Issues and concerns about breast cancer

 WELLNEWS

Victor Dumaguing MD

The article on breast cancer has spawned a number of texts and calls from our readers and friends with various questions and inquiries which obviously have been wanting to be clarified. Your columnist has always been a believer of the adage “your wish is my command” so we tried to group the queries-due to space constraints- with the hope that some nagging concerns bring some relief and consolation to our dear readers. However, at this juncture, it is strongly emphasized that this article is for information purposes only and is not a substitute for a detailed consultation with your family physician.
MALE BREAST MASS; 

Gynecomastia is the term for enlargement of the breast in males, which is normal during puberty,  which sis normal and transient and disappears within a few months or years due to hormonal surges from the testes and even adrenal glands. Among adults, probable causes include drug-therapies with estrogen, marijuana use and liver disease especially among chronic alcoholic with liver cirrhosis. The liver is a great detoxification organ, among its many functions. Truth to tell, in every woman, there is a “male in her”; in every man there is a “female in him”. 

The zona reticularis of the adrenal cortex secretes some amount s of both masculinizing as well as feminizing hormones which are easily neutralized by a normal liver. In the case of patients with cirrhosis, the liver is unable to detoxify the feminizing hormones, thus the male heavy drinker will most likely develop gynecomastia. As to tendency of breast masses of males becoming malignant/cancerous, it’s rare, 1-2% of female risk.
PILLS and HRT; 

Birth control pills contain the female hormones estrogen and progesterone which    could potentially increase the risk of breast cancer. Indeed a difficult clinical decision among doctors trying to weigh risk/benefit of giving pills to women. Fortunately, the dose of pills now are significantly much lower than when they were introduced as family-planning method, thus the current pill is a combination of estrogen and progesterone-unlike the sequential dose of estrogen followed by progesterone administration. HRT or hormone replacement therapy is given to post-menopausal women with the general intention to sustain and maintain their “female or feminine biological as well as sexual nature” However, again, being hormonal, there’s always the risk of breast malignancy thus there is the plant based phytoestrogen (estradiol) although again, must be given after a thorough discussion and consultation with your doctor, endocrinologist and OB-Gyne specialist.
BREAST IMPLANTS and AUGMENTATION: 

Most of the citizens of the world have removed the stigma and shame associated with procedures that modify, change and enhance the physical attributes of the body they were born with. Silicone has been and still is the preferred substance used by doctors to augment the breast of women- whose decisions to enhance their female assets must be respected by everyone. Naturally, since the implant is a “foreign body” there is always the fear about risk of increasing development of breast cancer. Current research and clinical experience show that the problem is pain and abnormal tissue surrounding the implant, plus there is associated ALCL-anaplastic large cell lymphoma- a non-Hodgkin’s type of lymphoma, although rare, it is still an issue that doctors tell prospective eager breast implant patients.

\SURGERY and OTHER MODALITIES for BREAST MASSES; A red flag is raised and other warning signs with the following; a mass palpated , retracted, inverted downward pointing of nipple, indentation of breast when the arm is raised, pitting or abnormal thickening of skin of breast-peau de orange or like the skin of an orange and nipple discharge. Common sense dictates that the sooner a mass is removed, the better, in consonance with the much-oft saying, prevention is better than cure. Statistics show that for Stage 0-1 breast cancer and stage l prostate cancer, the five year survival rate is in the high 90%. Lumpectomy is the simplest procedure to remove the lump/mass. For very big masses though, surgeons recommend chemotherapy to reduce the size of the cancerous tissue. In advanced stages, a radical mastectomy is indicated-removal of the breast plus axillary lymph nodes- that is after a very detailed careful discussion with the patient, with psychological counselling and even post-surgical rehabilitation

For this article I would like to acknowledge the gracious participation of my former students-now my consultants; Dr. Joan BADUA, OB-Gyne (09175072542), Dr. Sherry ONG, Surgery (09178458454, Dr. Erikson Madronio-Endocrinology (09152809850) Maraming Salamat po.

