Sunday Observer Online


Sunday, 11 October 2009





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Government Gazette

What all women should know of breast cancer

Awareness of breast cancer is important

Breast cancer is an uncontrolled growth of breast cells. The term "breast cancer" refers to a malignant tumour 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 tissues, which includes the fatty and fibrous connective tissues of the breast.

While we do not yet know exactly what causes breast cancer, we do know that certain risk factors are linked to the disease. Some risk factors, such as smoking, and diet are linked to things a person does. Others, like a person's age, race, or family history, can't be changed. Dr. Dilini Samarakoon of Sri Jayewardenepura Hospital who specializes in this disease, stated "While all women are at risk for breast cancer, the factors listed below can increase a woman's chances of having the disease"

Risk factors

Gender: Simply being a woman is the main risk for breast cancer. While men also get the disease, it is about 100 times more common in women than in men.

Age: The chance of getting breast cancer goes up as a woman gets older.

About two out of three women with invasive breast cancer are age 45 or older when the cancer is found.

Family history: Breast cancer risk is higher among women whose close blood relatives have this disease. The relatives can be from either the mother's or father's side of the family. Having a mother or sister with breast cancer doubles a woman's risk. However, it's also important to note that 70% to 80% of women who get breast cancer do not have a family history of this disease.

Recent use of birth control pills: Studies have found that women who are using birth control pills have a slightly greater risk of breast cancer than women who have never used them. Women who stopped using the pill more than 10 years ago do not seem to have any increased risk. It's a good idea to talk to your doctor about the risks and benefits of birth control pills.

Being overweight or obese: Being overweight or obese is linked to a higher risk of breast cancer, especially for women after change of life and if the weight gain took place during adulthood.

Lack of exercise: Studies show that exercise reduces breast cancer risk. The only question is how much exercise is needed. One study found that as little as 1 hour and 15 minutes to 2 1/2 hours of brisk walking per week reduced the risk by 18%. Walking 10 hours a week reduced the risk a little more.

Dr. Samarakoon also cautioned women to be aware of the symptoms of breast cancer which will enable all women to take the necessary precautions in time .

The symptoms of breast cancer and changes that could occur to the breast are as follows:-

- A lump or thickening in an area of the breast - A change in the size or shape of a breast -Sudden breast size increase - Dimpling of the skin - A change in the shape of your nipple, particularly if it turns in, sinks into the breast, or has an irregular shape -Inverted nipple - A blood stained discharge from the nipple - A rash on a nipple or surrounding area - A breast that is often itchy,red and blotchy:- A breast that is red or blotchy, even having a rash-like appearance should be evaluated by a doctor.

It is a symptom of "inflammatory breast cancer." In this case the whole breast can look red and inflamed and can be very sore. The breast may feel hard. The skin sometimes looks like orange peel because the pores stand out in the inflamed area. Breast and surrounding skin can take on a dimpled appearance, looking like an orange peel. Inflammatory breast cancer is a type of cancer that is often undected by a mammogram and self breast examination.

The red , scaly rash can be itchy. It looks a bit like eczema and is sometimes mistaken for that at first. Many women are too embarrassed to show a doctor, thinking it is cellulite or from being overweight. This is not the case. It's normal for a woman's breast to become swollen and tender during a normal menstrual cycle, but when it's constant, it needs to be evaluated by a doctor.

"Therefore, breast examination should be a part of your monthly health care routine, and you should visit your doctor if you experience breast changes.

If you're over 40 or at a high risk for the disease, you should also have an annual mammogram and physical examination by a doctor. The earlier the breast cancer is found and diagnosed, the better your chances of beating it" stressed Dr.Samarakoon.


According to Dr.Samarakoon most breast-cancer-related tests fall into one or more of the following categories:

- Screening tests: Screening tests (such as yearly mammograms) are given routinely to people who appear to be healthy and are not suspected of having breast cancer. Their purpose is to find breast cancer early, before any symptoms can develop and the cancer usually is easier to treat. A breast ultrasound is also another method of screening that uses sound waves to make a picture of the tissues inside the breast. A breast ultrasound can show all areas of the breast, including the area closest to the chest wall, which is hard to study with a mammogram. Breast ultrasound does not use x-rays or other potentially harmful types of radiation. A breast ultrasound is used to see whether a breast lump is filled with fluid (a cyst) or if it is a solid lump. An ultrasound does not replace the need for a mammogram, but it is often used to check abnormal results from a mammogram.

