Pink Ribbon: Nation observes breast cancer awareness month

Genetic disposition along with environmental factors, mainly linked to lifestyle, has presently exposed one out of every 8 to 9 woman in Pakistan at risk to be inflicted with breast cancer.

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Breast cancer is the most common cancer in women. During their lifetimes, 1 in 8 women will have breast cancer at least once.

Of course most women are aware of the warning signs of breast cancer: a lump or thickening in the breast or nipple, an irritation or rash in the skin of the breast or nipple that will not heal, breast or nipple dimpling or retraction, nipple discharge other than milk, or pain in the breast or nipple.

Anyone having a symptom like these should contact the doctor at once for a DIAGNOSTIC mammogram and/or a biopsy to be certain what is causing the symptom.

“Every Year 40,000 women die in Pakistan due to breast cancer. Pakistan has the highest rate of breast cancer in entire Asia.

October is celebrated as breast cancer awareness month globally and Pink Ribbon observes it in Pakistan as Pinktober. The theme of this year’s campaign is #SaveThe9th which hinges around the concept of sensitizing the society to support Pink Ribbon’s cause of building Pakistan’s first dedicated breast cancer hospital to save every ninth woman who is at high risk of breast cancer.

Every year, 90,000 new cases of breast cancer are reported in Pakistan. A majority of the cases are not recorded due to the sufferers’ hesitation and social pressure. Moreover, lack of healthcare facilities make the situation worse.

They said that the main reason of high growing breast cancer is Pakistani traditional society; there is no system of collecting data and to keep record of cancer cases. Major causes of disease among women are obesity, overweight and aversion to breastfeeding.

With specific reference to Breast Cancer, the disease is largely preventable through a healthy and active lifestyle with due attention towards weight control.

“Breast feeding is a natural mode to prevent the ailment often construed to be terminal”.

By turning pink for this lifesaving cause, which is concerning more than 10.2 million Pakistani women with high risk of breast cancer, the nation showed complete support to Pink Ribbon and pledged to help the organisation eradicate this fatal disease and reduce the resulting female mortality.

Explanation

Breast cancer is an uncontrolled growth of breast cells. To better understand breast cancer, it helps to understand how any cancer can develop.

Cancer occurs as a result of mutations, or abnormal changes, in the genes responsible for regulating the growth of cells and keeping them healthy. The genes are in each cell’s nucleus, which acts as the “control room” of each cell. Normally, the cells in our bodies replace themselves through an orderly process of cell growth: healthy new cells take over as old ones die out. But over time, mutations can “turn on” certain genes and “turn off” others in a cell. That changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.

A tumor can be benign (not dangerous to health) or malignant (has the potential to be dangerous). Benign tumors are not considered cancerous: their cells are close to normal in appearance, they grow slowly, and they do not invade nearby tissues or spread to other parts of the body. Malignant tumors are cancerous. Left unchecked, malignant cells eventually can spread beyond the original tumor to other parts of the body.

The term “breast cancer” refers to a malignant tumor that has developed from cells in the breast. Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include the fatty and fibrous connective tissues of the breast.

Over time, cancer cells can invade nearby healthy breast tissue and make their way into the underarm lymph nodes, small organs that filter out foreign substances in the body. If cancer cells get into the lymph nodes, they then have a pathway into other parts of the body. The breast cancer’s stage refers to how far the cancer cells have spread beyond the original tumor (see the Stages of breast cancer table for more information).

Breast cancer is always caused by a genetic abnormality (a “mistake” in the genetic material). However, only 5-10% of cancers are due to an abnormality inherited from your mother or father. Instead, 85-90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and the “wear and tear” of life in general.

There are steps every person can take to help the body stay as healthy as possible, such as eating a balanced diet, maintaining a healthy weight, not smoking, limiting alcohol, and exercising regularly (learn what you can do to manage breast cancer risk factors). While these may have some impact on your risk of getting breast cancer, they cannot eliminate the risk.

Developing breast cancer is not your or anyone’s fault. Feeling guilty, or telling yourself that breast cancer happened because of something you or anyone else did, is not productive.

Approximately 221,000 breast cancers were diagnosed in women of any race each year during the period from 2009 through 2013. Between 2010 and 2014, about 41,000 deaths from breast cancer occurred each year. Comparing the figures for African-American and European-American women, the team discovered some welcome news.

Between 2010 and 2014, death rates decreased by slightly more than 2% for black and white women younger than age 50.

Dr. Deepa Halaharvi, a breast cancer surgeon, explained that triple-negative breast cancers, which account for 10% to 20% of all diagnosed breast cancers, occur more often in black women than white women. These aggressive cancers return negative results when tested for factors related to the hormones estrogen and progesterone as well as the protein HER2. As a result, triple-negative breast cancers do not respond to all therapies.

“If you catch them early on, we have really good chemotherapy agents that we can use to treat them,” Halaharvi said. “But the thing is, you have to catch the cancer early on. You have to catch it in the really early stages.”

Examining death rates more closely, the CDC researchers discovered that some racial disparities still existed.

Although deaths decreased for all women over time, a slightly faster rate of decline occurred for white women than black women from 2010 to 2014. White breast cancer patients, as a group, experienced a decline in deaths of 1.9% per year, compared with 1.5% per year for black women.

