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How Can I Better Support A Breast Cancer Survivor?

Introduction

In 2020, <a href="https://merisehat.pk/disease/breast-cancer">breast cancer</a> accounted for 28.7% of new cancer cases in Pakistani women of all ages<a href="#accordion">[1]</a>. With the highest incidence in Asia, the country continues to struggle with increasing morbidity and mortality rates, especially among young females<a href="#accordion">[2]</a>.&nbsp;

As per a Pakistani study, 89% of breast cancer patients are diagnosed at a later stage while 59% present at an advanced stage<a href="#accordion">[3]</a>. This delay in diagnosis can reduce survival rates and cause an increased mortality rate among patients. Researchers believe that a lack of awareness and a combination of sociocultural and personal factors contribute to the delay. Furthermore, a delayed diagnosis also translates into a poor prognosis and the need for more aggressive treatments.&nbsp;

Treatments such as chemotherapy, radiation, and mastectomy can affect an individual&#39;s physical and mental health. The fear of side effects of chemotherapy such as loss of hair and eyebrows often causes women to delay seeking help. Moreover, mastectomy is often associated with body image issues that can be extremely challenging in a world where a woman&#39;s attractiveness is solely based on her physical appearance.&nbsp;

However, <a href="https://www.merisehat.pk/disease/breast-cancer">breast cancer</a> can have an implication on the lives of both survivors and their friends and family. Thus, it is important to identify the challenges they face and effectively address them to improve their overall quality of life.&nbsp;

&nbsp;

Understanding How To Support A Breast Cancer Survivor

A UK study looked at more than 50,000 breast cancer survivors and a control group consisting of over 200,000 women with no history of cancer. The results revealed a higher risk of anxiety, depression, fatigue, pain, and sexual dysfunction among the survivors<a href="#accordion">[4]</a>. This is similar to the results of a Pakistani study in which 74% of survivors reported feeling varying levels of anxiety. Moreover, 83% complained of fatigue, 75% of body pain or headache, 77% had reduced appetite, 63% had weight loss, and 77% reported sleep disturbances<a href="#accordion">[5]</a>. The fear of the recurrence of cancer is believed to further add to the anxiety. Thus, breast cancer can take a physical and psychological toll on the survivors.

In a society where physical beauty is often given preference over everything else, it is no surprise that breast surgery can elicit depression and anxiety in breast cancer patients. Across all cultures and countries, including Pakistan, a woman&#39;s breasts are considered a symbol of femininity, sexual beauty, and motherhood. Thus, the physical change associated with breast surgery or mastectomy can significantly lower a woman&#39;s self-esteem<a href="#accordion">[5]</a>. They may develop a negative image of their bodies, leading to lowered self-confidence and mental health problems. Furthermore, hairlessness, loss of eyelashes and eyebrows, and skin discoloration associated with cancer treatment also take a toll on the person&#39;s mental health.&nbsp;

The combination of all these factors may lead to the survivors feeling stigmatized. This can lead to many women never seeking help or talking about their concerns and self-isolation in some cases.&nbsp;

&nbsp;

The following are some of the ways one can help breast cancer survivors with their physical and mental health:

<ul>
	<li>
	<h5>Breast Reconstructive Surgery </h5>
	</li>
</ul>

Many women opt for reconstructive surgery following mastectomy or lumpectomy. A plastic surgeon may use an implant, a flap tissue from another part of the patient&#39;s body, or both to create a breast shape. However, if you don&#39;t want to go for reconstructive surgery, there are other options such as a breast form or prosthesis that one can wear under the bra.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Wigs And Accessories</h5>
	</li>
</ul>

​​​​​​​Women dealing with hair loss can wear a wig, hat, or scarves while they wait for the hair to grow back. Or you may feel comfortable flaunting the baldness which is just a reminder of the challenges you&#39;ve overcome as a survivor.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Cognitive Behavioral Therapy (CBT) </h5>
	</li>
</ul>

​​​​​​​CBT can prove beneficial in treating mental disorders among breast cancer survivors. It can also help them deal with the fear of recurrence.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Acceptance And Commitment Therapy (ACT)</h5>
	</li>
</ul>

​​​​​​​Unlike CBT which aims to change one&#39;s unhealthy thoughts and feelings, ACT teaches skills that help people accept their realities and live with them.

&nbsp;

<ul>
	<li>
	<h5>Mindfulness-Based Therapy</h5>
	</li>
</ul>

​​​​​​​Mindfulness meditation helps people become aware and accepting of their thoughts and feelings, without any judgment. In breast cancer survivors, it can help improve fatigue, stress, and symptoms of depression and anxiety.

&nbsp;

<ul>
	<li>
	<h5>Medication</h5>
	</li>
</ul>

​​​​​​​Some patients may also benefit from anti-anxiety pills and anti-depressants. However, professional help should be sought before starting any medication.

&nbsp;

<h4>"Supporting cancer survivors can lower their stress levels. Head on over to the <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a> to monitor your stress level today!" </h4>

While cancer is a challenging time for the patient, it also takes a toll on one&#39;s family and friends who are helping them through the disease. Moreover, it can often put a strain on people&#39;s relationships with their partners. According to research, anxiety, and depression more commonly affects long-term cancer survivors and their spouses compared to healthy controls<a href="#accordion">[6]</a>.&nbsp;

If a friend or family member is a breast cancer survivor, the following can help you deal with the emotional and psychological toll:

<ul>
	<li>Support Groups - Online or in-person support groups can help people realize that they are not alone. It allows you to talk about your feelings in a safe space and trade advice with others going through similar experiences. There are also many support groups for family members of survivors on social media.&nbsp;</li>
	<li>Couples Therapy - Cancer can often affect one&#39;s personal relationships. Many partners may benefit from couple&rsquo;s therapy to improve their family and marriage relationships.&nbsp;</li>
</ul>

&nbsp;

Conclusion

While a cancer diagnosis and going through treatment is emotionally and physically exhausting, the post-cancer period is often what really tests the person. Both cancer survivors and their family members go through a period of psychological distress. Therefore, there is a need for programs and interventions that target both patients and their caretakers and family. Moreover, early screening breast cancer patients for mental health disorders can also help provide timely intervention and reduce the disease burden.

Key Points

<ul>
	<li>A combination of physical, cultural, and social factors contributes to a delayed diagnosis of breast cancer among women. This leads to a poor prognosis and the use of aggressive treatments.</li>
	<li>Breast cancer survivors often report fatigue, pain, sleep disturbances, <a href="https://merisehat.pk/disease/depression">depression</a>, and <a href="https://merisehat.pk/disease/anxiety">anxiety</a>. Moreover, post-mastectomy or breast surgery, women report lower self-esteem and body image issues as breasts are considered a symbol of femininity, beauty, and womanhood.&nbsp;</li>
	<li>Breast reconstructive surgery, cognitive behavioral&nbsp;therapy, mindfulness meditation, acceptance and commitment therapy, and medications can help breast cancer survivors improve their overall quality of life.</li>
	<li>Partners of breast cancer survivors also report similar levels of anxiety and depression as them. Therefore, there is a need for effective programs that target both survivors and their families to help provide them timely support.&nbsp;</li>
</ul>

&nbsp;

[1] International Agency for Research on Cancer, 2021. Pakistan Globocan 2020. [Online]

[2] Sohail, S. & Alam, S. N., 2007. Breast cancer in pakistan - awareness and early detection. Journal of the College of Physicians and Surgeons Pakistan, 17(12), pp. 711-2.

[3] Gulzar, F. et al., 2019. Identifying the reasons for delayed presentation of Pakistani breast cancer patients at a tertiary care hospital. Cancer management and research, Volume 11, pp. 1087-1096.

[4] Carreira, H. et al., 2021. Associations between breast cancer survivorship and adverse mental health outcomes: A matched population-based cohort study in the United Kingdom. PLOS Medicine, 18(1).

[5] Azam, M. et al., 2021. An empirical study on quality of life and related factors of Pakistani breast cancer survivors. Scientific Reports, Volume 11.

[6] Mitchell, A. J. et al., 2013. Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis. The Lancet Oncology, 14(8), pp. 721-732.

Nimrah H. Sattar

Medilink Consultant clinic

ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Menopause And Breast Cancer

According to research, in all of Asia, Pakistan has the highest rate of <a href="https://merisehat.pk/disease/side-effects-of-breast-cancer-treatment">breast cancer</a>, with 1 in 9 women at risk of getting diagnosed with breast cancer<a href="#accordion">[7]</a>&nbsp;<a href="#accordion">[6]</a>. This is usually because of the myths associated with the condition. Delayed screening means the cancer is diagnosed when it has advanced and there is little chance of survival.

Understanding the link between Menopause and Breast cancer

Age is one of the major risk factors for developing breast cancer. The likelihood of being diagnosed with a malignant tumor in the breast is greatest between the ages of 45 and 55. Unless an individual has previously undergone chemotherapy, surgeries such as hysterectomy or oophorectomy, or possesses a genetic predisposition to experience early menopause, this is when a natural decline in hormone levels occurs.

The decreased production of estrogen and progesterone leads to irregular menstrual periods before they eventually cease. During this phase, one may experience hot flashes, sexual difficulties, insomnia, memory problems, osteoporosis, and anxiety.

