Humza Khizer

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Madeeha Syed

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Beat The Heat: What Happens When Heat, Sweat And Skin Collide

Overview

The summer months can be a fun time for outdoor activities and spending time with friends. But if you&rsquo;re prone to chafing or rashes, they may not be so enjoyable.&nbsp; 
&nbsp;

effect of heat on skin

Chafing and rashes are a common problem, especially during the summer months. The main cause of these annoying conditions is sweat. When your skin gets wet and rubs against itself or another surface, it can become inflamed and tender to the touch.

When you put on clothes that are too tight or made with synthetic materials like lycra, they can act like a glue trap for sweat, which contributes to chafing and rashes by trapping moisture between your skin and clothing. Sweat can also irritate sensitive skin as it evaporates off of your body &mdash; this is why you should always wear breathable fabrics such as cotton when exercising outdoors or in an air-conditioned room on hot days. 
&nbsp;

Sweat is the main cause of chafing, but it&rsquo;s not the only one. Friction is also a major factor in causing irritation and soreness that can make you unable to enjoy your day-to-day activities. 
&nbsp;

There&rsquo;s a rash for every occasion:

<ul>
	<li>Boob Rash: It&rsquo;s the bane of many a lady&rsquo;s existence, especially during sweaty summers and strenuous workouts. The friction of your bra rubbing against your skin causes irritation, which leads to red bumps and rashes.</li>
	<li>Thigh Chafing: Similar to boob rash but on your legs instead of chest, thigh chafing is caused by the constant rubbing of clothing against bare skin as you walk or run around all day long &mdash; especially if you&rsquo;re wearing shorts or skirts!</li>
	<li>Nipple Chafing: This is one particular type of nipple rash that can happen during pregnancy or breastfeeding when there&rsquo;s excess fluid flowing through those delicate glands in addition to sweat from exercise! 
	&nbsp;</li>
</ul>

Sweat itself doesn&rsquo;t cause chafing, but it can make things worse. If your skin is already sensitive to friction or susceptible to rashes and blisters, then sweat will make it even more sensitive.

&nbsp;

When you&rsquo;re trying to keep cool in the summer heat, it&rsquo;s easy to over-hydrate and end up with a gush of liquid dripping down your back as you walk around. When that happens, you might start thinking that all this sweat must be causing me some discomfort &mdash; but in reality, we just need a little bit more salt!

&nbsp;

These rashes could cause serious health problems if left untreated

Cuts and scrapes can lead to infections. Chafing can lead to blisters, and, in turn, those blisters can become infected.

Infections in the skin can cause damage that leaves you vulnerable to infection by other germs and even viruses like <a href="https://merisehat.pk/disease/hepatitis-b-113">Hepatitis B</a> and C or <a href="https://merisehat.pk/disease/hiv-61">HIV</a>, which can be fatal if left untreated.

To avoid these rashes in the first place, you need to keep the skin dry, reduce friction and stop rubbing your skin raw.

A rash is an uncomfortable, and sometimes painful, skin condition that can occur due to a variety of reasons. The most common cause of rashes is sweat and friction. To avoid these rashes in the first place, you need to keep the skin dry, reduce friction and stop rubbing your skin raw. 
&nbsp;

Avoiding Sweat And Friction: Using a lubricant between two surfaces that rub together without causing much wear (skin against fabric) will help prevent chafing and blisters caused by sweating under heavy loads or tight-fitting clothing like cycling jerseys or hiking shorts. Silicone-based lubricants work well because they stay slick longer than water-based lubricants; however, they&rsquo;re not as safe for use around water because silicone doesn&rsquo;t absorb into fabrics so it can be slippery when wet!