- Diagnostic tests: Diagnostic tests (such as biopsy) are given to people who are suspected of having breast cancer, either because of symptoms they may be experiencing or a screening test result. These tests are used to determine whether or not breast cancer is present and, if so, whether or not it has travelled outside the breast. Diagnostic tests also are used to gather more information about the cancer to guide decisions about treatment.

A biopsy is a procedure that takes a sample of tissue, so that it can be sent for testing by a lab. It's important to get accurate results from a biopsy, because if there is any disease, the biopsy result will help to determine what your next course of action should be.The type of Biopsy's are: -Fine Needle aspiration -During a fine-needle aspiration, the surgeon will put a thin needle through the skin and into the lump. Cells will be drawn into the needle, and given to a pathologist to look at under a microscope. Needle aspiration might also be done to determine if the lump is solid or liquid (a cyst). If the lump is a cyst, after the fluid has been removed, the cyst will deflate and disappear. If there is no fluid, and the tissue in the lump is too hard to draw into the needle, then you may need a different type of biopsy, in order to get the best results.

Core Needle Biopsy :- For a core needle biopsy, the surgeon will use a large, hollow-core needle, which has a special tip.

The surgeon puts this needle through the skin and into the lump. A very small tissue sample will be taken into the core needle. Sometimes the surgeon will also use suction, in order to remove a slightly larger sample of tissue. The sample is then sent for lab tests.

- Surgical Biopsy :- This surgical technique requires a cut in the skin, in order to remove a sample of the lump, or sometimes, the entire lump. An open surgical biopsy will be done in a hospital or surgical centre. A tissue sample will be surgically removed and sent for testing immediately.

"In Sri Lanka around 22% women are affected by breast cancer making it one of the commonest cancers amongst women in our country. Unfortunately out of most women with breast cancer, more than half aren't even aware they have it. If detected early and treatment started rightaway more than 90 percent of breast cancer patients can become survivors.

Therefore don't let yourself or someone you love become another victim of breast cancer, when all women have a chance at beating the disease, with early detection and treatment," commented Dr. Dilini Samarakoon.

Dengue in Sri Lanka:

What the community should know and could do

(Contd. from last week)

This is an area which is not very much stressed or given much importance in our dengue control programme in Sri Lanka. However, it is a very important method to avoid individuals from mosquito bites at all times as one of those could be an infective bite which may decide his fate. Wearing long sleeved shirts, application of mosquito repellents on the body is effective when working or staying out doors especially during peak biting hours. There are so many brands, types (coils, mats, liquid, vaporizers etc.) of mosquito repellents which are commercially advertised and available in the market. All these give a temporary protection against mosquito bites inside houses. Spraying the rooms with insecticide aerosols or hand sprayer with insecticide solutions will kill the mosquitoes resting and hiding in the rooms. The effect is temporary and mosquitoes could come into the room if there are openings. Sleeping inside mosquito nets is another very good and effective way of avoiding mosquito bites. Insecticide treated nets are much better than untreated nets as they provide physical protection as well as kill the mosquitoes which come into contact with it. It is very important that any one suspicious of having dengue fever should sleep inside a net to prevent the Aedes mosquito getting his blood and spreading the disease to the others.

It is the most effective control measure to prevent the spread of the disease as there are no drugs to kill the virus in the patient.

To reduce man vector contact, screening the houses with fly wires is the most effective way to keep the mosquitoes out. Majority of Sri Lankans have got so used to mosquito bites and getting bitten by mosquitoes either inside or outside houses has become a part of our culture. Only the importers of fly-wire advertise their products once-in a way. Community education is very necessary to encourage this healthy and not so expensive practice. In most countries where mosquito borne diseases are a problem it is mandatory to have provision for insect screening to get approval for a building application. Even the architects and house builders should be motivated to become partners of the dengue control programme and their assistance is necessary to encourage the community to use this very important and comfortable preventive strategy.