However, menopause itself is not our concern here. Menopause itself is not related to a higher risk of getting cancer. It&rsquo;s the fact that 1 out of 8 cases of breast cancer occur during their lifetime, mostly in women over 50, that&rsquo;s worrisome<a href="#accordion">[8]</a>. This is why the age factor is important &ndash; a girl who starts menstruating before 12 and/or experiences menopause after 55 will have an increased number of ovulations and, thereby, increased exposure to hormones like estrogen.

And then there&rsquo;s the issue of medications or treatments like hormone replacement therapy one may be taking to manage the menopausal symptoms, which increases the risk of breast cancer. 
&nbsp;

While menopause is a risk factor for breast cancer, interestingly, breast cancer can also induce menopause. Treatments like chemotherapy, ovarian suppression (through surgery, hormone therapy, or radiotherapy), and hormone therapy (e.g., anastrozole, exemestane, letrozole, and tamoxifen) cause menopausal symptoms<a href="#accordion">[9]</a>.&nbsp; While each woman reacts differently to therapy, premature menopause due to breast cancer may be permanent (rather than temporary) if they&rsquo;re closer to the natural age of experiencing it. 
&nbsp;

Menopausal signs that are frequently experienced include:

<ul>
	<li>Joint pain</li>
	<li>Night sweats</li>
	<li>Anxiety and irritation</li>
	<li>Mood change</li>
	<li>Heart palpitations</li>
	<li>Change in libido</li>
	<li>Hot flushes</li>
	<li>Changes to hair and skin</li>
	<li>Weight gain, especially around our waist</li>
	<li>Difficulty sleeping</li>
	<li>Memory issues</li>
	<li>Vaginal dryness 
	&nbsp;</li>
</ul>

The onset of these symptoms can be gradual or sudden. It is worth mentioning that not all individuals experience all the listed symptoms, and the severity of symptoms can vary among individuals. 
&nbsp;

The estrogen-driven breast cancers, also known as estrogen-receptor-positive cancers, are a more common occurrence than aggressive cancers. They tend to develop gradually and have a lower mortality rate. In other words, they require less aggressive therapy and have a better outlook and reduced chance of recurrence.

According to studies, if you&rsquo;re overweight or obese post-menopause, you have a 20-60% greater risk of developing breast cancer than those who are lean<a href="#accordion">[10]</a>. This extra fat is the main source of estrogen at that time. It also produces proteins that increase inflammation throughout the body, which causes breast cancer to recur. 
&nbsp;

<h5 style="text-align:justify">Medications</h5>

There are two distinct kinds of drugs, and they both function differently. Aromatase inhibitors (AIs) reduce or halt the body&#39;s production of estrogen, which causes the tumors to die. Tamoxifen prevents estrogen from acting on breast cancer cells.

Both tamoxifen and an aromatase inhibitor can be used to treat postmenopausal individuals with estrogen-positive breast cancer. However, aromatase inhibitors are generally more effective and do not increase the risk of blood clots or uterine cancer<a href="#accordion">[10]</a>. 
&nbsp;

Exercising, a balanced diet, quitting smoking (including avoiding passive smoking) and drinking alcohol, and relieving stress can help breast cancer patients deal with the symptoms. 
&nbsp;

Menopause can be a risk factor for breast cancer and vice versa. However, you can overcome both issues with a balanced diet, a healthy lifestyle, proper checkups, and the right therapy.

[1]Sohail S, Alam SN. Breast cancer in Pakistan-awareness and early detection.

[2] Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. International journal of cancer. 2010 Dec 15;127(12):2893-917

[3] Clemons M, Simmons C. Identifying menopause in breast cancer patients: considerations and implications. Breast cancer research and treatment. 2007 Aug;104:115-20.

[4] Biglia N, Bounous VE, Sgro LG, D'Alonzo M, Pecchio S, Nappi RE. Genitourinary syndrome of menopause in breast cancer survivors: are we facing new and safe hopes?. Clinical Breast Cancer. 2015 Dec 1;15(6):413-20.

[5] De Villiers TJ, Pines A, Panay N, Gambacciani M, Archer DF, Baber RJ, Davis SR, Gompel AA, Henderson VW, Langer R, Lobo RA. Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. Climacteric. 2013 Jun 1;16(3):316-37.

[6] Academic.oup.com.

[7] Khan NH, Duan SF, Wu DD, Ji XY. Better Reporting and Awareness Campaigns Needed for Breast Cancer in Pakistani Women. Cancer Manag Res. 2021;13:2125-2129. Published 2021 Mar 2. doi:10.2147/CMAR.S270671

[8] NHS choices.

[9] Menopausal symptoms and breast cancer. Breast Cancer Now.

[10] Stepko B, En español , español E, 03 O. Dealing with breast cancer after menopause. AARP

Syeda Qurat-ul-Ain

Obesity And Breast Cancer

However, the relationship between <a href="https://merisehat.pk/disease/obesity">obesity</a> and breast cancer is not straightforward. Research indicates that gaining weight as an adult increases the risk, but being overweight since childhood does not have the same effect. Additionally, excess fat around the waist will pose a greater risk than having it around the hips or thighs<a href="#accordion">[1]</a>. 
&nbsp;

Understanding of the link between Obesity and Breast Cancer

A study using BMI and cancer incidence data found that around 37,670 new cases of cancer in men and 74,69 new cancer cases in women between 2011 and 2015 were due to excess body weight (i.e. overweight, obese, or morbidly obese)<a href="#accordion">[2]</a>.

The percentage of cases due to excess weight varied across different types of cancer, with the highest number of cases of liver/gallbladder and endometrial cancers in women and esophageal adenocarcinoma in men. 
&nbsp;

Obesity is a well-established risk factor for various cancers in women. For instance, obese women are at a high risk of developing breast cancer. Moreover, they experience different treatment outcomes due to their body weight.

Both pre-and postmenopausal women are at an increased risk of developing breast cancer due to increased body weight. However, it is believed that this risk may be lower in very young premenopausal women who have no family history of breast cancer and live in developed countries. Nevertheless, obese women, regardless of age, generally have poorer survival rates. 
&nbsp;

Obesity increases the risk of some cancers in the following ways<a href="#accordion">[2]</a>:

<ul>
	<li>Fat tissue produces excess estrogen, which is associated with increased risks of breast, endometrial, ovarian, and some other cancers.</li>
	<li>Obese people usually have increased blood levels of insulin and insulin-like growth factor-1, which is responsible for the development of colon, kidney, prostate, and endometrial cancers.</li>
	<li>Obesity combined with chronic inflammatory conditions, such as gallstones or non-alcoholic fatty liver disease, can cause oxidative stress and increase the risk of the biliary tract and other cancers.</li>
	<li>Fat cells produce hormones called adipokines that can stimulate or inhibit cell growth, with high levels of leptin promoting aberrant cell proliferation and low levels of adiponectin having antiproliferative effects that protect against tumor growth.</li>
	<li>Obesity increases risk through impaired tumor immunity and changes in the mechanical properties of the scaffolding tissue that surrounds developing tumors.</li>
	<li>A poor diet is also linked to obesity since it lacks essential nutrients for maintaining healthy cells and preventing cancer.</li>
	<li>Sedentary behavior and lack of physical activity are associated with an increased risk of obesity and breast cancer.</li>
	<li>Certain genetic factors make individuals more susceptible to obesity and breast cancer.</li>
	<li>Obesity can lead to difficulties in cancer screening and management. For instance, screening for cervical cancer is not very effective in obese women. 
	&nbsp;</li>
</ul>

Note: While obesity is a risk factor for breast cancer, not all obese individuals develop breast cancer. Other factors, such as age, family history, and lifestyle choices, can also influence an individual&#39;s risk of breast cancer. 
&nbsp;

Observational studies suggest that obese people losing excess weight can reduce the risk of certain types of cancer, such as breast, endometrial, colon, and prostate cancers. However, these studies cannot prove that obesity causes cancer, and caution should be exercised in interpreting their findings.

In a study of postmenopausal women, intentional weight loss of more than 5% of body weight was associated with a lower risk of obesity-related cancers, especially endometrial cancer. 
&nbsp;

Bariatric surgery among obese people, particularly women, was associated with reduced risks of cancer overall, hormone-related cancers, and obesity-related cancers such as postmenopausal breast cancer, endometrial cancer, and colon cancer.

Nevertheless, more research is needed to fully understand the relationship between weight loss and the risk of cancer among obese people<a href="#accordion">[2]</a>. 
&nbsp;

Losing weight can improve overall health:

<ul>
	<li>Reduces risk of chronic diseases, such as type 2 diabetes, heart disease, and certain types of cancer</li>
	<li>Lowers blood pressure and improves cholesterol levels</li>
	<li>Decreases strain on joints, hence, reducing pain and improving mobility</li>
	<li>Improves sleep quality and reduces the risk of sleep apnea</li>
	<li>Improves mood and decreases risk of depression and anxiety</li>
	<li>Increases energy levels and improves physical performance</li>
	<li>Reduces risk of pregnancy complications and infertility</li>
	<li>Improves immune function and reduces inflammation</li>
	<li>Improves brain function and cognitive performance 
	&nbsp;</li>
</ul>

An effective way to reduce weight includes a combination of a healthy diet, regular exercise, and lifestyle changes. Here are some specific tips that can help<a href="#accordion">[3]</a>:

Eat A Balanced And Nutritious Diet: It&rsquo;s important to eat a balanced diet, which includes plenty of fruits and vegetables, whole grains, lean proteins, and healthy fats. Avoid processed and high-calorie foods.

