Breast Cancer: an alarming threat for woman's health in Jammu & Kashmir

Cancer is a group of related diseases marked with abnormal cell growth and metastasis to different parts of the body (National Cancer Institute, 2014). Cancer has become a major challenge in health sector for both developing as well as developed countries. It is the second leading cause of death in United States. According to GLOBOCAN estimates 2012, cancer caused 8.2 million deaths worldwide: out of which 617,000 in USA (7.5% of total cancer deaths), 1.3 million in European Union (15.6% of total cancer deaths) and 683,000 in India (8.3% of total cancer deaths). The worst scenario it is estimated that the deaths will raise to 13.0 million by 2030 around the world (IARC.GLOBOCAN 2012, Ferlay et al., 2015). Leukemia (5.3%) and breast cancer with (30-31%) are among most diagnosed and leading cause of deaths among cancers patients globally (Siegel et al., 2017).

Of late Jammu and Kashmir, especially Kashmir is witnessing rise in cancer with lung and breast cancers topping the list. Recent survey of Regional Cancer Centre, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, has reported the alarming number of cancer cases and also testified over 22,002 patients died out of cancer from the period of 2018-2022 across J&K. the alarming increase in Cancer cases has enforced Union Healthy Ministry to conduct a survey. Official survey disclosed astonishingly huge number of estimated cancer patients of 39041, among which 12675 were recorded in 2019, 13012 in 2020 and 13354 in 2021 alone. If “National Cancer Registry Programme Report 2020”, data of Cancer registry by Indian Council of Medical Research’s (ICMR) is to be believed the cases of cancer are very grim and future regarding cancer incidences does not look so bright, as they believe cancer related deaths will increase.  Further surveys from SKIMS indicate that Srinagar tops with (24%), followed by Anantnag (12.86%), Baramulla (12.60%), Budgam (9.49%), Pulwama (9.14%), Kulgam (5.93%), Kupwara (5.61%), Ganderbal (4.56%), Bandipora (4.17%) and Shopian (3.94%).

Let’s have a brief overview of Breast cancer. Like any other part of the world, Breast Cancer is the one of the leading causes of cancer in women in Jammu & Kashmir also. Breast Cancer develops because of genetic mutations or damage to DNA. Often Breast cancer is either a result of inherited genes that can cause cancer, such as the BRCA1 and BRCA2 genes or exposure to estrogen. Unlike the immune system of a healthy person, whose immune system attacks any abnormal DNA or growth, Cancerous persons does not do so and as a result uncontrollable cell division within breast tissue begin, resulting in breast Cancer, which deprives surrounding cells of nutrients and energy. Usually, the inner lining of the milk ducts or the lobules are the first cells to be affected with the breast Cancer and from there on, it can spread to other parts of the body through metastasis.

STAGES OF BREAST CANCER

A doctor will determine the stage of tumor based on the size of the tumor and how it has spread to lymph nodes or other parts of the body. Different stages of breast cancer are as follows

• Stage 0: when Cancerous cells are present only in ducts and have not spread to surrounding tissues.

• Stage 1:  Tumor usually measures up to 2 centimeters (cm) across at this stage. Lymph nodes are not affected, and only small number of cancerous cells are present in lymph nodes.

• Stage 2: When either tumor is 2 cm across and spread to nearby nodes or 2-5 cm across and has not spread to lymph nodes yet.

• Stage 3: When either tumor is 5cm across and spread to nearby nodes or larger than 5cm across and has started to spread to lymph nodes.

• Stage 4:  This is the stage when cancer starts to overtake to spread to distant organs, most often the bones, liver, brain, or lungs.

The following factors make developing breast cancer more likely, and some may be preventable.

Risk Factors: Main risk factors are

• Age

• Genetics

• History of breast cancer or breast lumps

• Dense breast tissue

• Estrogen exposure and breastfeeding

• Body weight

• Alcohol consumption

• Radiation exposure

• Hormone treatments

• Race

• Cosmetic implants and breast cancer survival

At the age of 20 years, breast cancer chances increase by 0.06% and by the age of 70 the same figure goes up to 3.84%. Likewise, the persons with certain mutations in the BRCA1 and BRCA2 genes has a higher chances of breast cancer, ovarian cancer, or both. Also, some mutations in TP53 are linked to increased breast cancers. These mutations are linked to heredity traits. People should often keep close watch if any of their relative have or had breast cancer as they are on high risk.

Symptoms:

Breast Cancer symptoms one should watch for:

The first of many symptoms in breast cancer is usually area of thickened tissue in the breast or a lump in the breast or an armpit. often rash on nipples or around, bloody discharge from nipples, inverted or sunken nipples, change in the size or shape of breast and peeling, scaling of the skin of breast or nipples should be watched for.

Diagnosis:

Upon the suspicious of any of the above symptoms one should visit doctor and he or she may diagnose for breast cancer by following methods:

• Breast Exam

• Imaging Tests: 

• Mammogram

• Ultrasound

• MRI

• Biopsy

Treatment:

The treatment of cancer depends on many factors like stage, age, hormonal level, and overall health of patient. The main treatment options include:

Surgery:

• Lumpectomy

• Mastectomy

• Sentinel node biopsy

• Axillary lymph node dissection

• Reconstruction

Radiation therapy

Chemotherapy

Hormone-blocking therapy

Biological treatment

Prevention:

We cannot prevent breast cancer. However, lifestyle changes like reducing alcohol consumption, having healthy diet like fresh fruits and vegetables, and getting enough exercise may reduce risk of getting breast cancer.

Lifestyle, food habits and lack of public awareness and education are believed to be main driving force of growing cancer in Jammu and Kashmir. Be it overloaded pesticide in our day today food, fast foods, or overdose of smoking, each one of them contributes towards cancer development. We at DAR Medicare are committed for the public awareness of preventive measures of cancer especially in Kashmir and we will be conducting seminars in this regard very soon; so, you all stay tuned and till next blog take care of your health.

                                                                                                                            -Dr. Javeed Ahmad Bhat