WELLNEWS

Victor Dumaguing MD

Feeling safe from crime linked with lower risks of heart attack and death

AMSTERDAM, Netherlands -- Feeling safe from crime is associated with a 9% lower risk of premature death and 6% lower likelihood of a heart attack, according to a study in more than 35,000 adults presented at ESC Congress 2023.1
“There is increasing evidence that the neighbourhood we live in affects our health,” said study author Dr. Mengya Li of the National Center for Cardiovascular Diseases, Beijing, China. “This study highlights the importance of many aspects of our surroundings for heart health and longevity, including feeling safe, having shops, transport and parks close by, cleanliness, and feeling that our neighbourhood is a good place to live and to raise children.”
    The researchers used data from the PURE-China study to investigate the association between neighbourhood characteristics, cardiovascular disease (CVD) and death. The study included 35,730 adults aged 35 to 70 years from 115 communities (70 urban and 45 rural) in 12 provinces of China between 2005 and 2009. The average age of participants was 51 years and 60% were women.
    Trained research staff conducted face to face interviews to collect baseline information on the neighbourhood environment using the Neighbourhood Environment Walkability Scale (NEWS). The questionnaire contains eight subscales. Scores for each subscale were added up to obtain a total NEWS score. High scores reflected positive perceptions about the community.
The eight subscales covered: 1) how long it takes to walk to shops, restaurants, banks, pharmacies, work, transport stops and parks; 2) perceived ease of walking to shops and transport stops; 3) the distance between intersections (which indicates ease of getting around); 4) infrastructure for walking/cycling (e.g. pavements to walk on); 5) aesthetics (e.g. trees shading the pavement, interesting things to look at while walking, freedom from litter); 6) safety from traffic (e.g. the amount of traffic, safety crossing the street); 7) safety from crime (e.g. street lighting at night; crime rate and safety walking during the day and night); and 8) community satisfaction (e.g. with public transportation, commute to work, access to shopping, a good place to live and to raise children).
    Participants were followed up for all-cause death, death due to CVD, major CVD events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure), myocardial infarction, stroke and heart failure.     The primary outcome was a composite of major CVD events and all-cause mortality.
    The researchers analyzed the associations between each subscale and the total score and health outcomes after adjusting for factors that could influence the relationships including age, sex, body mass index, education, household income, marital status, tobacco consumption, alcohol consumption, physical activity, household cooking fuel, pollution, history of CVD, high blood pressure, diabetes and regular medications.
    During a median follow up of 11.7 years, there were 2,034 (5.7%) all-cause deaths, of which 765 were attributed to CVD, and 3,042 (8.5%) major CVD events. A higher neighbourhood environment score was associated with a 6% lower risk of the primary outcome of major CVD events and all-cause mortality, a 12% lower likelihood of death during follow up, and a 10% reduced risk of death due to CVD.
    The subscale with the greatest association with health outcomes was safety from crime. A higher neighbourhood safety score was associated with a 9% lower risk of death during follow up, 10% lower risk of death from CVD, 3% reduced likelihood of major CVDs, 6% reduced risk of myocardial infarction and 10% lower likelihood of heart failure.
    For all subscales, a high score was linked with a lower risk of all-cause death during follow up, with percentages ranging from 2% to 9% lower risk. In addition, a high score on the subscale covering how long it takes to walk to amenities was also associated with 1% lower risks of death due to CVD, major CVDs and heart attack.
    Dr. Li said: “While some of the percentage reductions in risk are small, they affect large numbers of people and therefore could have a wide-ranging impact. The findings can be used by policymakers to take action to mitigate the adverse effect of poor community conditions on health, such as improving local amenities and transport connectivity, providing green spaces and street lighting, and building paths for walking, running with police presence especially during inclement weather with unavoidable brown-outs to ensure safety of citizens.

