The New Nation - Internet Edition

Bijan Lal Dev

Cancer develops when cells in a part of the body begin to grow out of control. Normal body cells grow, divide, and die in an orderly fashion. Because cancer cells continue to grow and divide, they are different from normal cells. Instead of dying, they outlive normal cells and continue to form new abnormal cells. Cancer cells develop because of damage to DNA. This substance is in every cell and directs all its activities. Most of the time when DNA becomes damaged the body is able to repair it. In cancer cells, the damaged DNA is not repaired. People can inherit damaged DNA, which accounts for inherited cancers. Many times though, a person's DNA becomes damaged by exposure to something in the environment, like smoking, radiation, effects of chemicals and infectious agents. Cancer may affect people at all ages, even fetuses, but risk for the more common varieties tends to increase with age. Cancer causes about 13% of all deaths across the world. In the developed countries, cancer is presently responsible for about 25% of all deaths. Breast cancer is the fifth most common cause of cancer death after lung cancer, stomach cancer, liver cancer and colon cancer worldwide.

Breast cancer is a cancer that starts in the tissues of the breast cancer, that is, the glandular breast tissue. There are two main types of breast cancer: 1) Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to the nipple. Most breast cancers are of this type. 2) Lobular carcinoma starts in parts of the breast, called lobules, which produce milk. In rare cases, breast cancer can start in other areas of the breast. Many breast cancers are sensitive to the hormone estrogen. This means that estrogen causes the breast cancer tumor to grow. Such cancer is called estrogen receptor positive cancer.

Because the breast is composed of identical tissues in males and females, breast cancer also occurs in males, though it is less common. Women are 100 times more likely to get breast cancer than men. In 2005, breast cancer caused 502,000 deaths throughout the world. It is 7 per cent of cancer deaths and almost 1 per cent of all deaths. Among women worldwide, breast cancer is the most common cause of cancer death. Over the course of a lifetime, one in eight women will be diagnosed with breast cancer. In Bangladesh breast cancer causes death to over 22,000 women every year and out of them 15,000 die without any treatment.

Detection: Breast cancer screening is an attempt to detect unsuspected cancers. The most common screening methods are self and clinical breast exams, x-ray mammography, breast Magnetic Resonance Imaging (MRI), ultrasound, and genetic testing. Breast self-examination has been widely discussing since 1990s as a useful modality for detecting breast cancer at an earlier stage of presentation. Every women over 20 years of age should follow breast self-examination every month and clinical examination once a year. Changes in the appearance or shape of the breast can raise suspicions of breast cancer. Early breast cancer can in some cases present as breast pain or a painful lump. The women can be taught self-exam tended to detect breast nodules. Another reported symptom complex of breast cancer is Paget's disease of the breast. This syndrome presents as eczematoid skin changes at the nipple, and is a late manifestation of an underlying breast cancer. Self-examination has chances to ignore even the definite cancer symptoms. So, mammography is still the modality of choice for screening of early breast cancer, since it is relatively fast, reasonably accurate, and widely available in most of the countries. Breast cancers detected by mammography are usually at earlier stage than those detected by patients or doctors as a breast lump. Annual mammography of women older than age 40 or 50 is recommended by numerous organizations as a screening method to diagnose early breast cancer and has demonstrated a protective effect in multiple clinical trials. Mammography has been estimated to reduce breast cancer-related mortality by 20-30%. Women with one or more first-degree relatives (mother, sister, and daughter) with pre-menopausal breast cancer should begin screening at an earlier age. It is usually suggested to start screening at an age that is 10 years less than the age at which the relative was diagnosed with breast cancer. The breast cancer is best diagnosed by the examination of surgically removed breast tissue. Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Metastatic breast cancer will cause symptoms that depend on the location of metastasis. More common sites of metastasis include bone, liver, lung, and brain. The detection of such cancers is very difficult.