Control Portion Sizes: Use smaller plates and cups, and measure the portions to avoid overeating.

Stay Hydrated: Drink plenty of water and avoid sugary drinks.

Exercise Regularly: At least 30 minutes of moderate-intensity exercise every day, such as brisk walking, cycling, or swimming, is recommended.

Be Active: Find ways to stay active throughout the day. For instance, take the stairs instead of the elevator or walk during lunch breaks.

Get Enough Sleep: Aim for at least 7-8 hours of sleep every night, as lack of sleep can affect weight loss.

Manage Stress: Stress can contribute to weight gain, so find ways to manage stress, such as meditation or deep breathing exercises.

Seek Support: A registered dietitian or a personal trainer can help develop a personalized weight loss plan and provide support and accountability. 
&nbsp;

Obesity has been linked to an increased risk of breast cancer in postmenopausal women. This is thought to be because adipose tissue produces estrogen, which can promote the growth of estrogen-sensitive breast cancer cells. Additionally, obesity can lead to chronic inflammation and insulin resistance; both increase the risk of breast cancer. 
&nbsp;

However, the relationship between obesity and breast cancer is complex and not fully understood. Other factors, such as age, family history of breast cancer, and hormone therapy use, can also affect a woman&#39;s risk of developing breast cancer. Therefore, women should maintain a healthy weight and engage in regular physical activity to reduce their risk of breast cancer and other health problems. Additionally, regular breast cancer screening, such as mammograms, can help detect breast cancer early when it is most treatable. 
&nbsp;

Key Takeaways

<ul>
	<li>Obesity is a major risk factor for breast cancer, especially in postmenopausal women.</li>
	<li>Excess body fat can cause hormonal imbalances that increase the risk of breast cancer.</li>
	<li>Obesity can also lead to inflammation, which can promote the development of breast cancer.</li>
	<li>Obese women are more likely to have larger tumors and more aggressive forms of breast cancer.</li>
	<li>Obesity can reduce the effectiveness of breast cancer treatment and increase the risk of recurrence.</li>
	<li>Losing weight can reduce the risk of developing breast cancer in postmenopausal women.</li>
	<li>Maintaining a healthy weight through a balanced diet and regular exercise can reduce the risk of breast cancer.</li>
	<li>Obese women may have difficulty detecting breast cancer through self-examination or mammography.</li>
	<li>Breast cancer survivors who are overweight or obese have a higher risk of recurrence and lower survival rates.</li>
	<li>Addressing obesity through lifestyle changes and medical interventions can improve overall health and reduce the risk of breast cancer. 
	&nbsp;</li>
</ul>

[1] How your weight may affect your risk of breast cancer. American Cancer Society.

[2] Obesity and cancer fact sheet. National Cancer Institute.

[3] Health effects of overweight and obesity. Centers for Disease Control and Prevention.

[4] Clinics in oncology research article.

Sarah Mhowwala

Is A Family History Of Ovarian Cancer A Risk Factor For Breast Cancer?

Inherited mutations in the BRCA1 and BRCA2 genes are known to increase the risk of both breast and ovarian cancers. About 3% of breast cancers and 10% of ovarian cancers are caused by inherited mutations in these genes1. Other inherited mutations can also increase the risk of developing breast and ovarian cancers, but BRCA1 and BRCA2 are the most common.

Even though breast cancer is more common in women, men with these mutations are also at an increased risk of developing breast cancer. Additionally, BRCA mutations can also increase the risk of pancreatic cancer and, in men, high-grade prostate cancer.

Genetic counseling and testing can help you determine if you are at increased risk for these cancers and allow you to take steps to prevent them or detect them earlier when they are more treatable.

This article explores the link between breast and ovarian cancer, and how your family health history can help you assess your risk for these cancers. 
&nbsp;

Understanding the link between Ovarian Cancer and Breast Cancer

Ovarian cancer is a term used to describe a group of diseases that begin in the ovaries, fallopian tubes, or the peritoneum, which is the lining of the abdominal cavity.

In women, the reproductive system includes two ovaries in the pelvis, one on each side of the uterus. Ovaries don&rsquo;t just produce eggs. They are also responsible for the female sex hormones estrogen and progesterone, which play an important role in the development of female reproductive organs and the regulation of the menstrual cycle.

Ovarian cancer affects their ability to function properly and causes a range of symptoms, including abdominal pain, bloating, and changes in bowel habits. Successful treatment and survival depend on early detection and treatment of cancer. 
&nbsp;

Hereditary Breast and Ovarian Cancer (HBOC) is a genetic condition that is passed down from one generation to another within a family. It is caused by mutations in two genes, called BRCA1 and BRCA<a href="#accordion">[2]</a>. 
&nbsp;

These genes play a crucial role in regulating the growth and repair of cells in the body, including breast and ovarian cells. Women who carry a harmful mutation in either BRCA1 or BRCA2 have an increased risk of developing breast and ovarian cancers during their lifetime.

The risk of developing breast cancer is estimated to be between 40-85% for women with a BRCA1 mutation. BRCA2 carriers have about the same risk of breast cancer<a href="#accordion">[2]</a>. The risk of developing ovarian cancer is 39-44% for BRCA1 mutations and 11-17% for BRCA2 mutations<a href="#accordion">[3]</a>. 
&nbsp;

HBOC is usually considered in case of a personal or family history of any of the following:

<ul>
	<li>Women diagnosed with breast cancer at the age of 45 or younger</li>
	<li>Women diagnosed with breast cancer at the age of 46-50 or younger, along with at least one close blood relative with breast cancer at any age or limited family history</li>
	<li>Women diagnosed with triple negative breast cancer at the age of 60 or younger</li>
	<li>Men diagnosed with breast cancer at any age</li>
	<li>Individuals diagnosed with ovarian, fallopian tube, or primary peritoneal cancer</li>
	<li>Individuals diagnosed with cancer in both breasts</li>
	<li>Individuals diagnosed with pancreatic cancer or <a href="https://merisehat.pk/disease/prostate-cancer">prostate cancer</a> with a Gleason score of 7 or higher</li>
	<li>Individuals with a family history of breast, ovarian, pancreatic, or prostate cancer among multiple blood relatives</li>
	<li>Individuals with Ashkenazi (Eastern European) Jewish ancestry</li>
	<li>Individuals with a known BRCA mutation in the family 
	&nbsp;</li>
</ul>

Individuals at high risk should consider genetic counseling and testing to determine if they carry a harmful mutation in one of these genes, and to explore options for managing their cancer risk, such as increased surveillance or risk-reducing surgeries. 
&nbsp;

Yes, women with a family history of ovarian cancer should consider undergoing breast cancer screening at an earlier age than women without a family history.

The American Cancer Society recommends that women with a family history of breast or ovarian cancer consider genetic counseling and testing to determine if they have a higher risk of developing cancer<a href="#accordion">[4]</a>. 
&nbsp;

Women with a BRCA1 or BRCA2 mutation have the following screening options:

<ul>
	<li>Monthly breast self-examinations beginning at 18 years</li>
	<li>Bi-annual clinical breast examinations beginning at 25 years</li>
	<li>Annual MRI scans of both breasts between ages 25 and 29</li>
	<li>Annual breast MRI and mammogram between ages 30 and 75</li>
	<li>Bi-annual pelvic exam, a transvaginal ultrasound, and CA-125 blood test beginning at age 30-35</li>
	<li>Prophylactic salpingo-oophorectomy between ages 35 and 40 and after the woman is done giving birth to children 
	&nbsp;</li>
</ul>

Men with a BRCA1 or BRCA2 mutation have the following screening options:

<ul>
	<li>Monthly breast self-examinations beginning at 35 years</li>
	<li>Annual clinical breast examinations beginning at 35 years</li>
	<li>Baseline mammogram beginning at age 35 (in case of BRCA2 mutation along with gynecomastia)</li>
	<li>Annual prostate cancer screening, PSA blood test, and digital rectal exam beginning at 45 years 
	&nbsp;</li>
</ul>

Note: Talk to your doctor about your screening options as each person is different and also because, with new methods being developed, these options may change over time. 
&nbsp;

The following lifestyle changes can help reduce the risk of breast cancer in women with a family history of ovarian cancer<a href="#accordion">[5]</a>: 
&nbsp;

<h5>Maintaining A Healthy Weight</h5>

Studies have shown that women who are overweight or obese are more likely to develop breast cancer, particularly after menopause. Therefore, women with a family history of ovarian cancer should maintain a healthy weight through a healthy diet and regular exercise. 
&nbsp;

<h5>Sticking With Your Exercise Program</h5>

Regular physical activity can help reduce the risk of breast cancer in women, including those with a family history of ovarian cancer. Studies have shown that women who engage in regular physical activity have a lower risk of developing breast cancer than those who lead a sedentary lifestyle. It is recommended that women engage in at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week. 
&nbsp;

<h5>Quitting Alcohol</h5>

Alcohol consumption has been linked to an increased risk of breast cancer. Women with a family history of ovarian cancer should quit alcohol to reduce their risk of breast cancer. 
&nbsp;

<h5>Eating A Healthy Diet</h5>

A healthy diet, which is rich in fruits, vegetables, and whole grains, may help reduce the risk of breast cancer. Additionally, it is recommended that women limit their intake of processed and red meats to further reduce their risk. 
&nbsp;

Note: These lifestyle changes may not eliminate the increased risk associated with a family history of ovarian cancer. However, they can still be beneficial in reducing the risk of breast cancer and improving overall health. 
&nbsp;

A family history of ovarian cancer is a risk factor for breast cancer. Women with a first-degree relative (mother, sister, or daughter) with ovarian cancer have a higher risk of developing breast cancer than women without a family history. Additionally, women with a family history of both breast and ovarian cancer have an even higher risk of developing breast cancer. 
&nbsp;

Women with a family history of ovarian cancer need to undergo breast cancer screening at an earlier age and consider genetic counseling and testing to determine if they have a higher risk of developing cancer.

