frequent examination for higher risk patients. Mammography involves the X-ray of the breast.
BREAST SELF EXAMINATION: It involves the monthly examination of the breasts and under arm area to discover any changes at the early stage. It should begin at the age of 20 and then continued thereafter. In case of menstruating women it should be done 5-7 days after the beginning of the period, whereas in case of menopausal and pregnant women at the same date during each month and it takes about 20 minutes. However most of the women don’t do BSE due to fear, embarrassment, lack of knowledge, too busy and forgetfulness.
The best time to examine your breasts is usually 1 week after your menstrual period starts, when your breasts are least likely to be swollen or tender. Examining your breasts at other times in your menstrual cycle may make it hard to compare results of one examination with another. If menstrual cycle is irregular, or if menstruation stopped due to menopause or by the removal of uterus (hysterectomy), do your examination on a day of the month that’s easy to remember.
To do Breast self-examination:
* Remove all your clothes above the waist. Lie down and spread your breasts evenly over your chest as it makes it easier to feel lumps or changes. Check your entire breast by feeling all of the tissue from the collarbone to the bottom of the bra line and from the armpit to the breastbone.
* Use the pads of your three middle fingers – not your fingertips. Use the middle fingers of your left hand to check your right breast. Use the middle fingers of your right hand to check your left breast. You can use an up-and-down pattern or a spiral pattern. Move your fingers slowly in small coin-sized circles.
* Use three different levels of pressure to feel all of your breast tissue. Light pressure is needed to feel the tissue close to the skin surface. Medium pressure is used to feel a little deeper, and firm pressure is used to feel your tissue close to your breastbone and ribs. Avoid lifting your fingers away from the skin as you feel for lumps, unusual thicknesses, or changes of any kind.
* Ask your doctor for tips that can help you to do it correctly.
When should you see a doctor?
After you know what your breasts normally look and feel like, any changes should be checked by a doctor. Changes may include:
* Any new lump – whether painless or painful to touch.
* Unusual thick areas.
* Sticky or bloody discharge from your nipples.
* Any changes in the skin of your breasts or nipples, such as puckering or dimpling.
* An unusual increase in the size of one breast.
* One breast unusually lower than the other.
* Even if you choose to do breast self-examination, talk to your doctor about having regular mammograms as well as regular breast checkups.
THEME 2022: This year’s BCAM theme is: Together We C.A.N. CAN is an acronym that stands for: C-Change the conversation, A-Assist those impacted by breast cancer to get the information they deserve and need and N-Nurture and build a community of support.
PREVENTION:
Current strategies to decrease a woman’s risk of developing breast cancer include primary prevention, such as avoiding tobacco/alcohol use, exogenous hormone use (OCPs/HRT) and excess exposure to ionizing radiation, breastfeeding, exercise regularly, eating a healthy balanced diet and maintaining a normal weight. Mastectomy and/or bilateral oophorectomy are reasonable strategies for women who have deleterious mutations in genes that dramatically increase the risk of developing cancer in either breast. Increase the use of chemo preventive agents with proven efficacy in the prevention of breast cancer
To summarize, a healthy stress free lifestyle, timely pregnancy, adequate lactation, avoid overuse of OCPs and abstinence from tobacco and alcohol are certain measures which can definitely reduce the incidence of breast cancer.
(The author is Consultant Medical Oncology)

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