A woman is more precious than jewels, and nothing you desire can compare with her. Long life is in her right hand; in her left hand are riches and honor. Her ways are ways of pleasantness, and all her paths are peace. She is a tree of life to those who lay hold of her; those who hold her fast are called blessed.”- Proverbs 3:15-18
“Charm is deceptive, and beauty is fleeting; but a woman who fears the Lord is to be praised. Honor her for all that her hands have done, and let her works bring her praise at the city gate”- Proverbs 31:30-31
Mangaluru: This year the International Women’s Day (IWD) -2016 campaign theme is Pledge For Parity, and the children of Mount Carmel Central School (MCCS) highlighted the theme with various acts during the International Women’s Day celebrations held at the School auditorium on 8 March 2016 from 9 am onwards. Large number of parents had assembled to take part in the celebrations, where their children entertained them with music, songs and dance.
It was a day to celebrate the social, economic, cultural and political achievement of women. Yet the progress of women has slowed in many places across the world, so urgent action is needed to accelerate gender parity. Leaders across the world are pledging to take action as champions of gender parity. The International Women’s Day is observed 8 March ever year since 1900s to celebrate the social, economic, cultural and political achievements of women all across the globe. The theme for this year’s women’s day is “Planet 50-50 by 2030: Step It Up for Gender Equality.”
“The idea of this theme is to consider how to accelerate the 2030 Agenda, building momentum for the effective implementation of the new Sustainable Development Goals, especially goal number five -Achieve gender equality and empower all women and girls- and number 4 –Ensure inclusive and quality education for all and promote lifelong learning,” according to United Nations.
Dr. Venkatesh Sanjeeva, Consultant Surgeon of Gastro Intestinal and Breast Surgery and Dr. Amitha, Paediatrician from A.J. Institute of Medical Science were the two eminent speakers for the day. It was an occasion for the members of the MCCS family to pause for a moment and reflect on themselves, to appreciate how much has been done and what more needs to be done in the field of gender equality. Moreover, it was the day to acknowledge all the men and women in the world for making this world a better place for everyone to live in.
Dr. Venkatesh, in his address to the gathering highlighted the need for early detection, conservation and reconstruction about Breast Cancer and stressed on the positive thinking among cancer survivors.(Elaborate details of his talk is incorporated below). Dr. Amitha spoke on happy and healthy childhood and urged them to develop positive parenting pattern. In her talk she urged the parents to,provide nutritious diet to their children, keep their children away from junk food, take away their cell phones, not allow their children to spend more time watching TV, play video games or chat on mobile phones.
The significance of the Day was highlighted by the students of Class II. The theme given for the year 2016 “Pledge for parity” was elucidated. Role of women in a family was enacted by the little children. Their meaningful action and conversation was followed by a dance which made everyone sail in the memories of their individual childhood. Children dressed up as renowned women personalities such as Mother Theresa, Kiran Bedi, Madam Marie Curie, Rani Lakshmi Bai, Kalpana Chawla and Saina Nehwal reminded the audience of their incredible record they have made amidst the hurdles they had to overcome.
The Vote of Thanks was delivered by Nidhi and Vidyuth of class II. The programme was a success as about 300 parents were the beneficiaries of the talk – the significance of the day by the students and health awareness given by Dr.Venkatesh and Dr. Amitha Rao.
The following talk on Awareness regarding Breast Cancer and Breast Disease was delivered by Dr Venkatesh Sanjeeva ( MBBS, MS, FRCS (Edinburgh), FRCS (Glasgow) during the International Women’s Day celebrations held at MCCS
Diseases of the breast bring in a significant stress in women, especially when the diagnosis of the breast cancer is made. The impact of this disease threatens the body image, disturbances in the form of self esteem, femininity and sexuality. Hence there is a need to understand the disease for better quality of life.
The magnitude of breast cancer problem is increasing in India. Recent study of breast cancer risk in India revealed that one in twenty eight women develop breast cancer during her life time. In rare cases even men become victims of breast cancer.
Breast cancer starts when cells in the breast begin to divide and grow in an abnormal way. Breast cancer usually starts of in the inner lining of milk ducts or lobules. Breast cancer invades locally and spreads through regional lymph nodes, blood stream or both. Metastatic commonly affects lungs, liver, bone and brain.
Female sex hormones (eg Oestrogens, progesterone etc.) Play important role in development and growth of the breast, Changes in breast during menstrual cycle, pregnancy and lactation. Diseases of breast are mainly due to changes in hormone secretion, that is, changes in duration, amount and relation between other hormones. It is difficult to pinpoint the exact cause of breast cancer, but certainly should consider some risk factors.
1) Heredity: A woman with family history of breast cancer (mother, sister or aunt) has an increased risk of developing breast cancer in her life time.
2) Menstrual cycle: Girls attaining puberty at much earlier age, pregnancies being delayed beyond 32, breast feeding shortening and late menopause are some of the major factors why urban Indian women are increasingly becoming susceptible (due to excessive level of estrogen in the body). Long term use of hormone replacement therapy increases the risk of breast cancer.
3) Lifestyle: Studies show those women who consume alcohol, eat excessive fat in diet and smoke cigarettes are susceptible to develop breast cancer.
Breast cancer can occur at any age. In last 10 years, the disease has shown a dramatic increase among younger women in India.
Painless lump in the breast is the commonest symptom of breast cancer. Since these lumps are painless, most of the women neglect it as a result these lumps and spread to the other parts of the body.
· Blood stained nipple discharge, changes in nipple shape or itching around the nipple.
· Changes in size and shape of breast.
· Changes in the skin of the breast- redness, prominent veins, dimpling or ulceration.
· Swelling (lymph nodes) in arm pit or lower parts of neck.