While lifestyle changes such as maintaining a healthy weight, engaging in regular physical activity, and quitting alcohol can help reduce the risk of breast cancer, they may not eliminate the increased risk associated with a family history of cancer. Therefore, early detection through regular screening and genetic counseling is important to manage the risk of breast cancer in women with a family history of ovarian cancer. 
&nbsp;

<ul>
	<li>Family history of ovarian cancer is a risk factor for breast cancer. Women with a first-degree relative with ovarian cancer have a higher risk of developing breast cancer than women without a family history.</li>
	<li>Women with a family history of both breast and ovarian cancer have a higher risk of developing breast cancer.</li>
	<li>Women with a family history of ovarian cancer should consider undergoing breast cancer screening at an earlier age than women without a family history.</li>
	<li>Early detection through regular breast cancer screening and genetic counseling is important to manage the risk of breast cancer in women with a family history of ovarian cancer. 
	&nbsp;</li>
</ul>

[1] The BRCA1 and BRCA2 genes. Centers for Disease Control and Prevention.

[2] Pruthi S, Gostout BS, Lindor NM. Identification and Management of Women With BRCA Mutations or Hereditary Predisposition for Breast and Ovarian Cancer. Mayo Clin Proc. 2010;85(12):1111-1120. doi:10.4065/mcp.2010.0414

[3] Walker M, Jacobson M, Sobel M. Management of ovarian cancer risk in women with BRCA1/2 pathogenic variants. CMAJ. 2019;191(32):E886-E893. doi:10.1503/cmaj.190281

[4] Hereditary breast and ovarian cancer. Cancer.Net

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

Breast Self-Exam: The Hows and Whys

In Pakistan, 1 in every 9 women is at risk of developing <a href="https://www.merisehat.pk/disease/breast-cancer">breast cancer</a><a href="#accordion">[1]</a>.. Moreover, breast cancer is also the most frequent cancer among both men and women in the country, accounting for 14.5% of new cases in 2020<a href="#accordion">[2]</a>. Moreover, the country continues to have a high mortality rate from the disease.&nbsp; 
&nbsp;

Developing countries like Pakistan, despite the lower incidence, have a higher morbidity and mortality rate of breast cancer than developed Western nations. This contrast is due to a myriad of reasons namely: less number of screening and treatment facilities, women are often unaware of <a href="https://www.merisehat.pk/disease/breast-cancer">breast cancer symptoms</a> or treatments and delay seeking help. As a result, many are diagnosed at a later stage and have higher mortality rates. The situation can be reversed with increasing awareness and the widespread availability of&nbsp; breast cancer screening programs.&nbsp; 
&nbsp;

Although mammograms can help detect breast cancers even before one feels a lump, breast self-exams allow you to become more familiar with the anatomy of your breasts and identify any changes.&nbsp;

&nbsp;

Understanding how to perform a self breast exam

Before you begin a breast self-exam, it is always good to discuss the correct technique with a doctor and ask for a demonstration. 
&nbsp;

Since hormonal changes can cause breast changes, a breast self-exam should be conducted a few days after the end of your menstrual cycle. However, post-menopausal women can choose any day of the month. The exam should be done while standing and lying down. It typically begins with a visual inspection.&nbsp; 
&nbsp;

<ul>
	<li>Look In The Mirror: The first step of a breast self-exam is to stand in front of a mirror without your shirt and bra and look for any changes. The arms should be hanging by the sides while you assess the breasts for any swelling, skin changes, nipple changes, dimpling of the skin, redness, or nipple discharge. The same should be repeated with the arms raised overhead. Next, press your hands firmly on your hips to flex the chest muscles as you examine for any breast changes. Remember to visually inspect both the breasts. 
	&nbsp;</li>
	<li>In The Shower: Lathering the fingers with soap and water helps them glide better over the skin. Using the pads of your three middle fingers, press with different levels of pressure on each part of the breast and feel for any lumps or thickening. Next, massage the fingers in a circular motion as you move from one spot to another. The last step is to squeeze the nipples and check for any discharge. The entire breast should be examined from the collarbone to the armpit. You can use the right hand for the left breast and vice versa.&nbsp; 
	&nbsp;</li>
	<li>Lying down: The same steps should be repeated while lying down on the back with one arm under the head. In all positions, it is important to check under the areola and the armpit.&nbsp;</li>
</ul>

&nbsp;

The following signs and symptoms are often associated with breast cancer: 
&nbsp;

<ul>
	<li>painless lump near the breast or underarm</li>
	<li>the skin over the breast thickens or becomes red</li>
	<li>breast swells, becomes painful, or develops a pitted appearance like an orange peel</li>
	<li>a recent change in nipples (become inverted)</li>
	<li>nipples or areola become scaly, sore, or develop a rash</li>
	<li>bloody or clear nipple discharge 
	&nbsp;</li>
</ul>

Don&#39;t panic if you feel a lump or find any other abnormality. Several conditions can also cause breast lumps such as fibroadenoma, and fibrocystic breast disease, both of which are benign. However, do not ignore the lump and instead make an appointment with an expert to gain a professional diagnosis. 
&nbsp;

<h4>"An early diagnosis is vital to improving one’s quality of life. Head on over to our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a> and check your stress level today!" </h4>

In Pakistan, 1 in 4 cases of hereditary breast cancer and 1 in 5 cases of male breast cancer is a result of the BRCA1/2 gene mutation<a href="#accordion">[3]</a>,&nbsp;Moreover, women with a BRCA gene mutation also have a higher risk of ovarian and other cancers. On the other hand, men with genetic changes are at a higher risk of prostate and other cancers. Therefore, if a family member has a gene mutation or a history of breast cancer, it is best to consult a genetic counsellor. They might suggest genetic testing to look for various gene mutations associated with breast cancer.&nbsp;

According to the American Cancer Society, the 5-year survival rate for all women diagnosed with breast cancer is almost 91%<a href="#accordion">[4]</a>. However, the survival rates are highly dependent on the stage one is diagnosed at, the type of cancer, the person&#39;s age, and several other factors. Early-stage diagnosis can help increase the five-year survival among these patients. Although the ACS does not recommend breast self-exams for cancer detection, researchers predict that a simple breast exam can detect around 60% of cases<a href="#accordion">[5]</a>. Hence, women are often advised to conduct regular breast self-exams to reduce their risk of delayed diagnosis. 
&nbsp;

In Pakistan, most women are unaware of breast self-exams. A study done in Islamabad, among newly diagnosed breast cancer patients, found that none of the patients with stage III and IV cancer had any concept of self-exams<a href="#accordion">[6]</a>. A lack of knowledge among women is one of the major reasons behind these statistics. Therefore, there is a need for widespread breast cancer awareness programs for women to reduce the disease burden among the population. 
 
&nbsp;

<ul>
	<li>In Pakistan, breast cancer is the most frequent cancer among both men and women and accounted for 14.5% of all new cancer cases in 2020.</li>
	<li>Breast self-exams can help women understand their breasts better and timely identify any pre-cancerous changes. The examination should be done monthly while standing and lying down.</li>
	<li>While conducting a breast self-exam, one should look out for signs such as a painless lump near the breast or armpit, skin changes, breast swelling or redness, nipple changes, and any bloody nipple discharge.&nbsp;</li>
	<li>The majority of women in Pakistan are unaware of breast self-exams or breast cancer symptoms; therefore, there is a need for effective screening and health awareness programs for the population.&nbsp;</li>
</ul>

&nbsp;

[1].Sohail, S. & Alam, S. N., 2007. Breast cancer in pakistan - awareness and early detection. Journal of the College of Physicians and Surgeons Pakistan, 17(12), pp. 711-2.

[2].International Agency for Research on Cancer, 2021. Pakistan Globocan 2020.

[3].Rashid, M. U. et al., 2019. Spectrum and prevalence of BRCA1/2 germline mutations in Pakistani breast cancer patients: results from a large comprehensive study. Hereditary Cancer in Clinical Practice, 17(27).

[4].American Cancer Society, n.d. Breast Cancer Facts & Figures 2019-2020. , Atlanta: American Cancer Society.

