Breast Cancer Is A Big Killer

Breast cancer has emerged the largest common cancer amongst urban women in India and we are losing a large number of women to this highly treatable disease because of poor awareness and very late diagnosis and detection.

It is high time that we built a high degree of awareness amongst all strata of society about breast cancer.Education and awareness will play a big role in future in saving precious lives of women in our society.

So what really is the cause of breast cancer?

Certain changes in DNA can cause normal breast cells to become cancerous. DNA mutations lead to enhanced risk of developing breast cancer.There have also been some genetic factors that have been found to cause breast cancer that runs in the family through generations. For example , BRCA1 and BRCA2 are two genes that have been found to be responsible for hereditary breast cancer in women. But most breast cancer DNA changes happen in single breast cells during a woman's lifetime instead of getting resulted from the genetic factors or gene mutation. What then are some of the things that can reduce the risk of breast cancer ? 1. Exercise:

Exercising apart from the obvious benefits may decrease hormone levels and help lower breast cancer risk. The effect of exercise on breast cancer risk may be greatest in premenopausal women of normal or low weight. The routine must involve a workout regimen four or more hours a week on a sustained basis.

2. Reduced Exposure to Estrogen:

Decreasing the length of time a woman's breast tissue is exposed to estrogen may help prevent breast cancer. Exposure to estrogen is reduced in the following ways:

• Pregnancy: Estrogen levels are lower during pregnancy. The risk of breast cancer appears to be lower if a woman has her first full-term pregnancy before she is 20 years old.
• Breast-feeding: Estrogen levels may remain lower while a woman is breast-feeding.
• Ovarian ablation: The amount of estrogen made by the body can be greatly reduced by removing one or both ovaries, which make estrogen. Also, drugs may be taken to lower the amount of estrogen made by the ovaries.
• Late menstruation: Beginning to have menstrual periods at age 14 or older decreases the number of years the breast tissue is exposed to estrogen.
• Early menopause: The fewer years a woman menstruates, the shorter the time her breast tissue is exposed to estrogen.

Endogenous estrogen is a hormone made by the body. Being exposed to estrogen over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating. A woman's exposure to estrogen is increased in the following ways:

• Early menstruation: Beginning to have menstrual periods at age 11 or younger increases the number of years the breast tissue is exposed to estrogen.
• Late menopause: The more years a woman menstruates, the longer her breast tissue is exposed to estrogen.
• Late pregnancy or never being pregnant: Because estrogen levels are lower during pregnancy, breast tissue is exposed to more estrogen in women who become pregnant for the first time after age 35 or who never become pregnant..

Radiation Exposure :

Radiation therapy to the chest for the treatment of cancers increases the risk of breast cancer, starting 10 years after treatment and lasting for a lifetime. The risk of developing breast cancer depends on the doseof radiation and the age at which it is given. The risk is highest if radiation treatment was used duringpuberty. For example, radiation therapy used to treat Hodgkin disease by age 16, especially radiation to the chest and neck, increases the risk of breast cancer.

However, radiation therapy to treat cancer in one breast does not appear to increase the risk of developing cancer in the other breast.

For women who are at risk of breast cancer due to inherited changes in the BRCA1 and BRCA2 genes, exposure to radiation, such as that from chest x-rays, may further increase the risk of breast cancer, especially in women who were x-rayed before 20 years of age.

Obesity:

Obesity increases the risk of breast cancer in postmenopausal women who have not used hormone replacement therapy.

Alcohol:

Alcohol consumption also increases the risk of breast cancer. The level of risk obviously increase as the alcohol intake increases.

October is a breast cancer month.We are organizing a breast cancer " Walk for Life" on 25th October at the Noida stadium.

Please do join in or organize an event of your own in your community.

Let us increase awareness about cancer in our immediate environment.

You can save many precious lives.

" Every Life Matters"

Pradeep K Jaisingh

www.internationaloncology.com

Stem Cell Transplantation: All you should know.

These days many of you must have come across the term Stem cell transplant just like Bone Marrow transplant. Both the terms are commonly used though there are some important differences between the two that must be clearly understood.

Blood stem cells (hematopoietic stem cells ) are found in the bone marrow and were detected and isolated from the bone marrow cell cultures.In a typical bone marrow transplant, these cells were first harvested and subsequently re-infused and grown with the purpose of re-constituting the damaged bone marrow. But of-course, these stem cells, in smaller numbers, are also available in the peripheral blood stream and therefore could be harvested through leukopheresis using a pheresis machine and then storing them cryogenically using liquid nitrogen.

What has further enabled easy harvesting of these stem cells is the use of HGF ( hematopoietic Growth Factors) . HGFs play a vital role in the entire development cycle of blood cells from stem cells stage to their maturity and help generate large number of cells that are easy to harvest in viable numbers. Patients that are being prepared for a transplant are first administered HGF injections to increase their WBC as well as their peripheral stem cell counts. The harvesting of these cells is then far more easy and a lot quicker saving valuable time.