· In late stages, these tumours can spread to the rest of the body mainly liver, lungs, bone, brain and these patients can present with symptoms attributed to those organs.
Diagnosis: 3 ways – triple assessment
· Examination of the patient
· Radiological investigations- mammogram and ultrasound
Clinical examination: Patient co-operation is vital in examination. Doctor should look for any change in size and shape of breast and nipple. If any swelling felt, doctor should confirm the nature of the lump in form of size, hard or soft, mobility, fixed to skin or chest wall. Breast specialist can detect a breast cancer in early stages.
1) Mammogram: (soft tissue x -ray of the breast) Mammogram is useful only after the age of 40 years, under age of 40 the breasts are denser, and it is difficult to detect cancer. Mammogram can detect tiny breast lumps which are not palpable.
2) Ultrasound: Useful in young ladies less than 40, pregnant and lactating women. When diagnose cysts it can be aspirated through ultrasound .
Biopsy: Fine needle aspiration cytology/core biopsy/stereotactic biopsy
A needle is inserted into the affected tissue and cells extracted with the help of a syringe and examined under microscope. Sometimes the suspicious lump has to be removed for biopsy.
Treatment: Modalities are Surgery, Chemotherapy, Radio Therapy, Hormone Therapy and Targeted Treatment (Biological Treatment). Often a combination of two or more of these are required and these depend on :
Cancer itself: Tumour size and stage (whether it has spread), grade of the cancer cell, whether it is hormone responsive or contained HER2 receptors.
Women with Cancer: Age, menopause status, general health and personal preference
· Initial stage (stages I and II): Lump is less than 5 cm in size and movable lymph nodes (glands) in arm pit.
At an early stage, if there is small lump in a large breast away from the nipple, then the whole breast need not be removed except the lump (Lumpectomy). In other cases the entire breast needs to be removed (Mastectomy). At the same time the glands from the arm pits also removed. Following the surgery, depending upon the histopathology report, radiotherapy, chemotherapy or hormone therapy is given to control the spread of the tumor to other parts of the body.
Women who have undergone excision of the breast in early breast cancer, we can reconstruct an artificial breast.
· Stage III: Breast lump is large in size and fixed to the skin, chest wall and fixed glands in the arm pit. In these cases the patient is given chemotherapy. Depending upon the response of the therapy, further treatments like surgery/ radiotherapy/ harmone therapy are given.
· Stage IV: Features of tumor spread to liver, lungs, bone, and brain. In these cases it is difficult to cure them. Instead palliation in the form of chemotherapy/hormone therapy /radiotherapy and pain management is given.
Self examination of breast:
Breast self examination is the key to early detection of breast cancer. If it is detected earlier, cancer can be cured with the modern treatment.
Body hormones have constant influence in the day to day changes in the breast, breasts are lumpy, swollen and painful just before the menstrual period, and best time to examine the breast is 4 – 5 days after the periods.
Looking: It should be done in front of a mirror- check for any change in size and shape of breast, changes in skin, nipple size and shape.
Feeling (palpation): Done in lying down position. To feel right breast, raise your hand behind the head, and use the pads of left hand to feel for any lump or mass under the skin. Also gentle squeeze the nipple for any discharge and finally check arm pits for any glands. Same examination is repeated in the left breast using right hand.
Remember, any change in the breast should not be ignored. It merits a visit to the specialist to set your mind at rest. Never wait and worry.
Non cancerous breast diseases (benign)
1. Fibroadenoma: These are non cancerous tumors which appear in young women, between the age group of 15 – 25 years. Most of these lumps are 1-2 cm in size and rarely they grow beyond 5cm. These are firm, smooth to feel and very mobile inside breast tissue. If a breast specialist rules out cancer by clinical examination, ultrasound scan and biopsy, no need for excision of the tumor
2. Breast pain: This is a common symptom affecting 70% of women. Usually it occurs 1-2 days before the menstrual period. It is due to hormonal changes in the body. Sometimes it is related to chest muscle or rib cage. This can be managed by medicines.
3. Nipple discharge: This can present in any age. It may be watery, greenish, blackish or blood stained. Blood stained discharge from the nipple may be an early sign of breast cancer. In this case it is better to take the opinion of a breast specialist.
4. Breast abscess: Commonly seen during lactation (breast feeding) patient can have fever, swelling, redness etc. In initial stages the infection settles down with antibiotics but a well formed abscess needs an operation.
In non lactating women, breast abscess may be sign of breast cancer. It is advisable to take the opinion of a breast specialist in these cases.
1. Breast cancer is the second common cancer in Indian women and magnitude of the problem is increasing in India that too among younger women.
2. By self examination of the breast, cancer can be detected in early stages and can get cured by modern treatment.
3. If a woman notices any change/problem in the breast, without any hesitation should contact a breast specialist.
4. Any lump in the breast need not be a cancer. Never wait and worry, always take the opinion of a breast specialist.
About the speaker :
Dr Venkatesh Sanjeeva completed his MBBS in 1987, and MS in General Surgery in 1991 from KMC Mangaluru. Thereafter he served in the same college as an Assistant Professor of Surgery from 1992 to 1995. In 1995 he left for UK to pursue his higher studies. He obtained FRCS from two prestigious Royal Colleges of Surgery – Edinburg and Glasgow in 1996. He continued higher surgical training in Gastro-Intestinal and Breast Surgery from various reputed Hospitals in England from 1996 – 2000. Armed with vast knowledge he once again joined KMC as an associate professor of surgery in 2000. After five fruitful years of service, he joined A J Medical College as a Professor in the department of general surgery from 2005-2009. In April 2009 he resigned his job to concentrate on his private practice in the city.
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