Keeping Skin Dry: You should apply sunscreen before you go outside since sun exposure makes you more susceptible to getting burned &mdash; especially if there isn&rsquo;t any breeze to cool down your body temperature during long runs outdoors (or even short ones). 
A good rule of thumb is that if it&rsquo;s hot outside but feels less humid than usual then put on sunscreen anyway just in case because humid conditions make it harder for sweat from evaporating off our bodies which means we need more frequent hydration breaks during long workouts outside in summer heat waves! 
Don&rsquo;t forget about protecting yourself against UV rays too because even though clouds may block direct sunlight from reaching us directly down here on earth&rsquo;s surface &mdash; they don&rsquo;t block UV rays which come through holes in them called &ldquo;glare points.&rdquo; These glares points are responsible for generating many different kinds of reflections including glare reflection off surfaces such as pavements when walking along city streets. 
&nbsp;

The first rule of treating any skin condition is not to try to rub it off. The rubbing can make it worse, and you may introduce bacteria into the area, which could cause inflammation and infection. The best thing to do is keep the area dry by using talcum powder or a non-oily moisturizer with a high water-content like Vaseline or Petroleum Jelly. 
&nbsp;

<h4>&quot;Most rashes will clear up within a few days after you adopt prevention techniques that keep your skin dry and limit friction&quot; 
&nbsp;</h4>

If you&rsquo;re at risk of developing a rash, it&rsquo;s best to take the following precautions:

<ul>
	<li>Use a towel to dry off immediately after swimming or sweating.</li>
	<li>Apply a moisturizer with an SPF of at least 30 every morning and reapply in the afternoon if you plan on being outside for longer than an hour.</li>
	<li>If you are wearing clothes that rub against your skin, use an anti-chafing product such as zinc oxide paste until your rash clears up and then switch to a heavier formula like dimethicone which will protect against future rashes. You may also want to try tea tree oil or aloe vera gel if those options appeal more strongly than using medication prescribed by a healthcare professional. 
	&nbsp;</li>
</ul>

The best way to prevent chafing while running is to take steps before your run. You can start with a good exfoliating shower and apply some body lotion or cream to dry areas. Then, wear the right clothes. Make sure they fit you well and aren&rsquo;t too tight or too loose where it counts &mdash; the thighs and crotch area are particularly susceptible to chafing.

Lastly, you should use products like Vaseline on dry spots before you hit the road. These products will help protect against rubbing and chafing during exercise so that when it&rsquo;s time for your next long run, all of those miles won&#39;t be spent dealing with embarrassing rashes instead of crossing finish lines! However, this is not just limited to the girlies who are active. Even when you are going on with your daily life, you can always incorporate these hacks to make summers more comfortable for you. 
&nbsp;

Bottom Line

We know that dealing with these rashes can be frustrating. We want you to know that there is hope, though! They are all preventable, and it&rsquo;s not just about following the rules of hygiene either. You need to keep your skin dry and limit friction by wearing loose clothing and changing out of sweaty clothes as soon as possible after an activity ends. If you find yourself with a rash or chafing, don&rsquo;t try rubbing it off&mdash;that will only make things worse! Instead let your body heal naturally by keeping the affected area clean and dry until the symptoms subside on their own.

Umna Salah

Getting Back To Working Out After Giving Birth

The weeks after one&rsquo;s delivery can be as stressful as they are joyous. Newborn babies need constant attention and it&rsquo;s difficult to take out time to care for oneself. When the baby is down for a nap, it&rsquo;s our chance to get some sleep too or catch up on chores. Naturally, there&rsquo;s very little time or mental space for fitness and physical activity. Plus, there&rsquo;s the physical exhaustion that comes with long nights and breastfeeding. 
However, taking care of our bodies is essential to recovering quickly from pregnancy and childbirth. Taking time out for fitness enables us to better manage the stressors that come with a newborn baby, both physically and emotionally. This, in turn, ensures that we are able to enjoy the joys of new motherhood as well.

