Kashmir’s first female organ specific oncosurgeon  Dr Shabnam Bashir in conversation with senior reporter Rising Kashmir, Sameer Showkin Lone

Dr Shabnam advocates that avoiding smoking, alcohol, reducing weight,child bearing at appropriate age and breastfeeding can help lower the chances of breast cancer. 

Q1) What is breast cancer?                                

 

Ans:  Contrary to what the most public might think, all breast cancers are not the same. Female breast is made up of lobules that produce milk, ducts that carry that milk and other secretions to the nipple and fibrofatty supportive tissue. Breast cancer can arise from any of these tissues and will accordingly be named as lobular carcinoma, ductal carcinoma , mesenchymal tumour etc .

But the commonest cancer is that arises from the ducts and the commoner one is infiltrating duct carcinoma which has many other subtypes like Hormone positive, Her-2 Neu positive , or Triple negative breast cancer. There are many other less frequent types as well

 

 

Q2) Who is at the risk of getting breast cancer?

Ans:  It is very important for the public to understand that all cancers are multifactorial. It is an interplay of inherent genetic tendencies to get mutations and the outside environmental factors. 

There are certain non-modifiable factors that can increase the risk of cancers:

Female gender- men can also get breast cancer especially if family history of breast cancers and BRCA gene mutation but that constitutes less than 1 percent of total number.

Age: No age is immune to breast cancers but in the western population it is more than 50 years but unfortunately it is striking our population a decade earlier.

Dense breast : Dense breast has more chances of having cancers ( bigger breast does not necessarily mean dense breast- it is the increased glandular tissue rather than fat that makes one more susceptible)

Taller women: A few studies have hinted that taller women have a slightly increased risk of breast cancers. 

Personal history of breast cancer: Women who have had breast cancers have slightly higher risk of having another breast cancer on the same side or opposite breast.

 

 

Q3): What are the main causes behind the fatal disease?

Ans: Smoking: Whether direct or indirect, can increase the chances of breast cancers. So all attempts should be made to discourage it. Smoking can increase risk of 15-17 types of cancers in the body and increase their aggression as well. 

Alcohol: Alcohol consumption can increase the chances of breast cancer along with other 8-10 types of cancers.

Late Child bearing: The risk of breast cancers increases slightly with increased maternal age and the recommended is having 1st child before the age of 30 years.

Breast feeding: Adequate breast feeding for around 2 years is seen to reduce the risk of breast cancers in women.

Physical Activity: An analysis of 35 studies found that highly active women had a 14% lower risk of developing breast cancer compared with the least active women.

Obesity: Increased Body Mass Index can increase the chances of breast cancer in menopausal women by 50%!! Increased BMI can also increase the risk of many other cancers like ovarian and colorectal cancers

Prolonged use of HRT: Prolonged use of Hormone replacement Therapy after menopause or premature ovarian failures is related to increased risk.

Previous chest eradication: Any chest radiation especially in teens for any diseases like Hodgekins lymphoma etc can increase the chances of breast cancers in future.

 

 

 

Q4) What are the symptoms of breast cancer?

Ans: A lump in the breast- The breast tissue extends from collar bone to 6th rib and from midline of chest to line under armpit ( anterior axillary line). Any lump in this region can be presentation of breast cancer

Though the majority of lumps would be non cancerous but still a triple assessment is to be carried out by a specialist to rule out cancers before calling it off. 

Constant pain in one part of the breast or in the armpit- though mastalgias ( breast pain ) is very common in the breast as it is a hormonal organ but any pain which does not decrease or go needs to be evaluated.

 

 

 

Q5) What is the status of breast cancer in Kashmir? Do we have treatment options available locally?

Ans: Around 23 lakh new cases are being detected across the globe every year.

As per ICMR data around 2.23 lakh new cases detected every year in India, around 1 lakh deaths occur annually due to breast cancer.

This has become the number one cause of cancer related deaths in women in the reproductive age group. One in every 28 Indian Women is likely to develop breast cancer during her lifetime!!!

State Cancer Centre SKIMS in 2016 had noted 4336 new cases – and roughly 15 new cases get registered everyday at SKIMS! This again is underestimation of the actual burden as we do not have a population based cancer registry covering all regions as of now. And a lot of women are missed in centrally located hospital based registries because they either go outside Kashmir for treatment or do not share their diseases for the fear of taboos or end up in alternative medicine centres. So we expect far bigger actual numbers that need to be tapped by a kind of door to door census. 

 

 

Q5) How can the chances of breast cancer be lowered?

Ans: Women have to take care of all modifiable risk factors already mentioned like avoiding smoking, alcohol, staying physically active, reducing their weight, trying to get their first child before the age of 30 years, breast feeding their children adequately, trying to avoid unnecessary prolonged HRTs, having proper sleep and de-stressing. They should stay aware of any signs and symptoms and go for evaluations  or screenings to concerned specialists. 

Unfortunately women put their health at the bottom of their priority list. In our society even educated financially independent women are dependent on men in their family regarding any of their health issues, be it evaluations or treatments. I think we as a society need to take the collective responsibility of keeping our women in pink of their health as families are the smallest unit of any society hence their health determines their positive constructive participation towards betterment of our society in the large

 

 

Q6) How can breast cancer be screened?

Ans:  Various breast screening methods include Self Breast examination, Clinical breast Examination, Ultrasound Mammo, X Ray Mammo, in limited cases MRI mammo.

In women aged less than 40 years, breast tissue is dense- so the preferred modality is USG ( Ultrasound)- Sonomammo. And above  40 years of age: X ray Mammogram ( preferable digital mammo) is recommended. 

 

 

Q7) Which age group is more prone to risk of getting breast cancer ? 

Ans: Though no age is immune to breast cancers but the majority of women in western world are more than 50 years of age but unfortunately it is striking our population a decade earlier. And the worrisome factors are that our women have more of aggressive pathologies like Grade 3 and triple negative breast cancers and the majority are presenting in advanced stages increasing the breast cancer related deaths. A lot of our women are having Young Age Breast Cancer and are in their 30s and 40s & even 20s of age.