These cells are then infused in the patient and made to grow new blood stem cells in an accelerated fashion thereby minimizing the risk of infection in the patient ( an extremely important factor in the transplant process) and also enabling a much shorter timeframe for the entire process.

Overall, there are two types of transplants---autologous and allogenic. In autologous transplant, the stem cell is derived from the same person who is undergoing the transplant. This is primarily used to deliver very high doses of chemptherapy to the patient which would have otherwise not been possible because of tremendous damage that high dose chemo causes to the bone marrow.

The allogenic transplant on the other hand essentially requires a donor who in most cases is a sibling. The donor needs to be tested and HLA matched before being selected.There is only a 25% probability that one sibling will be HLA matched to another sibling. In smaller families, therefore, it becomes rather improbable to be able to find a matched donor.

The other possible options are to have a partially matched sibling or a matched unrelated donor.
Using partially mathced siblings for a transplant is a riskier endeavour and will require even more intensive chemotherapy and radiation therapy regimens.
The other possibility of finding a matched unrelated donor can be a game of chance unless one gets very lucky and through random testing a match is sudeenly found. A National registry, however, with a HLA database will go a long way in tackling this challenge. In US there is a National Marrow Donor Program which is a central depository of over 5 Million HLA matched volunteers. The database is also linked with the regisrties of various other countires for international matching.


The allogenic transplant,therefore, is a much more complex exercise with significant risk of graft rejection as well. The success rates of partially matched and matched unrelated donor based transplants is lower than the matched sibling donors based transplants and also only a few centres attempt to do the former.

However, the scope of stem cell transplantation is large and very promising for the future and provides a ray of hope for the patients and in some cases the only possibility of any kind of cure whatsoever.

We are in the process of setting up a world class transplant programme at International Oncology's cancer centre at Fortis Noida.

Let us work towards leveraging the great potential that this tehcnology offers becuase "Every Life Matters"

Pradeep K Jaisingh
www.internationaloncology.com

ASCO 2009-----Orlando

American Society of Clinical Oncology or ASCO as it is popularly known is the biggest annual gathering of oncologists in the world and this year the conference was held in Orlando. Over 30,000 professionals connected with the filed of cancer care attended the meeting and included oncologists( medical, surgical and radiation) , researchers,pharmaceutical industry executives and scientists, venture capitalists etc.

On 30th May evening was the dinner event hosted by the Indo American Cancer Association ---IACA ( http://www.iacaweb.com/) where a large number of oncologists of Indian origin working in US were present along with the oncologists visiting from India. It was quite a nice gathering as it presented an opportunity for people travelling from India to interact with their counterparts settled in US and exchange professional inputs.

IACA has been doing an excellent job under the leadership of its current President Dr Vinay Jain who has spearheaded some impressive new initiatives. One of these initiatives is to provide fellowship opportunites to oncologists from India.
Those interested in applying for the fellowshio can apply using the link

http://iacaweb.com/index.php?option=com_forme&fid=1&fellow=fellow

Preference will be given to candidates who are from geographical areas of Indian Subcontinent which are under-served in terms of basic care of the cancer patients including palliative care. The eligible candidates must have worked in an oncologic discipline for 1 to 5 years and achieved some basic knowledge of oncology and are interested in upgrading their skills in Patient care, Clinical research or Palliative care.

I think this is a very useful initiative that will help upgrading the skill levels of professionals in the field working in the under-served region of India.

Apart from this several members of IACA have made excellent efforts to work in areas like children's cancer , cancer care in rural India and also palliative care / hospice initiatives for the terminally ill patients in India.

It is always great to see the commited young professional wanting to make a difference and doing their part in such an important healthcare area.

Please do join in and do your part for improving the cancer care in India because " Every Life matters"

Pradeep K Jaisingh

Managing Side Effects of Cancer Treatment--Part II

In continuation with the last post, let us talk about managing the side effects of the cancer treatment.

1. Loss of appetite----Many cancer patients receiving chemotherapy experience a loss of appetite and also a perceptible change in their taste and aroma of food making it unappetising. Some foods may taste or smell too stong, bitter and other foods may tase very medicinal and therefore unappealing to most patients.

This is a significant problem while patients are receiving the treatment as it further adds to the already challenging situation wherein the patient is fighting with other emotional aspects like depression etc. The other very important factor is that loss of appetite may result in inadequate nutrition and thereby compromising the immune function leading to enhanced risk of infection and a general feeling of weakness and lethargy.