Factors risking breast cancer: There are some risk factors for developing breast cancer that you cannot change. These are: 1) Age and gender - Your risk of developing breast cancer increases as you get older. The majority of advanced breast cancer cases are found in women over age 50. 2) Family history of breast cancer - You may also have a higher risk for breast cancer if you have a close relative has had breast, uterine, ovarian, or colon cancer. About 20-30% of women with breast cancer have a family history of the disease. 3) Genes - Some people have genes that make them more prone to developing breast cancer. These genes normally produce proteins that protect you from cancer. But if a parent passes you a defective gene, you have an increased risk for breast cancer. Women with one of these defects have up to an 80% chance of getting breast cancer sometime during their life. 4) Menstrual cycle - Women who get their periods early (before age 12) or went through menopause late (after age 55) have an increased risk for breast cancer.

According to the US National Cancer Institute, there are other risk factors which can be changed. These include: 1) Alcohol use - Drinking more than 1-2 glasses of alcohol a day may increase your risk for breast cancer. 2) Childbirth - Women who have never had children or who had them only after age 30 have an increased risk for breast cancer. Being pregnant more than once or becoming pregnant at an early age reduces your risk of breast cancer. 3) Obesity - Obesity has been linked to breast cancer, although this link is controversial. The theory is that obese women produce more estrogen, which can fuel the development of breast cancer. 4) Radiation - If you received radiation therapy as a child or young adult to treat cancer of the chest area, you have a significantly higher risk for developing breast cancer. The younger you started such radiation, the higher your risk - especially if the radiation was given when a female was developing breasts. Besides, hormone replacement therapy for several years to reduce the symptoms of menopause and using diethylstilbestrol for preventing miscarriage may have an increased risk of breast cancer after age 40.

Treatment: Breast cancer behaves very differently. It grows at different rate and responds to different treatments. It may be one of the oldest known forms of cancer tumors in humans. The oldest description of cancer (although the term cancer was not used) was discovered in Egypt and dates back to approximately 1600 BC. "There is no treatment." For centuries, physicians described similar cases in their practices, with the same sad conclusion. It was William Stewart Halsted who started performing mastectomies that is, removing the lymph nodes, breast tissue, and underlying chest muscle through a surgical procedure in 1882. It was remained popular for breast cancer treatment up to the 1970s. Till the mainstay of breast cancer treatment is surgery when the tumor is localized, with possible adjuvant hormonal therapy, chemotherapy, and/or radiotherapy. Depending on clinical criteria (age, type of cancer, size, metastasis) patients are roughly divided to high risk and low risk cases, with each risk category following different rules for therapy. Treatment possibilities include radiation therapy, chemotherapy, hormone therapy, and immune therapy in addition to surgery.

Prevention: Plant estrogen intake, such as from soy products, in early adolescence may protect against breast cancer later in life. Studies have found that foliate intake counteracts breast cancer risk associated with alcohol consumption and "women who drink alcohol and have a high foliate intake are not at increased risk of cancer. Foliate is involved in the synthesis, repair, and functioning of DNA. Foods rich in foliate include citrus fruits, citrus juices, dark green leafy vegetables (such as spinach), dried beans, and peas. Vitamin B9 can also be taken in a multivitamin pill. Removal of ovaries, in high-risk individuals, when child-bearing is complete, reduces the risk of developing breast cancer by 60%, as well as reducing the risk of developing ovarian cancer by 96%. Fatty diet, obesity and alcohol consumption are major reasons of breast cancer while physical exercise and early detection can prevent the fatal disease.

Conclusion: Early detection of breast cancer is the only way to live long and may eliminate death risks in many cases. There are medicines now for treating breast cancer and cure rate is now 90 percent if you detect early. But ignorance, innocence, negligence and shyness make the women prey of breast cancer. Even educated and urban women show reluctance to follow the health care rules. So, building massive awareness is the best way to prevent breast cancer.

There are many ways in creating awareness but media could play the dominant role at this end. Over 68 per cent of the breast cancer mortalities in Bangladesh die without any treatment. Both print and electronic media can play a significant role by elaborating the risk factors, symptoms, detection means, and treatment and prevention methodologies. We should inspire the womenfolk of the country to learn and follow the detection and treatment procedures of breast cancer and know how to prevent this deadly disease.