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| HEALTH TRIBUNE | Wednesday, October 23, 2002, Chandigarh, India |
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Breast cancer scenario in India AYURVEDA & YOU |
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Breast cancer scenario in India Breast cancer is one of the commonest cancers affecting females. It is estimated that this disease will afflict one in eight females in America during their lifetime. The disease is not so common in India, but is also not so uncommon as was thought earlier. Statistics reveal that breast cancer is rapidly increasing in its incidence in India and it has overtaken cancer of the cervix. The ICMR’s recent data shows that breast cancer is the commonest cancer to affect Indian females in metropolitan cities. Breast cancer is a disease of the old age, the peak incidence is in the fifth and sixth decades. But in India the disease is seen a decade earlier, probably because of shorter longevity in Indian females as compared to their counterparts in America. Breast cancer is supposed to be more common among affluent people, those exposed to the modern environment; the evidence being that the disease is seen very commonly among Parsis. But, then, in India the disease is seen very commonly in poor, illiterate and backward class people also. The explanation may be because a majority of our people belong to this lower social stratum. Statistically, breast cancer is supposed to be more common among spinsters, women who have got married but have not born children, have born children but have not breast-fed their babies. Literature does show the correlation of smoking, alcohol drinking and high fat intake to the causation of breast cancer, and this probably explains its etiological relationship to the modern environment. An interesting study shows that Indian women who migrate to the USA are not as susceptible to breast cancer as American women are, but the second generation of migrants become as vulnerable to breast cancer as their counterparts in the USA. Probably, environmental factors take time to bring about the required changes in the chromosomal level. Breast cancer has a genetic linkage. It is supposed to be more common among females whose first relatives had this problem. This is of importance as such women are bracketed among “high risk patients” and have to start their screening process at least a decade earlier than women with a negative family background. The identification of the abnormal chromosome and its repair by genetic engineering is being tried at the experimental level. In developed countries shortly it would be made available, but in India the application of such a highly sophisticated technology may still require a long time. Breast cancer, from the viewpoint of clinical management, is divided into three stages: early breast cancer, locally advanced and late, or metastatic disease. Early breast cancer includes tumours of less than 5 cm in diameter; locally advanced tumours are more than 5 cm and any patient with secondaries from the breast tumour in other organs are included in the late stage of disease. The common sites for secondaries being lymph nodes (at distant sites, axilla being included in early breast cancer), bones, lungs, liver, brain, skin, etc. In India, we see very few patients of early breast cancer, hardly 5 to 10 per cent of patients; whereas in developed countries a majority of the patients are of this group. As a matter of fact, in America, early breast cancer includes only the patients in whom the tumour is not palpable from outside but has been detected by mammography only. In India, about 50 per cent of patients of breast cancer are in the locally advanced group. It has been clearly shown that the size of the tumour at the time of starting treatment is directly related to the ultimate result; survival for 20 years is found in more than 90 per cent of the patients with a tumour diameter of 1 cm. This comes down to only 50 per cent of the tumour diameter is 3 cm, or more. This clearly shows the importance of early detection of tumour. The cancer tumour can be detected in the asymptomatic stage when the person does not have any complaint regarding the tumour, and this is possible by following regular screening protocols. The screening protocol should be started from the age of 40 years and consists of mammography, clinical examination by a specialist surgeon and self-examination of breasts by the female herself. Regular mammography of both breasts every second year coupled with a clinical examination by a competent surgeon are supposed to decrease the deaths from breast cancer by almost 30 per cent. Breast screening is commonly practised in developing countries, but unfortunately in India, because of financial constraints, it has not become a common practice. Mammography costs only Rs 900 and it is a worthwhile investment for all those who can afford it. Self-examination of breasts has to be learnt so that it can be practised properly. Mammography can detect a swelling as small as 0.5 cm in the depth of the breast which may not be palpable from the surface. A biopsy of this lump requires to be taken for the confirmation of the diagnosis, and this can be undertaken by stereotaxis technique or by mammotome. The former technique is available at a few centres in the country, but the later is still to come into practice. A breast cancer patient has to be thoroughly investigated not only to rule out the presence of metastasis in other parts of the body but also to assess her suitability for operation, chemotherapy and radiotherapy. It has now been conclusively proved that a breast cancer patient not only requires operation but also multimodality treatment, which includes chemotherapy, radiotherapy, hormone therapy and immunotherapy. A right combination of different modalities of treatment with proper planning and sequencing is important to get the maximum benefit to the patient. This depends upon the stage of the disease, the menstrual status of the patient, the histopathological findings of the excised tumour, the evaluated