Health: Glimmer of hope
By Suchitra Steven Samuel
Mention breast cancer and the immediate feelings are of devastation and confusion. It is a disease that is becoming increasingly common in the developed world. One in every 10 women is likely to develop breast cancer in her lifetime and early detection is the key to fight the disease.
"Breast cancer is the most frequently diagnosed cancer in women. It is the second cause of death after lung cancer and affects women in the age group of 40 to 59 years, predominantly 50 years and over. However, today, many cases are diagnosed even in the 30s and some in the 20s," says Dr Farid Khalifa, consultant medical oncologist at Dubai Hospital.
Being diagnosed with breast cancer is a shattering experience, but the good news is that as a result of the massive public education effort a growing number of cases are detected early enough to allow for effective treatment. Early screening, diagnosis and management of the disease offer better chances of survival.
Worldwide statistics are alarming. More than one million new cases of breast cancer are reported annually and more than 400,000 women die each year from the disease. The risk of a woman developing breast cancer during her lifetime is approximately 13 per cent (about one in seven of all women in the United States). In the European Union, more than 191,000 new cases are diagnosed each year and more than 60,000 women may die. In the US, this year there are 215,000 new cases and 40,000 are expected die.
Though official figures are unavailable for the UAE, based on his experience, Dr Khalifa estimates that there are 50 to 60 cases per 100,000 population. The highest incidence is in Kuwait with close to 80 to 100 per 100,000. The age group affected is 40 to 50. In the UAE, surgery is done at Rashid Hospital and the management after surgery is done at Dubai Hospital.
"Early detection is the best method for successfully treating the disease. When breast cancer is found and treated in the early stages, the five-year survival rate is around 95 per cent," adds Dr Khalifa.
In the early stages it is found in the lymph nodes and in the later stages, through the blood, it affects the liver, lungs and bones.
Stresses Khalifa: "Right now, the most important thing any woman can do to decrease her risk of dying from breast cancer is to learn how to perform breast self examinations, have regular mammogram screening or have a physical examination by the doctor."
Between 20 and 39, a woman should have a clinical breast examination done every three years. After 40, she should have an annual clinical examination.
A clinical breast examination is done to feel for lumps and look for changes in the size or shape of the breasts. When that is done one learns how to do a breast self-examination. "Every woman should do a self breast exam once a month, about five days after the period ends. If any change is noticed, the doctor has to be notified. About 15 per cent of tumours are felt but cannot be seen by regular mammographic screening," says Khalifa.
The mainstream treatment for breast cancer is breast surgery followed by chemo, hormone and radiation therapy.
Elaborating on the latest developments in the field Dr Khalifa said that The New England Journal of Medicine has published the results of a landmark phase III study that demonstrates that an adjuvant (after surgery) Taxotere showed a significant 28 per cent reduction in risk of relapse and a significant 30 per cent reduction in the risk of death after 55 months of follow-up in women with operable node positive breast cancer. Conducted by the Breast Cancer International Research Group (BCIRG) this trial involved 1,500 patients from around the world. The standard adjuvant regimen is known as Fluorouracil Adriamycin Cytoxan.
Taxotere is indicated for early stage and metastatic breast cancer, lung cancer and androgen-independent metastatic prostrate cancer. Taxotere has been in use in government hospitals all over the UAE since 1999 and is US Federal Drug Administration approved for certain indications.
Taxotere inhibits cancer cell division by essentially "freezing the cell's internal skeleton, which is composed of microtubules. Microtubules assemble and dissemble during a cell cycle. It promotes assembly and blocks disassembly, thereby preventing many cancer cells from dividing and resulting in death in some cancer cells.
"These results provide hope for women with node positive early breast cancer. Nine out of ten women in this study are alive at five years compared to eight out of ten with the standard FAC regimen or traditional treatment."
A step-by-step guide to Breast Self-Examination (BSE) can help one in early diagnosis and treatment of breast cancer. This method should be done in the privacy of the home once every month. It is important that one looks and feels the entire breast and chest area. When examining, one should use a vertical pattern, cover the entire breast, and use adequate pressure (light, medium and firm) while doing so.
It is important to use the pads, not the tips, of the fingers. The best time to do a BSE is right after the menstrual cycle, when the breast swelling and tenderness are over. If one is past menopause one should do this at the same time of the month, every month, so that it's not forgotten.
For self examination place a pillow or towel under your right shoulder, lying down. Put your right hand under your head. Check your entire breast area with the finger pads of your left hand. Use small circles and follow an up-and-down pattern. Use light, medium and firm pressure over each area of your breast. Repeat these steps on your left breast.
Before a mirror, check for any changes. Note any skin or nipple changes such as dimpling or nipple discharge. Inspect in four steps: Arms at side, arms overhead, hands on hips pressing firmly to flex chest muscles, and bending forward.
In the shower, raise your right arm. With soapy hand and fingers flat, check your right breast. Use the method described in the "lying down" step. Repeat on your left breast.
Dr Khalifa opines that women deserve much more information than they usually get about how low-fat, plant-based diets can help them survive this disease or even prevent it in the first place. "Avoid obesity and a sedentary lifestyle, eat fresh fruit and vegetable, drink plenty of water, involve in sport and physical activity like walking and avoid junk food."