[5].Weiss, N. S., 2003. Breast cancer mortality in relation to clinical breast examination and breast self-examination. The Breast Journal, Volume 9, pp. 86-9.

[6].Manzoor, A., Waqar, S. H., Janjua, A. & Shah, S. A., 2017. Breast Self-Examination Knowledge and Practice Among Newly Diagnosed Patients of Carcinoma Breast. J. Soc. Obstet. Gynaecol. Pak., 7(3).

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

Breast Is The Best!

Breastfeeding is not as challenging as it is typically portrayed. Of course, the entire idea of breastfeeding your baby is up to you. But if you&rsquo;re giving up solely because you are unsure about it, then let&rsquo;s just discuss some benefits of breastfeeding today (both for the mom and the baby), so you can make an honest choice. 
&nbsp;

Well, to begin with, breastfeeding is an organic process. Initially, it might appear as a daunting task, much like pregnancy. You might constantly hear &quot;breast is best!&quot; and &quot;breastfeeding saves lives&quot; from the women in your circle as well as your doctor, especially when you are new to the whole experience.&nbsp; 
&nbsp;

In the United States, nursing an infant at the breast is seen as &quot;normative&quot;, with 75% of mothers doing so<a href="#accordion">[1]</a>. Still, nursing is not yet considered the standard method of feeding newborns. Mothers don&#39;t prefer to breastfeed until health professionals and government authorities advise it. However, it should be practiced appropriately, in order to increase the chances of improving mother and newborn health. 
&nbsp;

As there is so much to learn about nursing and its benefits, let&#39;s just dive straight into it.

&nbsp;

Exclusive Breast Feeding (EBF) is a phenomenon in which your baby would only consume breast milk for the first 6 months. This breast milk could be yours, or a personal nurse, or <a href="https://merisehat.pk/article/milk-a-nutritional-powerhouse">expressed milk</a> without the addition of any other liquid or semi-liquid substance, with the exemption of drops or syrups containing vitamins, minerals, or medications.

&nbsp;

Understanding Pros And Cons Of Breastfeeding

Did you know that breast milk is packed with nutrients that nourish your baby, and that its composition changes over time to meet your baby&#39;s requirements? The United States currently has a 77% breastfeeding introductory rate, the highest level since the middle of the 20th century<a href="#accordion">[2]</a>. 
&nbsp;

As this is the first meal your baby would consume, you anticipate that breast milk would provide the fundamental nutrients they need, such as carbs, proteins, and lipids, as well as water to keep them hydrated. Yes, breast milk contains all the necessary nutrients and more - it is a special kind of food that offers benefits beyond nourishment, such as helping to develop immunity. 
&nbsp;

<h5>The First Few Days &mdash; Colostrum</h5>

Colostrum is the first milk your breasts make right after your delivery. This thick, soft, sticky breast milk is commonly called &quot;liquid gold&quot;. It is not just because of its yellow or orange hue, but also because it is crucial for nourishing and safeguarding your helpless child. 
&nbsp;

<h5>Baby&rsquo;s Milk Consumption</h5>

At the beginning, you&#39;d only create 40-50 ml (1.4-1.8 fl oz) over the course of a day and that&#39;s all your baby needs because their stomach is only the size of a marble. The digestion of colostrum is quite easy too. The colostrum quality matters more than quantity. 
&nbsp;

The Colostrum&#39;s Composition

The composition of colostrum is the same as those found later in your milk. However, because it is specifically formulated to meet the needs of your infant, the levels of each of its constituents are different. 
&nbsp;

<h5>Benefits Of Colostrum</h5>

1. Organic Immunisation

Because of its high quantities of antibodies and white blood cells, colostrum is mainly referred to as a &ldquo;natural immunisation&quot;. It shields your child from illnesses and infections once they leave the security of your womb. 
&nbsp;

2. Maintain A Healthy Digestive System

Your newborn&rsquo;s digestive system needs to be protected. Colostrum covers and closes the porous intestinal lining that babies are born with. This is especially crucial if your kid is premature, since they will be more susceptible to the potentially fatal gastrointestinal ailment - necrotising enterocolitis (NEC). 
&nbsp;

3. Vitamin Source

It contains more vitamins A, E, and K than mature breast milk and is also abundant in minerals and protein. Colostrum functions as a laxative to assist your infant in passing their first poop, known as meconium (the first thick, tarry, and black stool), and to ward off jaundice. 
&nbsp;

<h5>A Few Weeks After Delivery &mdash; Transitional Milk</h5>

2-4 days after delivery, the amount and composition of breast milk you produce changes. Your breasts might feel bigger and stiffer as your milk &quot;comes in&quot; during this transition period. 
&nbsp;

<h5>Baby Milk Consumption</h5>

Your kid would drink 300-400 ml (10.5-14 fl oz) of breast milk per 24 hours on the third day, and by the fifth day, this rises to 500-800 ml (18-28 fl oz). As a result, it&#39;s understandable if your breasts seem larger on the third day.

Your milk is referred to as transitional milk during days 5-14. It is transitioning from colostrum to mature milk, as the name implies. 
&nbsp;

<h5>Benefits Of Transition Milk</h5>

This milk is creamier in appearance and texture. It is higher in fat, calories, and lactose (a natural sugar), making it the perfect diet for your newborn who is fast developing.

Rest assured that it contains an abundance of defense-enhancing antibodies, living cells, &quot;good&quot; bacteria, as well as various bioactive components to support the baby&rsquo;s health. 
&nbsp;

<h5>After 4 Weeks: Mature Milk</h5>

The nutrient content and component levels in mature milk generally stay stable after 4 weeks. Though, your breast milk&#39;s content can still vary from day to day and feed to feed. 
&nbsp;

<h5>Composition Of Mature Milk</h5>

If you or your child is ill, your body would produce antibodies that pass into your milk and help fight that specific infection. Interestingly, your baby&#39;s count of bacteria-fighting enzymes in your milk increases as they start to explore the world and put objects in their mouth. Breast milk&#39;s compositional variety demonstrates how it changes to meet your baby&#39;s evolving demands. 
&nbsp;

Your breast milk would be fully developed 4 weeks following delivery. It is packed with bioactive substances, including hormones, growth factors, enzymes, and live cells, to promote your baby&#39;s healthy growth and development. It is also high in protein, sugar, vitamins, and minerals.

&nbsp;

<h5>What Are Foremilk And Hindmilk?</h5>

Towards the end of a feed, you might notice your milk becoming thicker and creamier. This is because milk moves through the breast, which allows the fat content to increase as the feed moves forward gradually. 
&nbsp;

Foremilk refers to the first, more &quot;watery&quot; milk, while the later milk is frequently referred to as hindmilk. Some people get confused and use these terms interchangeably, but they are two different things.&nbsp; 
&nbsp;

The transformation happens slowly. Both are important components of a completed feed and are a good source of:

<ul>
	<li>Vitamins</li>
	<li>Minerals</li>
	<li>Protein</li>
	<li>Carbohydrates 
	&nbsp;</li>
</ul>

Your milk&#39;s fat content is indirectly related to the enlargement of your breasts. Your breasts would be fuller at the start of some feeds (milk with less fat), while they would be more drained at the start of other feeds (milk with more fat). 
&nbsp;

Therefore, don&#39;t worry too much about foremilk and hindmilk as your baby would end up consuming a similar quantity of total fat each day over the course of 24 hours. 
&nbsp;

<h5>Breast Milk Composition After Six Months &ndash; Its Benefits</h5>

What happens to your milk if you nurse your child for a prolonged period? Could your body truly continue to produce such high-quality mature milk for months or even for years? The simple answer is not to devalue your breasts! 
&nbsp;

Even though you have to start giving your baby solid items at 6 months to let their iron stores grow, your milk would still be a significant part of their diet. 
&nbsp;

For instance, your baby would continue to receive 93% of their calories from breast milk, even when they turn 7 months old. They would get around half of their daily calories from milk between 11 and 16 months.

&nbsp;

1. Breast milk holds immunity. It provides both instant and lifetime immunisations to a newborn.

2. Breast milk provides your baby with the right kind of nutrition according to their needs. Moreover, your milk production changes depending on your kid&#39;s needs, which is incredible.&nbsp;

3. Your body would receive signals from your baby when she/he needs to be fed, and in response, it would produce the quality and quantity of milk required.

4. The risk of sudden infant death syndrome (SIDS) could be reduced for your baby by breastfeeding. The American Academy of Pediatrics advises moms to breastfeed for at least a year. Studies have shown that as little as 2 months of breastfeeding can reduce the incidence of SIDS by half.

5. Babies that are breastfed tend to have a sense of familiarity with their &quot;home base&quot; from the moment of birth. They use your heartbeat and the warmth of your skin to travel from the inside to the outside world.

6. A polyunsaturated fatty acid called docosahexaenoic acid (DHA), which is present in breast milk, aids in healthy brain development.

