Review | Sundayobserver.lk

Obesity is an important cause of type 2 diabetes, high blood pressure and hyperlipidaemia (high cholesterol and triglycerides). Obesity accelerates the development of atheroma (atherosclerosis) and increases the risk of coronary heart disease (heart attacks and angina) and early death.

Substantial evidence supports the link between increasing adiposity and higher risk of many cancers. International Agency for Research on Cancer (IARC) evaluated the link between weight and cancer in 2002 and concluded that some colon cancers, post-menopausal breast cancers, kidney cancers and cancers of the oesophagus could be prevented by avoiding weight gain.

Since IARC report, many scientists have investigated the association between overweight adiposity and cancer and the results indicate that more cancers are probably linked to obesity at than was thought originally, including cancer of stomach, gallbladder cancer, liver cancer, pancreatic cancer, certain types blood cancer (leukaemia) and prostatic cancer.

According to Reeves and colleagues who investigated one million women aged 50 - 64 with regard to their body mass index (BMJ 2007, 10, 1136) came to the conclusion, that overweight and obesity were associated with significantly increased incidence of breast cancer, womb cancer, kidney, cancer, cancer of oesophagus, leukaemia multiple mycloma, certain types of lymphoma, pancreatic cancer and ovarian cancer.

Recent studies suggest that insulin resistance (which is common in obese persons) is associated with pancreatic cancer. Another study found that a tendency towards central (versus peripheral) weight gain was associated with a 45% increase in risk of pancreatic cancer.

Obesity is a stronger prediction of colorectal cancer in men compared to women. Other research workers have found that waist circumference was a risk factor for colon cancer, that was stronger than BMI, both in obese men and women.

Increasing adipositys (both overall and central) is associated with many cancers probably due to metabolic and endocrine effects of obesity and the alterations they induce in the production of peptides and steroid hormones.

There is an epidemic of obesity in Sri Lanka especially in the urban areas and there are no signs of abating.

Obesity and overweight are quite common in the Western countries and more than 60% of the middle-aged and elderly people in USA are obese or overweight due to over eating and lack of exercise and so far all America's attempts of curbing the epidemic of obesity have failed.

Obesity is becoming more and more common in children. It is high time that the Ministry of Health especially the Director of Non-Commercial Diseases start a program to control this epidemic of obesity as early as possible.

State-of-the-art breast clinic at Sri Jayewardenepura G.H.

Breast cancer is the commonest cancer affecting women with more than one million new patients diagnosed per year, worldwide. Global incidence of breast cancer has been rising over the last few decades with more and more, younger females being the victims.

The WHO statistics indicate that breast cancer is an equally common problem in both developed and less developed countries. It is the most common cause of death from cancer in women accounting for almost 400,000 deaths per year throughout the world. However, incidence of breast cancer has started to decline in some of the developed countries with five year survival rates exceeding 70% mainly due to improvements in early detection and treatment. It is widely accepted that early diagnosis and appropriate treatment is the key to success with breast cancer care. Randomized trials have shown that mammographic screening can reduce the breast cancer mortality by 25-30% in the appropriate age group (45 - 65 years in Sri Lanka).

It is also believed that national screening programmes under optimal conditions with high compliance will be able to reduce the mortality by at least 20%. One other benefit of screening and early detection of breast cancer is that it allows surgeons to perform more localised cosmetically acceptable surgeries, avoiding mutilating mastectomies and expensive reconstructions.

Unfortunately, in most of the developing countries, including Sri Lanka, the majority of the patients present to the healthcare system with advanced disease, where current treatment is of little benefit. As a result, the developing countries contribute to approximately 250,000 of the annual breast cancer deaths, far more than the developed countries in spite of their higher incidence rates. Lack of awareness, proper screening programmes and access to breast care facilities are the main reasons for this discrepancy.

In Sri Lanka, according to the latest national statistics from the National Cancer Control Programme (NCCP), breast cancer is the commonest cancer among females in the country, accounting for 22.8% of all female cancers. In fact, it is the commonest cancer among the whole Sri Lankan population, contributing to 12.6% all cancers.

In the year 2000 Sri Lanka had a total of 1324 new females diagnosed with breast cancer with an annual age standardised rate of 19.1 per 100,000 population.

This was more than 6% increase compared to the previous cancer registry data, published in the year 1995. This rising incidence indicates that breast cancer is now emerging as a major health issue in Sri Lanka, one that needs to be addressed in a timely and an organised manner, to obtain objective outcomes.

A fully empowered breast clinic, with the input of multiple relevant disciplines which includes a surgeon, oncologist, radiologist and a pathologist as a team is the first step in the right direction for early diagnosis and treatment of breast problems, especially breast cancer.

There only a very few such clinics, especially devoted for breast care in the public health system throughout the island. Even within the Colombo district, which apart from having the highest population is also possibly draining the majority of the patients from throughout the island, there are only a few such specialised breast clinics.

Taking all of the above into consideration, a dedicated breast clinic is to be established at the Sri Jayewardenepura General Hospital (SJGH) with immediate effect, led by Consultant Surgeon Dr.(Mrs) Dilini H. Samarakoon MS MRCS (UK).SJGH a tertiary care health establishment is fully equipped with the necessary personnel and resources and its geographical situation allows easy access from any part of the country.

Availability of radiological assessment i.e. mammography and ultrasound scanning of the breasts with pathological assessment i.e. biopsy facilities of the breast lump in close proximity will allow this clinic to function essentially as a one-stop clinic, reducing the hassle associated with waiting for investigations for the patient. The pleasant hospital environment and friendly staff devoted to breast care will be added attractions to these patients seeking relief from fear and agitation of the possibility of being diagnosed with breast cancer.