<div>&nbsp;</div>

time to recover body

As a new mother, it&rsquo;s important to ensure that you are consuming all of the nutrients that are essential to your health and recovery. If you are breastfeeding, it is even more important that you consume a nutritious diet.&nbsp;

Try to include a good amount of protein in your diet, as well as good fats and essential fatty acids. Eating a sufficient amount of carbs will give you the energy you need to keep up with your baby. Make sure to include fruits and nutrients in your diet as they are an important source of <a href="https://merisehat.pk/article/a-guide-to-essential-vitamins-and-micronutrients-and-should-you-be-taking-them">micronutrients and fibre</a>.&nbsp;

If you have a straightforward vaginal delivery, you can start with gentle movement in the form of short walks as soon as the day you deliver; however, you will have to wait till your epidural has been taken out. If you delivered via a caesarean or faced postpartum complications, you may have to wait a few extra days to give your body time to recover.&nbsp; 
&nbsp;

<h5>Moderate Walking</h5>

Easy to moderate walking is the best way to start moving after childbirth. You can start with just 20 minutes a day and gently build up to half an hour over the course of four to six weeks. Consider breaking up your walks into several walks a day to avoid tiring yourself out and being able to fit them in more easily into your newborn&rsquo;s routine. You could start with two 10-minute walks a day, build that up to two 12-minute walks after a few days and so on. Walking burns calories, while also strengthening muscles and joints, and improving blood circulation. 
&nbsp;

<h5>Postpartum Exercises</h5>

Incorporate gentle postpartum exercises and stretches into your routine in the first few weeks after a delivery. There is a lot of information online about safe postpartum exercises. You can look some up and aim to do them for five minutes a day. YouTube videos focused on postpartum exercises can also be easy to follow along, and if you&rsquo;d like the opportunity to get out of the house, a postpartum exercise or yoga class might just be the thing for you. As with walking, start with just a few minutes a day and slowly build up as your body adjusts.

Your pelvic floor and core tend to be particularly weak after childbirth. Before you move onto high-impact exercises, it is important to build some strength in these parts of the body. You can start doing gentle pelvic exercises, like kegels and pelvic tilts in the first week after your delivery. Aim to do them for about five minutes at a time, up to three times a day. Again, there&rsquo;s no need to do long sessions and tire yourself out. Fitting in smaller movement sessions throughout the day will ensure that you are able to be consistent and don&rsquo;t end up pushing yourself too much.

About a month after childbirth, you can start exercising core exercises into your routine. Again, this also depends on what kind of delivery you&rsquo;ve had and whether you faced any complications during or after. Once again, incorporate a few minutes of core work into your daily movement sessions and break it up into two to three sessions a day.&nbsp; 
&nbsp;

<h5>As A Rule Of Thumb</h5>

You should wait at least six weeks after childbirth to get into high-impact exercises. It&rsquo;s important to prepare your body in the preceding weeks and to also take it slow when you do start with higher impact movement. Make sure to consult your doctor and get their okay beforehand. Even at this stage, start slowly and listen to your body. There&rsquo;s no need to push forward from the get go. What&rsquo;s important is that you maintain consistency and build up in a manner that is doable for you. 
&nbsp;

It&rsquo;s easy to forget to take care of ourselves in the first few months after childbirth. But we need to remember that we need as much love and care as our newborn babies do. Being kind to yourself and patient with your body is especially important after a delivery. Remember, the healthier you feel, the better you&rsquo;ll be able to enjoy the time you get with your newborn!

Ayesha Binte Rashid

Online Consultation

Ismail Munir

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

Pap Smear – A Crucial Step Towards Preventing Cervical Cancer

Introduction

After cancers of the mouth and <a href="https://merisehat.pk/disease/breast-cancer">breast cancer</a> of all age groups, cervical cancer is the third most prevalent disease in women under 50. Despite being a preventable disease, it unfortunately often does not receive due attention in Pakistan.&nbsp;Pakistan is in dire need of raising awareness in the masses on this pertinent issue while promoting screening and HPV vaccination.&nbsp; &nbsp;

This is important because invasive cervical cancer has an extremely high fatality rate. Every year, nearly 500,000 women worldwide are diagnosed annually, of which 273,000 women die.&nbsp;The majority of cervical cancer-affected females live in developing nations<a href="#accordion">[1]</a>. It&rsquo;s imperative that these countries practice the WHO policy for prevention with HPV vaccination, and set up scheduled Pap smear screening programs nationwide.&nbsp;

The Pap smear or Pap smear test, which changed how we view cervical cancer, was named after its founder Dr. Georgios Papanikolaou.