7. Chances of middle ear infections in babies decrease when you breastfeed.

8. You could lower your baby&#39;s risk of developing allergies by breastfeeding.

9. Breastfeeding lowers your baby&#39;s risk of acquiring diabetes because it doesn&#39;t include processed sugar.

&nbsp;

Ready to say &ldquo;hello!&rdquo; to the new you? Because breastfeeding would benefit you too: 
&nbsp;

<h5>1. Reduce Osteoporosis</h5>

Breastfeeding lowers the risk of osteoporosis (a disease in which bones weaken due to less bone mass and strength) in mothers who breastfeed their babies for more than 8 months. 
&nbsp;

<h5>2. Reduce Breast Cancer</h5>

Breastfeeding decreases the risk of breast cancer. As per research, breastfeeding changes the cells in the breast so they might be more resistant to changes that lead to cancer. 
&nbsp;

<h5>3. Reduce Ovarian Cancer</h5>

Scientists believe that breastfeeding helps prevent ovarian cancer because it could delay ovulation. The chance of a cell mutation (which leads to the disease) increases as more ovulations occur. 
&nbsp;

<h5>4. Increase Production Of Oxytocin</h5>

Breastfeeding stimulates the release of oxytocin from the brain. Oxytocin causes the uterus to shrink down after the birth of the baby. 
&nbsp;

<h5>5. Reduce Calories</h5>

Breastfeeding uses the mom&rsquo;s stored fat cells (thereby reducing the excess calories) to fuel milk production.

<h5>6. Reduce Postpartum Depression</h5>

Breastfeeding lowers the chance of developing postpartum depression since it allows the amount of pregnancy hormones to decrease slowly instead of abruptly. 
&nbsp;

<h5>7. Free Of Cost</h5>

Breastfeeding demands no money as it is the natural way for babies to receive nutrition.&nbsp;

&nbsp;

Although it is commonly known to everyone that breast milk is the best source of nutrition for growing children, the psychological advantages of nursing are sometimes disregarded. 
&nbsp;

Nursing is seen as burdensome by some moms &ndash; they &lsquo;sacrifice&rsquo; a lot to care for their children. It makes them resentful of the whole experience, instead of enjoying it as it happens. Negative feelings for other people crop up as well who seem to &lsquo;have it easy&rsquo;. Fortunately, science is working to improve the breastfeeding process for both mother and baby. A 2017 investigation on breastfeeding&#39;s benefits, conducted in the United States, stated that &ldquo;according to 38% of participants, breastfeeding takes less time than bottle-feeding&rdquo;<a href="#accordion">[3]</a>.&nbsp;

Let&#39;s have a look at the psychological effects associated with breastfeeding.

<h5>1. Stress</h5>

Individuals are most susceptible to experiencing depression when their levels of inflammation are high. Since inflammation is a component of the body&#39;s stress response, the level of inflammation in the mother could be reduced by breastfeeding. The risk of both diabetes and heart disease is much lower once the inflammation is reduced. 
&nbsp;

<h5>2. Sleep</h5>

The postpartum period is characterised by severe sleep disturbances, constant efforts to understand the infant&rsquo;s needs, and frequent concerns about the baby&rsquo;s safety and well-being. 
&nbsp;

Better sleep is one of the largest and perhaps most unexpected psychological advantages of breastfeeding. Mothers who exclusively breastfeed would discover that they sleep more and deeply. Also breastfeeding mothers tend to feel less depressed and feel better during the day.&nbsp;

<h5>3. Surge In Hormones</h5>

The body produces the hormones prolactin and oxytocin during breastfeeding. Oxytocin creates a calming, nurturing sensation that enables mothers to unwind and concentrate on their child. Additionally, it encourages a solid bond of love and bonding between you and your infant. 
&nbsp;

<h5>4. Improved Calmness</h5>

For the baby, breastfeeding improves their mental and emotional health. They cry less and experience fewer childhood illnesses. 
&nbsp;

<h5>5. Emotional And Physical Bonds</h5>

Because breastfeeding encourages skin-to-skin contact, greater holding, and stroking, it fosters a link between mother and child. According to several experts, this loving connection reduces social and behavioural issues in both children and adults.

Additionally, breastfeeding teaches women how to recognise their baby&#39;s cues, and teaches babies to have confidence in their caretakers.&nbsp;

&nbsp;

It can be incredibly exhausting to provide another person with the nourishment they need to survive. Sometimes you might want to cry; another time, you&rsquo;d probably laugh it off or have some other feelings. But, through all that, feeding your baby always remains a priority action.&nbsp; 
&nbsp;

You alone get to decide to breastfeed your baby or not. However, people closest to a mother frequently have a significant influence on her choice to breastfeed, having both positive and negative effects. 
&nbsp;

The advantages seem limitless. According to research, babies who are breastfed are less likely to develop allergies or dental caries. Along with proper facial growth, they also gain from the proper jaw, tooth, and speech development. As discussed above, breastfeeding has been found to be protective against a wide range of diseases and ailments.&nbsp; 
&nbsp;

Breastfeeding helps babies around the world avoid illness, and prolongs their lives. The risk of falling ill is also reduced for mothers when they breastfeed.&nbsp; 
&nbsp;

<ul>
	<li>&quot;Breast is best!&quot; and &quot;breastfeeding saves lives&quot; are common phrases among both women and doctors due to their uncountable benefits.</li>
	<li>The first milk after delivery is commonly known as &ldquo;Gold Milk&rdquo; because of its incomparable composition, especially the presence of antibodies.</li>
	<li>Breastfeeding is not only beneficial for babies but also useful for mothers of newborns.&nbsp; 
	&nbsp;</li>
</ul>

[1] Rupnicki, S., 2020. CDC. [Online]  Available at:

[2] DianeThulierMS, R. I. C. P. C. F., 2009. SCIENCE DIRECT. [Online]

[3] Kunst, A., 2019. Statista. [Online]

Nawal Adnan

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Breast Cancer Prognosis (By Stage)

Understanding the prognosis of <a href="https://merisehat.pk/disease/breast-cancer">breast cancer</a> is crucial for patients and their healthcare providers, as it helps guide treatment decisions. The prognosis varies greatly based on the stage at which the cancer is diagnosed, considering factors like tumor size, lymph node involvement, and molecular characteristics. 
&nbsp;

Understanding Breast Cancer Prognosis by Stage

Breast cancer staging is a critical process that helps categorize the extent of the disease. The stages range from 0 to IV, each indicating the size of the tumor and its potential spread to nearby lymph nodes or distant organs.<a href="#accordion">[1]</a> 
&nbsp;

<ul>
	<li>Stage 0: Ductal Carcinoma In Situ (DCIS)</li>
</ul>

Cancer cells are confined to the milk ducts and have not invaded surrounding tissues at this stage. The prognosis for DCIS is usually excellent, with a very low risk of recurrence after appropriate treatment.

<ul>
	<li>Stage I: Early-Stage Invasive Breast Cancer</li>
</ul>

The tumor is small and has not spread beyond the breast. The prognosis is often favorable, with a high chance of successful treatment and long-term survival.

<ul>
	<li>Stage II: Locally Advanced Invasive Breast Cancer</li>
</ul>

Stage II is divided into IIA and IIB, with varying tumor sizes and lymph node involvement. Prognosis can vary, but timely and comprehensive treatment can significantly improve outcomes.

<ul>
	<li>Stage III: Advanced Invasive Breast Cancer</li>
</ul>

Stage III breast cancer is locally advanced and may involve multiple lymph nodes. It&rsquo;s relatively more challenging to treat. However, advancements in therapies have improved survival rates for patients with Stage III disease.

<ul>
	<li>Stage IV: Metastatic Breast Cancer</li>
</ul>

At Stage IV, cancer has spread to distant organs. While metastatic breast cancer is not curable, ongoing treatments and personalized approaches can extend survival and maintain quality of life. 
&nbsp;

Several factors impact breast cancer prognosis, including:

<ul>
	<li>Tumor Size</li>
</ul>

Larger tumors often indicate a more advanced stage and a potentially worse prognosis. Early detection and treatment play a crucial role in improving outcomes.

<ul>
	<li>Lymph Node Involvement</li>
</ul>

Cancer that has spread to nearby lymph nodes suggests a higher risk of metastasis, influencing prognosis and treatment decisions.

<ul>
	<li>Hormone Receptor Status</li>
</ul>

Hormone receptor-positive tumors respond well to hormone therapy, which can positively affect prognosis.<a href="#accordion">[2]</a>

<ul>
	<li>HER2 Status</li>
</ul>

In the case of HER2-positive or HER-2 tumors, targeted therapies can help improve outcomes.

<ul>
	<li>Treatment Options</li>
</ul>

The prognosis for breast cancer is also closely tied to the treatment approach. Common modalities include surgery, chemotherapy, radiation therapy, hormone therapy, and targeted therapy. 
&nbsp;

Survivorship is an essential aspect of breast cancer prognosis. Advances in treatments and supportive care have led to increased survival rates and improved quality of life for patients post-treatment. 
&nbsp;

The term &ldquo;prognosis&rdquo; refers to the expected outcome of a disease. In the case of cancer, most doctors discuss 5-year survival rates with their patients to discuss their prognosis. This does not mean the person will survive only for 5 years. It implies that certain research studies have followed people for 5 years.

While breast cancer is challenging to live with, the good news is that the condition has one of the highest 5-year survival rates compared to other cancers, given that it&rsquo;s diagnosed early. However, these numbers don&rsquo;t predict what will happen to you. The outlook is different for everyone and depends on a lot of other factors.