The clinic will be devoted to dealing with all breast complaints, aiming to offer early diagnosis and planning of treatment, counselling and psychological support where necessary and all in all to provide holistic breast care to the patient.

* Lack of specialised breast clinics to deal with this emerging major health hazard, resulting in presentation of patient at a more advanced stage, increasing risk of morbidity and mortality.

* Fully-fledged breast clinic at SJGH with multidisciplinary input led by a lady surgeon.

* Availability of Triple Assessment i.e. clinical, pathological and radiological assessment of the breast which improves diagnostic capabilities.

Women suffer from womb to tomb

"Around the world, as many as one in every three women has been beaten, coerced into sex, or abused in some other way, most often by some one she knows, including by her husband or another family member; one women in four has been abused during pregnancy"

This is the an authoritative statement given by the United Nations Population Fund to draw the attention of gender based violence. In Sri Lanka, violence against women has always been widespread in rural, urban and plantation sectors. Due to the lack of a proper reporting system, it is difficult to identify its prevalence. The number of women victims of criminal offences in 1992 was reported as 3608, but in 1982 this number was 2688. Since the number has increased it cannot be attributed totally to the increase in crime against women and may also be a result of increased reporting to the police.

Women's reproductive health is affected by violence and miscarriage, pregnancy complications, unsafe abortion and maternal deaths occur due to violence. The mental harassments resulting from family members are also a cause of suffering for the unborn baby. All the stresses and mental harassments from the husband would be obstacles for the baby infant. Sometime he or she may be disabled, mentally retarded or not very active. When she was passing through her childhood she may have seen her mother suffering through the father's violence. The mother is attacked by the father. If she is a girl, her protection is also a burden to her mother as the husband is a drunkard.

Violence

When she becomes young, if her parents do not have enough money, it will be an obstacle for her education. As a young girl she will start working in a factory or somewhere with her little education. If she wants to earn more money she will try to find easy ways to earn money and get caught by the undesirable elements in the society.This vicious circle will run through her future generations also, in such a way that when she is old her children too will not have enough things to look after her. This will result in their not being able to prepare their customary obligations by their elders in the family.More often we have come to know about under aged workers. Even though this has been a long standing problem in our country, as the domestic work fall into the informal sector of employment, no data of women and children who work as domestic workers in Sri Lanka are officially recorded. But the problem is they have so many problems such as poor wages, Labour exploitation and their unproductive time. According to the ILO Convention on 'Domestic Labour, Domestic Labour' is defined as being work that is undertaken to facilitate the functioning of the domestic sphere and the fulfillment of personal needs.

As the majority of domestic workers are women, the suffering is a common thing for them. According to the media reports, the incidents of violence against women such as assault, attempted rape and sexual harassment are not recorded properly. It is recorded that around 100,000 to 125,000 domestic workers are engaged in domestic work in Sri Lanka, three fourth of the work without proper wages and characterized by lack of freedom.

The other unfortunate situation is that their services are confined to the houses, it is difficult to measure them and there is no proper method of tracking and monitoring the welfare of these people.

Compensation

Most crimes against them, specially the children, come under the purview of the penal code. On conviction, the offender gets is by a prison term of not less than two years and not exceeding 20 years, with a fine and an order to pay compensation to the victim as determined by the court. If there is a method to register all domestic workers with the department of labour by law, then only will they be able to make some recommendations for their rights and benefits. Till that we will not be in a position to assist them for their mental and physical sufferings.

It is high time for us to think seriously to eradicate every type of violence against women and girl in Sri Lanka. Preventive, punitive and remedial methods have to be adopted with the assistance of the Ministry of Child Development and Women's Empowerment. In addition to that nation-wide activities and programs have to be implemented to address the gender based violence in different stages.

Replies to your medical queries from SLMA

Dr. Rizvi Haniffa, Secretary of the Sri Lanka Medical Association (SLMA) has informed the Sunday Observer that while thanking the readers for a number of health questions they have sent, in response to the note to readers carried on this page, that the SLMA in its health awareness program for the public, would like to answer health queries from the Sunday Observer readers regularly through this page, that owing to the Association's annual sessions starting from March 14, the doctors are busy with working out programs and getting ready for the sessions.

Dr. Haniffa wishes to apologies to the readers for this delay. In the meantime the doctors would try to answer at least a few questions from the list in the coming week.

Symptoms of stroke

Discussion on strokes prevention

At the discussion on strokes prevention to be held today, (Sunday, March 8) at 10 a.m. at the Institute of Sports Medicine, Colombo 7.

The ISM Director General consultant Neurologist, Dr. Githanjan Mendis said that the former captain of the Sri Lanka Cricket team, Arjuna Ranatunga MP, will also be present.

Any questions relating to the medical aspect of the injured cricketers in the Pakistan incident could also be asked.

All those interested in stroke are welcome to attend this discussion.

Dr. Githanjan Mendis, Consultant Neurologist and member of the SLMA has sent us this short article on the symptoms which answer a few questions raised by two Sunday Observer readers.

A stroke is a medical emergency. Strokes happen when blood flow to your brain stops. Within minutes, brain cells begin to die. There are two kinds of strokes.

The more common kind, called ischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel in the brain.

The other kind, called haemorrhagic stroke, is caused by a blood vessel that breaks and bleeds into the brain. "Mini-strokes" or transient ischemic attacks (TIAs), occur when the blood supply to the brain is briefly interrupted.

** Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)

If you have any of these symptoms you must get to a hospital quickly to begin treatment. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot or by stopping the bleeding.

Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Drug therapy with blood thinners is the most common treatment for stroke.

Health wise

Overweight, obesity and cancer