Noting that October is Breast Cancer Awareness Month, “Know your breasts; know what’s normal for you. If there’s a mass that feels like a rock-hard marble, go see your doctor.

Diet

Breast cancer patients may have a better chance of survival when they follow a low-fat diet heavy in fruits, vegetables and whole grains, a US study suggests.

Researchers studied 19,541 participants in the federally funded Women’s Health Initiative (WHI) who were randomly selected to join a dietary experiment focused on limiting fat intake to 20 percent of calories. Researchers also looked at data for a control group of 29,294 women in the WHI study who didn’t alter their diets.

By the time the researchers had been tracking half the women for at least 8.5 years, 1,764 participants had been diagnosed with breast cancer.

A decade after their diagnosis, 82 percent of the breast cancer patients on the low-fat diet were still alive, compared with 78 percent in the control group.

For women on the low-fat diet who developed breast cancer, this translated into a 22 percent lower risk of death during the study, and these women typically didn’t succeed at reducing fat consumption by the amount suggested in the diet experiment.

“Decades ago, comparison of country-to-country differences in fat intake found countries with higher fat intake like the US and most of Western Europe had higher breast cancer mortality, but subsequent observational studies have had inconsistent results,” said lead study author Dr Rowan Chlebowski of City of Hope National Medical Center in Duarte, California.

The WHI dietary modification trial is the only full-scale randomized trial addressing this issue,” Chlebowski said by email.

The main goal of the diet experiment was to get women to change their eating habits, not to count calories or lose weight.

Women assigned to change their diets had a series of group and individual counseling sessions with certified nutritionists over the first year of the program, followed by group sessions four times a year for the remainder of the experiment.

After one year, women in the diet group got about 24 percent of their calories from fat compared with 35 percent fat in other participants’ diets. While weight loss wasn’t a goal, women in the diet group weighted about 2.2 kilograms (4.9 pounds) less than other participants.

While the diet experiment was ongoing, 671 women in the diet group and 1,093 who didn’t alter their eating habits developed breast cancer. This difference was too small to rule out the possibility that it was due to chance.

But women on the low-fat diet were less likely to develop certain hard-to-treat tumors.

One limitation of the study is that researchers relied on women to accurately describe their eating habits in questionnaires, the researchers note in JAMA Oncology. Another drawback is that women in the diet group managed only minimal increases in their consumption of fruits, vegetables and whole grains.

Because women in the low-fat diet group did lose weight relative to other participants, it’s also possible that weight rather than the fat content of the diet might explain the differences in cancer survival odds, said Dr. Graham Colditz, a researcher at Washington University School of Medicine in St. Louis, Missouri, who wasn’t involved in the study.

“For lowering breast cancer risk – and cancer risk overall – the most important part of diet is to keep calories in check,” Colditz said by email. “Weight gain and obesity is an important risk factor for postmenopausal breast cancer – and 12 other cancers.”

Not all fat is created equal, either.

Chemotherapy

The majority of women with a common form of breast cancer may be able to skip chemotherapy after surgery, based on their score on a genetic test, researchers said

As many as 65,000 women in the United States alone could be impacted by the study, described as the largest breast cancer trial to date, released at the American Society of Clinical Oncology annual meeting in Chicago.

Until now, women have faced a great deal of uncertainty about whether to add chemo to hormone therapy after a diagnosis with hormone-receptor positive, HER-2 negative breast cancer when found at an early stage before it has spread to the lymph nodes.

“With results of this ground-breaking study, we now can safely avoid chemotherapy in about 70 percent of patients who are diagnosed with the most common form of breast cancer,” said co-author Kathy Albain, an oncologist at Loyola Medicine.

“For countless women and their doctors, the days of uncertainty are over.”

A 21-gene test called Oncotype Dx that has been around since 2004 has helped guide some decisions, post-surgery.

A high recurrence score, above 25, means chemo is advised to ward off a recurrence while a low score, below 10, means it is not.

The current study involved more than 10,000 women and focused on those whose scores were in the middle range, from 11 to 25.

Patients, aged 18 to 75, were randomly assigned to receive chemotherapy followed by hormonal therapy or hormone therapy alone.

Then, researchers studied the outcomes, including whether or not cancer recurred, and overall survival.

“For the entire study population with gene test scores between 11 and 25 — and especially among women aged 50 to 75 — there was no significant difference between the chemotherapy and no chemotherapy groups,” said the findings, published in the New England Journal of Medicine.

The results show that all women over 50 with a recurrence score of 0 to 25 can be spared chemotherapy and its toxic side effects.

For women under 50 with a score of 0 to 15, chemo could be skipped.

However, among younger women with scores 16 to 25, outcomes were slightly better in the chemotherapy group, so in those cases doctors may urge patients to consider a chemo regimen.

The results “should have a huge impact on doctors and patients,” Albain said.

“We are de-escalating toxic therapy.”

According to first author Joseph Sparano of Montefiore Medical Center in Bronx, New York, “any woman with early stage breast cancer 75 or younger should have the test and discuss the results” with her doctor.

With input from AFP, REUTERS.

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