Get immediate medical assistance in case of suspicion of dengue.

As mentioned earlier there are 4 dengue virus serotypes D1, D2, D3 and D4. All these four types are present in the Sri Lanka today. All serotypes could cause dengue fever in human beings and signs and symptoms are similar, ranging from mild flue like symptoms in some to very high fever with severe body aches and pains in the bones (Breakbone fever) with a rash in others. Very often the signs and symptoms pass away within 6 - 7 days and the person gets fully cured with a long lasting (may be life time) immunity to that serotype of dengue virus. Some people who had an attack of dengue are not even aware that what they had was dengue. However, the predominant types during the last few years were D2 and D3.

If this person who is immune to one serotype of dengue virus gets another attack of dengue, obviously with another serotype he is liable to get complications known as Dengue Hemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS).

Both these conditions are serious and about 50% fatal. Early and correct management could bring down the fatality to 3 - 5 %. The exact cause for the occurrence of complications is not yet fully understood.

Some say it is due to interaction of immune bodies of different dengue serotypes at molecular level in the body tissue could initiate this fatal condition. Others believe that any concurrent viral infection in a patient suffering with dengue could trigger this reaction. It may be the first belief or the second belief or both beliefs may be acting. Whatever it is, the important thing is that this is a very serious condition and the fatality is very high. There are no drugs at present to treat dengue patients unlike for malaria. The earlier the case management starts the chance for survival of that patient is better.

A third attack of dengue (with another serotype) is still worse and very few people live to tell their experience of a fourth attack. Hence it is extremely important for any body suspecting of having dengue to be very observant to obtain urgent and correct medical assistance in case his condition becomes severe or signs and symptoms of DHF or DSS begin to appear.

The writer has functioned as the Senior Specialist Medical Officer -Vector Borne Diseases Control (VBDC) and Consultant Malariologist in Papua New Guinea for 17 years in addition to 14 years in different capacities with the Antimalaria Campaign in Sri Lanka.

Dr. Saw Huat's advice on walking into a healthy heart

Last week a leading Cardiothoracic Surgeon from Singapore speaking to the media on the important role they have to play, as much as the doctors in keeping a healthy society said it rests on a health educating of the public.

He said journalists know the best way a health message from a doctor could be carried to the people. This is where media cooperation is vital in solving some of the health issues facing the public.

Dr. Saw Huat Seong, the Cardiothoracic Surgeon from the Elizebeth Medical Centre, Singapore, who had come to participate at the annual sessions of the College of Physicians Sri Lanka, as a special invitee was speaking to the press on "Is Your Heart alright and What can be done about it" when he made this statement.

Citing heart diseases a main health issue facing the people, he said, walking is one of the best simple exercises to maintain a healthy heart.

Most people don't realise this.

That is why they take public or private (their own) transport to travel even short distances, like from one bus halt to another.

They don't realise that we can

Easily walk into a healthy heart! Cutting down on heavy expenses which they have to incur on heart medications by ignoring this and other simple exercises.

In his professional career, running for over twenty years now, he has successfully treated several heart cases, and done operations, simple and serious.

From this world to the other world

One operation, he recalled which remains ever fresh in his mind was of Malaysian patient who came to him with complaints of a blocked heart.

He, the patient had gone to some doctors earlier and got treatment done.

After examination he got the patient to do a surgery. In opening the body for the operation, he found it difficult to get into the heart because there were so many layers grown over, it could be following the earlier treatment.

The patient was on a heart lung machine for a number of hours. Several times he wokeup and said he was in another world, what were the doctors doing to him now. Why did the doctors get him back from the other world where he was. The patient survived and became friendly with him.

Credit to the team

The doctor said, he never wanted to get credit for the operations for himself. It's team work and the credit has to go to the team.

His advice to the people to lead a healthy life was "Don't overdo anything." "Moderation in life in everything is the best way to lead a healthy and a happy life."

LANKAPUVATH - National News Agency of Sri Lanka
Telecommunications Regulatory Commission of Sri Lanka (TRCSL)
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