The way to deal with these issues is to try and eat smaller portions at more frequent intervals going upto 6 to 7 times a day ensuring proper nutritional balance with adequate calories and protein at each serving. Fresh juices, soy milk, fruits like peaches, melon, plum etc, milk shakes, yoghurt etc. are good additions to the diet. In general do not try to go for foods with very strong smell, flavors. Go with your instincts and eat what looks appetising to you.

Your oncologist / nutritionist may be able to also recommend some appetite stimulants as well. Do share your diet plans with your doctor and make sure you are taking enough nutrition.

2.Nausea / Vomiting-----It is by far the most common and dreaded side effect of chemotherapy and created widespread angst and discomfort amongst patients. Many of the chemo drugs so far caused varying degree of damage to the gastrointestinal tract resulting in a nauseated and unpleasant feeling at the back of the throat and creating a vomiting sensation and many a times actual vomiting. The intensity and frequency of nausea and vomiting varies from patient to patient for the same drug.

The good news is many of the new generation chemo drugs have significantly reduced the nausea and vomiting side effect of chemotherapy. However, some drugs still cause it and many patients still respond differently.

Discuss your specific nausea/ vomiting pattern with your oncologist.Your doctor will also be able to prescribe some medicines that reduce the nausea and vomiting sensation. Drink plenty of juices like watermelon, sweet lime etc. Stay hydrated with energy / sports drinks and water.

Avoid pungent foods and also foods that could cause acidity like fried and spicy food, chips and similar snacks.Ginger has been found to be quite helpful in reducing the effect of nausea and vomiting amongst patients and therefore should be used in different forms in the food.


3. Hair Loss----Hair loss or alopecia is a common side effect wherein chemo drugs damage the hair follicles and cause partial to total hair loss. Though the hair loss is temporary, it still has very significant psychological impact on patients particularly in women patients.The extent of hair loss varies from patient to patient and so does the re-growth time frame though 6-8 weeks after the treatment is the general average.

Radiation therapy also causes hair loss in the targetted area.


How does one deal with the hair loss and the resulting image / appearance problem?

A hairpiece or a wig is certainly an option for many patients but should be ordered before the hair loss starts and could be designed to match one's hair style and color.

Hats/ caps/scarves and other traditional or commonly used headgear is another category of recommended options.


Overall, I think that some side effects are inevitable even with the rapid progress that has been made by the researchers in minimizing the toxic side effects of various drugs and other treatment options. Above mentioned suggestions will certainly help to a certain extent.

Once again, Good Luck and all the very best.
"Every Life Matters"

Pradeep K Jaisingh
http://outcancer.blogspot.com/
www.internationaloncology.com

Side Effects of Cancer Treatment

Cancer treatments invariably lead to some side effects or the other and that is a very major concern area for most patients. The treatments ( both chemotherapy regimens as well as radiation therapy) basically aim to destroy fast growing and multuplying cancer cells but in the process they also end up affecting healthy cells as well.

Minimizing side effects of the chemotherapy drugs ( while increasing their efficacy againgst the tumours) is a constant challenge for the researchers and medical oncologists and there has been significant progress on both counts. Many of the new chemo drugs have much lower toxicity and also result in fewer side effects.
On the radiation oncology front also, there has been an ongoing pursuit of maximizing the radiation doses to the tumour and minimizing the radiation exposure to the surrounding healthy tissues. The current technology like IGRT ( Image guided radiation therapy) aims to precisely attain just that objective through on-board imaging facilities while delivering the radiation. Cyberknife is another invention that has great capabilities of delivering precise radiation even to brain tumours.

Side effects are quite different for different types of cancers and different patients receiving same treatments respond very differently and develop highly varying degree of side effects ranging from substantial to none whatsoever. Patient's overall health, their living habits and related factors also play a part.

It is, therefore, very important to discuss in detail with your oncologist regarding your specific situation and what possible side effects are expected and what are his / her recommendations for minimizing the same and also what possible precautions could be taken to manage the resulting side effects as some of them are inevitable.

Amongst the most common side effects are nausea, hair loss, weight gain or weight loss, lower blood counts, appetite loss, dry mouth, physical abilities deterioration/ stamina loss , swelling in the limbs and sexual dysfunction etc. Each one of these side effects can cause significant distress to the patients and affect their self-image leading to psychological and emotional issues impacting their and their family members' lives in a substantial manner.

In the next issue of my blog, I will cover how to manage some of these issues so that the overall impact on you and yours is minimized.

Good luck and God bless. My thoughts and prayers are always there for each one of you whether you are directly or indirectly affected by this dreaded disease.
Remember " Every Life Matters"

Pradeep K Jaisingh

Cancer And The Genetic Risk: Is Cancer Herditary?

Can Cancer be hereditary? Many people ask this question especially another member of the family develops cancer when either a parent or a sibling had also suffered from the disease earlier.