Don&rsquo;t be afraid to have an open conversation with your doctor. The survival rates have improved so much over the past few years. More people now have a better understanding of the disease and, from screening to treatment options, are adopting a positive approach to it regardless of the stage of cancer. 
&nbsp;

<ul>
	<li>Breast cancer prognosis varies significantly by stage and individual characteristics.</li>
	<li>Early detection, personalized treatment plans, and ongoing research play pivotal roles in improving outcomes.</li>
</ul>

[1] Breast Cancer Stages. (2021). American Cancer Society.

[2] Breast Cancer Treatment (PDQ) - Health Professional Version. (2021). National Cancer Institute.

Staff Writer

Nipple Discharge

While it sounds strange, nipple discharge is actually an occurrence that affects both males and females. However, it affects women more than men, with 50-80% of women experiencing it during their reproductive years<a href="#accordion">[1]</a>.

It is the third most frequent breast complaint, after breast pain and breast mass. 97% of cases have a benign origin and nearly 6.8% of cases in women are referred to a breast surgeon<a href="#accordion">[1]</a>. 
&nbsp;

Understanding the causes of nipple discharge

The most common types of nipple discharge are: 
&nbsp;

<ul>
	<li>Milky Discharge - The most prevalent kind of nipple discharge. This occurs in women for various reasons. For instance, if you&rsquo;re a premenopausal woman experiencing hormonal changes or if you&rsquo;ve recently stopped breastfeeding, you&rsquo;ll most likely get a milky discharge.</li>
	<li>Bloody Discharge - Blood discharge can be induced by a papilloma, a noncancerous tumor that can agitate the tissue on the inside of a breast duct. However, this occurs only in rare circumstances.</li>
	<li>Clear Discharge - Bloody or clear nipple discharge can be an indication of breast cancer, particularly if it originates from a single breast. Individuals experiencing nipple discharge related to cancer often detect a lump on the affected breast as well. Clear discharges can happen in papilloma too.</li>
	<li>Green-Tinged Discharge - This mostly indicates that there&rsquo;s a cyst beneath the areola or nipple which is draining.</li>
	<li>Brown Or Cheese-Like Discharge - This is a sign of mammary duct ectasia, which is a blocked milk duct. 
	&nbsp;</li>
</ul>

Please Note: Seeking medical consultation is essential for any nipple discharge. At the very least, it can aid in the early detection of underlying conditions or help exclude potential diseases<a href="#accordion">[2]</a>. 
&nbsp;

Common causes of normal nipple discharge are: 
&nbsp;

<ul>
	<li>Pregnancy - During the early stages of pregnancy, women often have clear discharge coming from their nipples. In later stages, the discharge becomes watery or milky.</li>
	<li>Ending Breastfeeding - A milk-like fluid continues to be discharged from the breasts for a while after discontinuing breastfeeding. This can go on till 2-3 years after breastfeeding is stopped.</li>
	<li>Stimulation - Nipple discharge due to arousal is common. Natural nipple discharge can also happen when the bra rubs against the nipples frequently or when the individual engages in strenuous exercise like jogging.</li>
	<li>Hormones - Nipple discharge occurs due to fluctuation of hormones during menstruation<a href="#accordion">[1]</a>. 
	&nbsp;</li>
</ul>

Please Note: Seeking medical consultation is essential for any nipple discharge. At the very least, it can aid in the early detection of underlying conditions or help exclude potential diseases. 
&nbsp;

Common causes of abnormal nipple discharge are: 
&nbsp;

<ul>
	<li>Fibrocystic Breast Changes - The term &quot;fibrocystic&quot; describes the growth or presence of fibrous tissue and cysts. In this case, your breast tissue will develop lumps or thicken as a result of fibrocystic alterations and these alterations will occasionally result in the emission of clear,&nbsp;yellow, white,&nbsp;or green nipple discharge in addition to pain and itching. However, they do not suggest malignancy.</li>
	<li>Galactorrhea - You might have galactorrhea if you have a milky nipple discharge even though you are not pregnant or breastfeeding. Relax, this is not a disease. There can be multiple reasons for this condition, including:</li>
</ul>

<ol>
	<li>Tumors of the pituitary gland</li>
	<li>Medications, like psychotropic drugs or certain hormones</li>
	<li>Herbs, such as fennel or anise</li>
	<li>Hypothyroidism</li>
	<li>Illegal drugs, like marijuana</li>
</ol>

<ul>
	<li>Infection - Pus-filled nipple discharge is a sign that your breast is infected. You will also notice that your breast is tender, red, or heated to the touch if you have an infection or abscess there. This inflammation of breast tissue that occasionally involves infection is known as mastitis. Even though the condition is typically diagnosed in nursing mothers, it can also occur if you are not nursing.</li>
	<li>Mammary Duct Ectasia - It is the second most common reason for abnormal nipple discharge. It typically happens to women who are near menopause. The condition will cause inflammation and blockage of the ducts below your nipple. When these ducts are blocked, it can cause an infection, which will present as a thick, green nipple discharge.</li>
	<li>Intraductal Papilloma - These are benign or noncancerous tumors in the breast&#39;s ducts. They are the most frequent cause of abnormal nipple discharge in women. When inflamed, intraductal papilloma will cause a bloody or sticky kind of nipple discharge<a href="#accordion">[3]</a>. 
	&nbsp;</li>
</ul>

Nipple discharge is also possible in men. Some of the most common causes are:

<ul>
	<li>Deficiency of testosterone</li>
	<li>Gynecomastia, i.e., breast enlargement or tenderness</li>
	<li>Pituitary tumor</li>
	<li>Breast cancer</li>
</ul>

Nipple discharge is less common in men. Hence, they should see a doctor when and if they experience it. 
&nbsp;

Yes, you read it right &ndash; nipple discharge can also occur in babies! But don&rsquo;t be alarmed; the condition is usually NOT a cause for concern.

Nipple discharge in newborns is often related to the mother&#39;s hormones that they are exposed to during pregnancy and childbirth. Irrespective of gender, the baby will most likely have swollen breast tissue and will experience discharge from their nipples due to the presence of hormones in the mother&#39;s body, particularly estrogen. These hormones tend to stimulate the baby&#39;s breast tissue, causing it to become enlarged and sometimes produce milk.

An older name for this condition is &ldquo;witch&rsquo;s milk&rdquo; because people of the 17th century believed that witches would come and steal this milk from the baby to use in black magic! So, elders would squeeze the fluid out themselves to prevent that from happening. The practice continued until the 19th century when doctors began to discourage it as it would often result in abscesses and inflammation. Thank God for science, right?

A more medical name for the condition is neonatal galactorrhea, and it is usually harmless and goes away on its own within a few weeks to months after birth. However, parents should consult a healthcare provider if they notice any unusual or persistent symptoms, such as redness, warmth, or tenderness in the breast area, or if the discharge is accompanied by a fever<a href="#accordion">[4]</a>. 
&nbsp;

According to the International Journal of Preventive Medicine, nipple discharge can be a symptom of breast cancer. According to the same study, 7-15% of women who report nipple leakage with an unclear origin tend to develop breast cancer.

The most frequently identified diseases in women with malignant nipple&nbsp;discharge are ductal carcinoma in situ or papillary carcinoma.

Another rare kind of cancer that could result in nipple discharge is Paget&rsquo;s disease of the breast, a condition that develops in the ducts of the breasts and later moves to the nipple. 
&nbsp;

Note:&nbsp;If your doctor is unable to identify a clear benign underlying cause for nipple discharge, they&nbsp;will usually propose an imaging scan to confirm the absence of a possibly malignant lesion<a href="#accordion">[2]</a>. 
&nbsp;

Doctors use the patient&rsquo;s medical history and physical exam to diagnose nipple discharge. Some tests that are useful in diagnosing the cause of nipple discharge are:

<ul>
	<li>Imaging - mammography (X-ray of the breast), ultrasound, and MRI are recommended.</li>
	<li>Biopsy - if there is any abnormality in the previous tests, a sample of the breast tissue is taken.</li>
	<li>Blood Tests - hormone levels are measured by taking a sample of blood. 
	&nbsp;</li>
</ul>

Treatment involves eliminating the causative factor:

<ul>
	<li>Stopping or changing a medication that may be causing the discharge</li>
	<li>Removal of a cyst or lump</li>
	<li>The surgical removal of a milk duct that contains any abnormality or pathology.</li>
	<li>Treating any underlying disorders 
	&nbsp;</li>
</ul>

If you experience any of the following symptoms, visit your doctor immediately:

<ul>
	<li>A palpable lump in the breast</li>
	<li>A change in the shape or size of the breast</li>
	<li>Discharge from only one nipple</li>
	<li>Blood-colored discharge</li>
	<li>Discharge that goes on for days</li>
	<li>Swelling around the collarbone or under the armpit</li>
	<li>Nipple discharge in males</li>
	<li>Nipple discharge in females over the age of 40</li>
	<li>Smelly discharge</li>
	<li>Changes in the nipple shape, color, or texture (crusting) 
	&nbsp;</li>
</ul>

In conclusion, nipple discharge is a common condition that affects both men and women. While it can be a symptom of breast cancer, the vast majority of cases are not cancerous and can be treated easily.