<div>&nbsp;</div>

Understanding The Importance Of A Pap Smear Test

A Pap test, also commonly known as a Pap smear, is a procedure the doctor uses to check for cervical cancer in female patients. It can also be used to check for alterations in the cervical cells that would later develop into cancer.

Your cervix&#39;s cells are gently and carefully removed during the procedure and checked for suspicious changes. This procedure takes place in a proper healthcare environment with specialized tools. Although it could be moderately painful, it typically doesn&#39;t result in any permanent pain.

&nbsp;

<ul>
	<li>You will feel more positive and reassured when the results of a Pap test are normal.</li>
	<li>By identifying cervical cell abnormalities, routine Pap screenings assist in prompt treatment and/or exploring reasons for the abnormal cell presentation.</li>
	<li>A Pap test aids in the early detection of cervical cancer before any symptoms even appear. The early detection of cervical cancer makes it more manageable to treat. Also, early diagnosis may result in fewer treatments and a quicker recovery.</li>
	<li>Your probability of survival improves with earlier cervical cancer detection. 
	&nbsp;</li>
</ul>

<ul>
	<li>A Pap test could indicate cervical cell abnormalities even though there are none. This is called a false positive.</li>
	<li>At the other end of the continuum, a Pap test might not find abnormal cervical cells even if they do exist. This is called a false negative.</li>
	<li>Some forms of cervical cancer do not result in death and they don&rsquo;t even impact the quality of life. This identification of cervical cells is called overdiagnosis.</li>
	<li>Several women with cervical anomalies might be recommended for additional examinations or treatment for a disease that might not have progressed to cancer.&nbsp;</li>
</ul>

&nbsp;

A pap smear test&#39;s primary goal is to find precancerous changes, i.e., cellular abnormalities in the cervix that might lead to cervical cancer, whereas the HPV test looks for the human papillomavirus that can cause these changes. These tests can be done separately but it is also possible to test for HPV using a sample from a pap smear. This is called co-testing.

A pap smear can identify cervical cancer cells early, so the individual can begin therapy before the disease spreads and becomes more serious. One of the leading causes of cervical cancer is HPV, which can be acquired during intercourse. While using a condom or another barrier technique when practicing intercourse reduces your risk of catching the virus, nevertheless, all sexually active women should undergo a pap smear every 3 years at least since they risk getting HPV. 
&nbsp;

A pap test shouldn&#39;t be done while you are menstruating. The accuracy of the test is impacted by severe bleeding. Ask your doctor if you can reschedule the test if your test date falls during that time of the month.

Experts advise following these measures 48 hours before your test for the most reliable Pap smear:

<ul>
	<li>Avoid lubrication.</li>
	<li>Abstain from sexual activity.</li>
	<li>Keep sprays and powders away from the vagina.</li>
	<li>Tampons, tablets, creams, suppositories, and other items must not be placed within the vagina.</li>
	<li>Avoid washing the genital region with any liquid, including water, vinegar, or alcohol (douche). 
	&nbsp;</li>
</ul>

The exam is completed at a clinic or your doctor&rsquo;s office. It takes 10-20 minutes. You won&#39;t feel pain during the Pap test, although you might feel a slight pinch or pressure.

&nbsp;

1. As you lay on a table, your feet will be firmly secured in stirrups.

&nbsp;

2. Your doctor will ask you to spread your legs&nbsp;

&nbsp;

3. Then your doctor will gently insert a metal or plastic instrument (speculum) into your vagina. This is when you might feel a sensation of pain and discomfort and it&#39;s best to relax at this stage.

