Health Publication

Dr Sandeep Bipte

Prevent The Preventable & Cure The Curable

Fight The Breast Cancer
It’s the fear of having breast cancer which makes every woman more aware & alert about screening. Most of the breast lumps (90%) are benign, only a few will turn malignant. But, to win this battle, all women need to do is, go through breast self examination and screening mammography with experts opinion. Breast cancer is the second most common type of cancer in females nearly exceeding cervical cancer. India's National Health Profile 2011 predicts that by 2020; breast cancer will overtake cervical cancer as the most common type of cancer among women in India. Breast cancer is the commonest cancer in urban areas in India and accounts for about 25% to 33% of all cancers in women. However in Mumbai, it accounts for 28.7% of all cancers.
The life time risk of having breast cancer in women is 1 in 8 in the US, while in India its 1 in 30 in rural & 1 in 60 urban regions. This is due life style changes & other factors. WHO predicts that by 2020, one in every eight urban Indian women would develop breast cancer in her lifetime. In western countries, the awareness has reached to the level of prophalytic mastectomy for prevention of breast cancer even at a very young age group, but in India, this completely defies the trend. The majority of Indian population having breast cancer is young unlike most western countries. In India, it shows that breast cancer among young women is actually four times higher than in the west.

At present, I feel younger breast cancer patients aren't being brought to hospitals for diagnosis or treatment. Because women are shy, they don't complain when they find a lump in their breast. This is the reason they mostly get diagnosed very late & in the advanced stage. Combine this with the fact, that over 50% breast cancer patients in India present in stages 3 and 4, which will definitely impact the survival. ASCO article states that the overall 5 year survival rate of breast cancer patients in the United States, over the last few decades, has improved from 75% earlier (1975) to 89% presently (2004 data),But In India, the 5 year survival is only 60-65%.

Now a days, the management of breast cancer requires multimodality treatment option such as Surgery, Chemotherapy, Radiation and Hormonal therapy which in fact involve a huge cost to the patients. Most of the time, it’s the cost which is the key factor for delay in treatment.

To overcome the crisis of cost and late presentation, the best modality is prevention of breast cancer through breast cancer awareness programme for all age groups and Breast Self examination and expert consultation with screening modality. BSE can start at the age of 20 after the 5 th day of menses completion every month. As the general population screening, recommendation would be mammography after the age of 50 once in 2 years. For a high risk woman, apart from self examination, we recommend examination by an expert annually with mammogram or MRI. WHO says there is significant evidence to show that mammography screening among women age 50-70 years group reduces mortality by 15% to 25%.

Currently, the surgery for breast cancer has undergone novel changes from traditional procedure of radical mastectomy to the era of oncoplasty & reconstruction although the rate of acceptance for reconstruction is very low as compared to western countries. This awareness can be spread through mass education on awareness of breast cancer. Only awareness can reinforce the message that early detection of breast cancer CAN actually fully cure it.

Dr. Rakesh Katna

FAQs about Cancer in Head and Neck

» What are cancers of the head and neck ?
Cancers which originate from mucosal surfaces inside head and neck region eg. Oral Cavity, Nose. Throat and Tongue are collectively termed as head and neck cancers. Majority of these cancers are squamous cell carcinomas but head and neck cancers can also begin in the salivary glands and thyroid gland.

» What causes cancers of the head and neck ?
Head and neck cancers are the most common among cancers in India. they were predominantly seen in elderly age group and especially in males. Alcohol and tobacco use (including smokeless tobacco, sometimes called "chewing tobacco" or "snuff") are the two most important risk factors of head and neck cancers, especially cancers of the oral cavity, oropharynx, hypopharynx and larynx. In Indian subcontinent smokeless tobacco in the form of paan masala, gutkha and masheri is responsible for development of gingivobuccal cancers which are typical of this population as compared to western population. Human papilomavirus (HPV) is also deemed responsible for development of oropharyngeal cancers.

» What are the symptoms / presentation of head and neck cancers ?
The symptoms of head and neck cancers may include an ulcer in mouth or a lump in neck that does not heal, difficulty in swallowing and a change or hoarseness in the voice. It is important to check with a doctor about any of these symptoms.

» How are head and neck cancers diagnosed ?
The medical history, clinical examination and diagnostic tests including biopsy are required to make diagnosis of these cancers. The exams and tests may vary depending on the symptoms. Imaging and clinical examination is important to stage the disease accurately and helps in planning the treatment.

» How are head and neck cancers treated ?
Treatment for head and neck cancer can include surgery, radiation therapy, chemotherapy, targeted therapy or a combination of treatments. These Cancers are curable if detected early and treatment strategy differs with type of cancer and organ of involvement and stage at present. The patient and the patient and the doctor should consider treatment options carefully. They should discuss each type of treatment and how it affects form and function of the patient.

» What rehabilitation or support options are available for patients with head and neck cancer ?
The goal of treatment for head and neck cancer is to control the disease ,but preserving the function of the affected areas is of paramount importance and helps the patient return to normal activities as soon as possible after treatment. Rehabilitation is very important part of this process and it depends on the extent of the disease and the treatment that a patient has received.

» What new strategies or treatments are coming up for management of head and neck cancers ?
The newer techniques in surgical methods like Endoscopic resections, Robotic surgery (TORS), Transoral Laryngeal surgery and similarly emergence of newer techniques in radiotherapy have effected a major change in treatment practices. Advent of newer chemotherapy drugs and targeted therapy have also helped in management of patients affected these cancers.

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