It is important to seek medical attention, though, if you notice any changes in your nipple discharge, such as a change in color or consistency, or if it is accompanied by other symptoms like a lump in the breast, pain, or swelling.

Your healthcare provider will be able to diagnose the cause of your nipple discharge and recommend the appropriate treatment. Remember, early detection is key to the successful treatment of breast cancer, so it is important to stay vigilant and monitor any changes in your breast health. 
&nbsp;

<ul>
	<li>While it sounds strange, nipple discharge is actually an occurrence that may affect both males and females. </li>
	<li>The most prevalent kind of nipple discharge is white or milky. This can happen to women for a variety of reasons, including hormonal changes in premenopausal women or recently stopping breastfeeding.</li>
	<li>During the early stages of pregnancy, women often have clear discharge coming from their nipples. In later stages, the discharge becomes watery or milky. </li>
	<li>Nipple discharge in babies can also occur and is usually not a cause for concern. It is often related to the mother&#39;s hormones that the baby is exposed to during pregnancy and childbirth.</li>
	<li>According to the International Journal of Preventive Medicine, nipple discharge can be a symptom of breast cancer. According to the same study, 7-15% of women who report nipple leakage with an unclear origin tend to develop breast cancer</li>
	<li>Early detection is key to the successful treatment of breast cancer, so it is important to stay vigilant and monitor any changes in your breast health. 
	&nbsp;</li>
</ul>

[1] Sajadi-Ernazarova KR, Sugumar K, Adigun R. Breast Nipple Discharge. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls

[2] Nipple discharge: Causes and treatments. Medical News Today.

[3] Breast and nipple discharge: What it could mean. WebMD

[4] Crider C. Witch's Milk: Treatment and causes of neonatal galactorrhea. Healthline.

[5] Watson S. Nipple discharge. Healthline

Mariam Chughtai

Women who have had <a href="https://merisehat.pk/article/prophylactic-mastectomy-a-preventive-measure-for-breast-cancer">mastectomy </a>or lumpectomy surgeries may experience a range of emotions while exploring the option of breast reconstruction surgery. It is a significant and life-altering operation that aims to give women greater body confidence and comfort. Nevertheless, it can be a daunting experience.

In addition to various methods, such as implant-based reconstruction and autologous tissue reconstruction, new procedures for reconstructive breast surgery continue to be developed with a promise to improve aesthetic results and lower the risk of complications. 
&nbsp;

Breast reconstruction surgery is meant to rebuild a breast mound after a woman has had one or both of her breasts removed. 
&nbsp;

Understanding Breast Reconstructive Surgery

There are two main types of breast reconstruction surgery: implant-based reconstruction and autologous tissue reconstruction. 
&nbsp;

<ul>
	<li>
	<h5>Implant-Based Reconstruction</h5>
	</li>
</ul>

Breast implants are inserted behind the chest muscle during implant-based reconstruction. This is a really easy and basic surgery and may be done in one or two stages.

Two types of implants are utilized in this type of breast reconstruction surgery &ndash; silicone implants and saline implants. Silicone gel, a viscous, sticky fluid that closely resembles human fat, is used to fill silicone implants. In contrast, saline implants are filled with saltwater. Saline implants are usually preferred as they are a more cost-effective option than silicone implants.

Generally, implant-based reconstruction has an edge over autologous tissue reconstruction since it requires less surgical time and allows a quick recovery. However, implants are subject to ruptures, leaks, or capsular contractures, which occur when the surrounding tissue becomes stiff and painful. 
&nbsp;

<ul>
	<li>
	<h5>Autologous Tissue Reconstruction</h5>
	</li>
</ul>

Autologous tissue reconstruction uses tissue from other parts of the body, such as the belly, back, or buttocks, to build a new breast mound. The process is comparatively more difficult and recovery time is longer than implant-based reconstruction, but the results are frequently more realistic-looking and durable.

Some of the procedures that may be employed in autologous tissue reconstruction include the TRAM flap, DIEP flap, and latissimus dorsi flap. Each of these methods uses a different muscle or tissue group to build the new breast mound:

<ol>
	<li>TRAM Flap</li>
</ol>

The doctor removes skin, fat, and blood vessels from the lower belly to form the new breast. The TRAM flap is transferred as a pedicled flap or a free flap.

In pedicled flap surgery, the surgeon will cut off the supply from some of the blood vessels to the tissue that is to be transferred while keeping the other blood vessels intact. This way, they can create a tunnel beneath the skin to the chest area to transfer the tissue to create a pocket for the implant or create a new breast mound.

In free flap surgery, the surgeon will disconnect the tissue from its original blood supply and reattach the tissue to new blood vessels from near the chest.

While the TRAM flap gives the new breast a natural look, it can also cause the abdominal muscles to weaken. 
&nbsp;

<ol start="2">
	<li>DIEP Flap</li>
</ol>

The new breast mound is made entirely from the skin and fat of the lower belly. In other words, most of the abdominal muscle is left intact. Compared to the TRAM flap, this method is less invasive and not as complicated.

<ol start="3">
	<li>Latissimus Dorsi Flap</li>
</ol>

The latissimus dorsi flap involves removing muscle and tissue from the upper back, tunneling under the skin to the chest. It is frequently used for small and medium-sized breasts. Alternatively, it is also used to create a pocket for a breast implant. 
&nbsp;

<h5>New Breast Reconstruction Techniques</h5>

In recent years, there have been many advances in breast reconstruction surgery.

The pre-pectoral approach is one of the most promising new procedures for breast reconstruction. In this case, the implant or tissue expander is positioned above the chest muscle rather than below it, thus, reducing discomfort and pain and the chance of capsular contracture. Additionally, it enables a more realistic-looking breast mound, enhancing the surgery&#39;s overall aesthetic results. 
&nbsp;

The breast reconstruction surgery procedure varies depending on the type of reconstruction performed. Generally, most breast reconstruction surgeries follow the same pattern: 
&nbsp;

<ul>
	<li>First, the surgeon will make an incision in the chest area to create a pocket for the implant or tissue expander. In implant-based reconstruction, the implant is inserted into this pocket; in autologous tissue reconstruction, the tissue is moved from another part of the body to create a new breast mound.</li>
	<li>After the implant or tissue expander is placed, the surgeon will close the incision with sutures and apply a dressing or bandage to the area. Patients will usually be given pain medication and antibiotics to help manage pain and prevent infection.</li>
	<li>In the case of tissue expanders, the surgeon will gradually inflate the expander over time to stretch the skin and create a space for the final implant. Once the skin has been stretched enough, the tissue expander will be removed, and the final implant will be inserted. 
	&nbsp;</li>
</ul>

Recovery can take several weeks, depending on the type of reconstruction that was done. Patients may experience pain, swelling, and discomfort; they may also need to take some time off work to rest and recover after surgery.

To achieve quick recovery, patients must adhere to the postoperative advice provided by their doctor. For instance, they should wear a compression garment, avoid physically demanding activities, and take medicine as directed. They should also show up for follow-up consultations with their surgeon to ensure that the healing process is going as planned. 
&nbsp;

As we move forward, it&#39;s important to continue supporting and advocating for breast reconstruction surgery so that more women get access to this life-changing procedure. By doing so, we can help empower women and promote positive body image, one breast at a time. 
&nbsp;

<ul>
	<li>Breast reconstruction surgery helps women in regaining their self-esteem after a woman has had a mastectomy or lumpectomy.</li>
	<li>There are two main types of breast reconstruction surgery: implant-based reconstruction and autologous tissue reconstruction.</li>
	<li>However, implants are subject to ruptures, leaks, or develop capsular contractures, which occur when the surrounding tissue becomes stiff and painful.</li>
	<li>Autologous tissue reconstruction uses tissue from other parts of the body, such as the belly, back, or buttocks, to build a new breast mound.</li>
	<li>Some of the several procedures that may be employed in autologous tissue regeneration include the TRAM flap, DIEP flap, and latissimus dorsi flap.</li>
	<li>The pre-pectoral approach is one of the most promising new procedures for breast reconstruction.</li>
	<li>Depending on the type of reconstruction that was done, recovery following breast reconstruction surgery may take several weeks.</li>
</ul>

[1] American Society of Plastic Surgeons. (2021). Breast Reconstruction.

[2] American Cancer Society. (2021). Breast Reconstruction After Mastectomy.

[3] Nahabedian, M. Y., Cocilovo, C., & Buseman, J. (2020). Prepectoral Breast Reconstruction: A Safe Alternative to Submuscular Prosthetic Reconstruction Following Nipple-Sparing Mastectomy. Plastic and Reconstructive Surgery, 146(6), 727e-734e.

[4] Losken, A., Hart, A. M., Broecker, J. S., Styblo, T. M., & Carlson, G. W. (2017). New Innovations in Immediate Breast Reconstruction: Prepectoral Implant Placement and Infracostal Flaps. Clinics in Plastic Surgery, 44(3), 545-552.

[5] Kim, J. Y. S., Davila, A. A., Persing, S., et al. (2020). A Multicenter Study of Patient Satisfaction and Outcomes After Immediate Breast Reconstruction with Prepectoral Implants. Annals of Surgical Oncology, 27(6), 1703-1709.