The question is very natural and understandable but the answer unfortunately is not so simple or black and white. Though it has been widely understood by the cancer researchers and the scientific community that most cancer are not genetic yet there is a 5--10% chance of an inherited gene change leading to a cancer. So, just because a relative in your family has a cancer, there is no reason for you to panic thinking that you might also get that cancer.

However, cancer is such a complex disease to fully understand and to actually determine how it develops that even the most accomplished cancer scientists sometimes struggle to explain the basic questions that patients or their relatives put to them on the reasons behind their cancer.

So, overall, cancer is a result of the interaction between the genes of a person and his/ her environment. A genetic / DNA test determines the order in which the chemical letters of the genetic code are found in a gene. Mutations or the changes in the sequence /order can be used to predict the likelyhood of a person developing a partuculat cancer.
Cancer researchers, for example, have been able to find the genes called BRCA 1 and 2 that are linked to hereditary breast cancer. How exactly these mutations occur are also not an easy area for researchers.
There are two types of genetic mutations---germline ( that are passed on from generation to generation) and somatic ( that happen in the lifetime of a person and do not pass on).

The cancers that may develop due to germline mutation are breast , ovarian , bowel and womb(endometrial) . Genetic testing can be helpful in finding out some of the genes responsible for these cancers. There are some other cancers such as prostrate, pancreatic and testicular that may also be caused due to germline mutation but unfortunately genetic testting for these cancer is yet to be developed.

Overall, however, just because someone inherits a known cancer gene does not mean that that perosn will definitely get cancer. At best it only means that such a person has a significantly higher risk of developing cancer compared to the rest of the population. So you don't inherit cancer from your family, but you might inherit a predispostion or susceptibility to developing that particular cancer.

Good luck and God bless. "Every Life Matters"

Pradeep K Jaisingh

Cancer Diagnosis-------Should you take a second opinion?

The news of cancer diagnosis is an extremely serious and almost all cases a very difficult blow both for the patient as well as his/her family members. It can be devasatating emotionally and most people react in shock and in fact many of them go initially into denial and then it is generally followed by anger.
Many people wonder whether they should get a second opinion about their diagnosis?
I think, in general, it is a very good idea to go for a second opinion for a number of reasons.

First and foremost among them is that an accurate assessment of the specifics of your cancer is a major pre-requisite for the effective treatment plan that will give you the very best shot at dealing with your cancer.Unfortunately,in the field of oncology, that is not always easy. Even in a country like US with the world's best diagnostic and clinical infrastucture for cancer care, a study estimated that 1 in 5 cases of cancer is either mis-diagnosed or improperly staged. ( You must know that accurate staging of the cancer is as important as the correct diagnosis for the treatment to be effective).
In India while there is no such comparable study available to give relevant statistics, my assessment is that the figure is at least 2 in 5 or 40% . That really is a rather unfortunate and alarming situation but then we must not forget that in India an extremely large number of cancer go completely undetected or undiagnosed.
The other major reason for suggesting a second opininon is that cancer is rarely detected by an oncologist. In most cases it is detected by a general physician, a gynaecologist, a urologist or any other such specialists. They in turn then refer you to an oncologist---either a medical oncologist or a surgical oncologist or in some cases to a radiation oncologist. In a large number of cases most of these oncologists do not agree amongst themselves and therefore if you got referred to a surgeon, you will most likely be recommended a surgical removal of your tumour. On the other hand, a medical oncologist is very likely to recommend you a chemotherapy regimen . A radiation therapy course may be recommended by the both.

So, you see it gets really complicated and poses a big dilemma for the patient and the family members to decide on the future course of action.
My recommendation is that choose a comprehensive cancer centre for getting the second opinion. Approach a medical oncologist for an overall opinion but before that make sure that the medical oncologist is a properly qualified one. If he or she has had some international experience either in US or in Western Europe then that is really preferrable. Ask your medical oncologist whether they a tumour board at that cancer centre or not. A tumour board consists of specialists from all three branches of oncology mentioned earlier as well as the specialists from the diagnostic branch/ nuclear medicine area and also from pathology / lab. support areas.
Make sure that your case gets taken up in the tumour board. The suggested treatment plan from the tumour board will generally be the best way forward for you.
Presently, there are also options available for a tele-consult from an international cancer centre/ specialist in US and that might be a very cost effective option as well compared to the cost of going overseas. The NCCN( National Comprehensive Cancer Network---a non profit alliance for the world's 21 leading cancer centres) treatment guidelines are now widely available and the treatment plan suggested can easily be administered here.

So, overall if you or any of your family members ( or a near and dear one) has been diagnosed with cancer then please follow the suggestions given above because it is a matter of a precious life for "Every Life Matters".

Good luck and God bless.

Pradeep K Jaisingh