tumour markers and, most important, the expertise and experience of the treating surgeon. For over 100 years radical surgery for breast cancer has been practised all over the world. This mutilating operation has been giving a lot of psychological problems to the patients. For the last 25 years it has been conclusively shown that total removal of the breast is not required. The tumour can be excised along with a rim of normal breast tissue and the breast can be preserved, thus giving an excellent cosmetic look to the patient. Of course, this surgery has to be combined with the administration of other forms of treatment modalities so as to get the best results. And the best part is that the ultimate outcome or result remains equally good if not better than the total removal of the breast. Unfortunately, this form of breast conservation surgery is practised at very few centres in our country, hardly at 8 to 10 centres. The main reason is the non-availability of expertise or experience on the part of the surgeon. It has been reported that even in the USA only 50 per cent of the patients who can undergo this form of breast preservation surgery are subjected to total removal of the diseased breast. The continued follow-up of the patient with the treating surgeon is very important not only for the rehabilitation of the patient but also for detecting the recurrence or distant metastasis. The recurrence of the cancer of the breast can be effectively kept under control if it is detected early and proper treatment instituted in time. Another important fact the world-wide research has clearly brought out is the relationship of the treating doctor to the ultimate result of the cancer disease. It has been shown that if the treating surgeon is specialising in the management of breast cancer then the results are significantly much better than a surgeon who has no special experience or expertise in this subject. Unfortunately, breast cancer as a speciality has not become very popular. There are very few surgeons or centres taking very active interest in this topic. But, at the same time, there are a few centres and a few surgeons in our country also who can provide the same quality of breast cancer management as anywhere in the world. The writer, a senior consultant surgeon, is a former Professor and Head, Department of Surgery, PGI, Chandigarh.
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AYURVEDA & YOU R. Vatsyayan Curd is a biproduct of milk. According to a rough estimate, nearly 50 per cent of the total milk is transformed into this form. Though the Western world knows it as yoghurt, its Sanskrit name is dahi. All the leading lights of ayurveda, including Charaka and Sushruta, have amply written on its qualities and usefulness. It is considered as one of the most wholesome food items throughout the world. Ayurvedic texts describe it as sweet and sour in taste and sour in the post-digestive effect. Apparently, one feels that curd might be cooling in effect, but it is just the opposite. While aggravating kapha and pitta. It has heavy and unctuous properties. Modern medical science attributes curd to be rich in protein, vitamins and minerals, and says that it is the cultured form of milk. A bacteria called lactobacillus balgaricus turns it into coagulated form. Some ancient authors, while giving more details about curd, have said that there are three kinds of curd: sweet, sour and extremely sour. While the first one increases the slimy secretions of the organs and is nutritive whereas, other two have been described to derange kapha and pitta, resulting in the vitiation of blood. The curd which is half curdled has been considered as a totally unwholesome food item. There is a good deal of description about curd derived from various types of milk. The curdled cow milk has been told to be augmenter of the immune system, demulcent, easy to digest, appetising and strength-promoting while the curd prepared from buffalo milk is considered heavy and slow to digest. The quality of curd also depends, to a great extent, on the starter used. The better and measured the seed, the sweeter will be the aroma and firmer will be the texture of the curd. In ayurveda indications and contra-indications to use curd have been described depending upon the seasons, personalities and the types of the disease. The first half of winter is the best time to use curd, but is advised not to be used during the rainy season. Curd best suits as a food item at breakfast and lunch, but most authors have emphasised that it should never be taken at dinner time. Curd has its therapeutic value in many diseases. Not only that it has been described as a tonic and is credited with the properties to prevent premature aging, it also brings relief to patients of diarrhoea and dysentery and is recommended in chronic specific and non-specific colitis. In conditions where absorption is impaired and patients are unable to digest milk, one should take cloth-filtered curd or residual water of curd which is light, refrigerant and purifying to the internal channels of the body. In viral jaundice, one gm powder of the herb called kutaki taken two times a day with a small bowl of curd brings faster recovery. Curd is equally beneficial for external applications also. In many obstinate skin disorders like psoriasis and eczema where the application of soap aggravates the problem, patients are best advised to use curd while bathing. Conditions where skin is dry, coarse and discoloured, curd can be applied on the skin by mixing in it a crushed flake of the mustard seeds from which oil has been extracted. Curd is also used in Indian homes to vitalise and condition the hair. Despite so many benefits, ayurvedic texts have marked curd as “abhishyandi”, which means it can block the finer channels of the body. Curd can be made more suitable to the physiological systems by adding a pinch of the powder made of 200 gm of rock salt (saindha namak), 100 gm of roasted zeera and 50 gm of black pepper into it. The writer is an accomplished ayurvedic consultant based at Ludhiana. |
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