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
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
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
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
If you're over 40 or at a high risk for the disease, you should also
have an annual mammogramhttp://www.breastcancer.org/symptoms/testing/types/mammograms/
and physical examination by a doctor. The earlier the breast cancer is
found and diagnosed, the better your chances of beating it" stressed
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
"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
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
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
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
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
In his professional career, running for over twenty years now, he has
successfully treated several heart cases, and done operations, simple
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
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
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
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."