WELLNEWS

Victor Dumaguing MD

Fast facts about breast cancer  

October brings new and very disturbing, alarming statistics about breast cancer. Worldwide, every 20 seconds, a woman is diagnosed to have breast cancer and in every 74 seconds, a woman succumbs to the disease. Putting it another way, 400,000 women die from breast cancer yearly, and 400 men, yes, member of the male human species, also die from this malignancy.
    Breast cancer and lung cancer are on the top of the list of causes of women's mortality every year. In the Philippines 27, 160 + breast cancer cases are reported every year making it the third most fatal cancer among Filipino women
Defined in its simplest way, cancer is the excessive, uncontrolled, purposeless growth of cells, abnormal in their structural form and therefore dysfunctional or unable to do its intended role in the human body.
    To drive home the point, with the indulgence of our dear readers, allow me to share an instance in which the notion of cancer can be misunderstood. To the layman, white blood cells are the soldiers - defenders, protectors, warriors - that would destroy or kill microbes or any harmful invader that gains access or entry inside the body.
    Thus, if this same layman is told that leukemia is an excessive growth and increase in white blood cells or leukocytes, his " philosophically" streak would make him believe that, leukemia should be good for the patient, because, as his warped logic would go, there would be more soldiers to fight the invader.
    That said, it must be emphasized that the white blood cells in leukemia are defective to start with, and therefore are useless or as the French would say, inutile' in the defense system of the body.
    The breast has two types of tissues; the glandular tissues include the milk-producing cells, while the so-called stromal tissues include the fatty, fibrous connective tissues in between glandular cells and the surroundings of breast. The sad reality is that all women are at risk. Breast cancer is the leading cause of death among women in 40-55 age bracket. Family history and genetics are strong players in he causation of the disease.
     Previous breast mass although earlier was diagnosed as benign- fibroadenoma is the most common breast mass among women in the 15-25 age group- fortunately, a benign mass- but has been recurring. Another interesting issue is early menstruation, or having menstruation beyond age 50. Likewise, women who never had children or those women who have had their first child in their 30s are at risk. Of course, there is that nagging issue about use of contraceptive pills. 
    This columnist is lucky to have watched the interview with experts in breast cancer management who clarified that the risk with pills causing cancer of the breast would be higher if the pill had been taken continuously for more than two years.     However, if there is a very strong family history, then prudence dictates that other forms of family planning be used.
    Lately, doctors and researchers have linked diet as a possible participants in the causation of cancer or malignant degeneration. Dyslipidemia- high cholesterol, elevated triglycerides- has been cited in breast, prostate and colon cancer registry. 
    Breastfeeding gets a big boost because all other things being equal, breastfeeding mothers are less likely to have the cancer.
    By the way, for the record, the size of a woman's breast has no relation whatsoever with risk of breast cancer.
    As of the moment, the author humbly admits, it is still an unsettled debatable issue, with the pros and the cons being forwarded left and right, thus, the advice is to have a heart-to-heart talk with your doctor.
    Breast cancer is not always noticeable by the outward appearance of the breast. Or for that matter, deep-seated small masses may be missed even by palpation. However, there are warning signs like nipple retraction, dimpling of the skin of the breast, lump or mass, bloody nipple discharge, non-healing wound in the breast or uneven sizes of the two breasts.
    Most tumors or lumps are in the upper portions- usually 50% on Right quadrant, 15% on left quadrant, 18% on the areola or nipple area and the rest at the lower hemispheres or halves of the breast.
    Notable celebrities who have had breast cancers include the Hollywood child actress Shirley Temple, singer Olivia Newton-John, and Linda McCartney of the famous Paul of the Beatles. Richard Roundtree is the most famous celebrity male victim of breast cancer.
    These people spent significant part of their lives calling urgent attention to the cancer and raising awareness to the fact that early detection is crucial and important in the survival rate of a patient.
    In May 2023, the US Preventive Service Task Force issue its newest protocol  which recommends women with average risk of breast cancer undergo mammogram at age 40 and every two years after. Women with relatives who had breast cancer may need ultrasound and even MRI of problematic lumps in their breast for early detection
    When Socrates intoned, “Know thyself ", probably he meant not only the totality of our being, but also our anatomy. Isn’t it time women, eh, all of us examine our breasts?