&nbsp;

4. The speculum helps in keeping the walls of the vagina apart to enable a clear view of&nbsp; the cervix.

&nbsp;

5.&nbsp;Samples from your cervix will be taken and your doctor can obtain this sample in a few different ways:

<ul>
	<li>Some doctors use a spatula.</li>
	<li>Some doctors use a brush and a spatula at intervals.</li>
	<li>Some doctors use a cytobrush, which combines the functions of a spatula and a brush.</li>
	<li>Some doctors use a swab.</li>
</ul>

&nbsp;

6. You might experience a small push and discomfort during the sampling.

&nbsp;

7. Your cervix&#39;s sample of cells will be kept intact and transported to a lab to examine the presence of abnormal cells.

&nbsp;

8. After the exam, you might experience some minor scraping discomfort or slight cramping. Additionally, minor vaginal bleeding could occur just after the test. Let your doctor know if pain or bleeding persists beyond the test day. 
&nbsp;

Your test result will arrive at your doctor&#39;s office within a few days. It would either be negative (normal) or positive (abnormal).

&nbsp;

<h5>1. Normal Outcome</h5>

A normal outcome is actually a positive thing. According to your doctor, this indicates that there aren&#39;t any cancerous or precancerous cells on your cervix. Until your next scheduled Pap is due, you won&#39;t require another one.&nbsp;

&nbsp;

<h5>2. Abnormal Outcome</h5>

Your Pap smear test might show abnormal cells due to:

<ul>
	<li>Mild inflammation or minor cell changes (dysplasia)</li>
	<li>HPV or other infection</li>
	<li>Cancer or pre-cancer</li>
	<li>Lab test error</li>
</ul>

&nbsp;

<h5>3. Atypical Squamous Cells Of Undetermined Significance (ASCUS)</h5>

Squamous cells are thin and flat and grow on the surface of a healthy cervix. In the case of ASCUS, the Pap smear reveals slightly abnormal squamous cells, but the changes don&#39;t necessarily suggest that precancerous cells are present.

Your doctor can go for a liquid-based test to reanalyze the sample to check for the presence of viruses known to promote cancer development, such as some types of human papillomavirus (HPV). If no high-risk viruses are present, the abnormal cells found as a result of the test aren&#39;t of great concern. If worrisome viruses are present, you&#39;ll need further testing.

&nbsp;

<h5>4. Squamous Intraepithelial Lesion</h5>

This term indicates that the cells collected from the Pap smear may be precancerous. If the changes are low grade, it means that the cells&#39; size, shape, and other properties indicate that if a precancerous lesion is present, it would take years to develop into cancer. On the other hand, if the changes are high grade, there&#39;s a greater chance that the lesion may develop into cancer sooner; additional diagnostic testing would be necessary in this instance.

&nbsp;

<h5>5. Atypical Glandular Cells</h5>

Glandular cells produce mucus and grow in the opening of your cervix and within your uterus. Atypical glandular cells may appear to be slightly abnormal, but it&#39;s unclear whether they&#39;re cancerous or not. Further testing is needed to determine the abnormal cells&#39; source and significance.

&nbsp;

<h5>6. Squamous Cell Cancer Or Adenocarcinoma Cells</h5>

This result means the cells collected for the Pap smear appear so abnormal that the pathologist is almost certain a cancer is present. &quot;Squamous cell cancer&quot; refers to cancers arising in the flat surface cells of the vagina or cervix. &quot;Adenocarcinoma&quot; refers to cancers arising in epithelial cells. If such cells are found, your doctor will recommend a prompt evaluation.

&nbsp;

<h5>7. Cervical Cancer (Or Pre-Cancerous Stage) 
&nbsp;</h5>

It is important to note that not all positive tests equate to cervical cancer. Additional testing is usually done to rule out other causes before a definitive diagnosis of cervical cancer is made. For example, your doctor can decide to &quot;wait and see&quot; if you experience inflammation or moderate cell abnormalities. Or they could advise that you get a second Pap test in a few months. If the abnormal cells still exist, your doctor might suggest more tests. One of these could be a technique known as colposcopy. 
&nbsp;

A colposcopy is used to diagnose genital warts, cervicitis (inflammation of the cervix), and precancerous changes in the cervix, vulva, and vagina.&nbsp;Similar to the Pap test, a speculum is inserted into your vagina during a colposcopy by your doctor. The colposcope is used to examine the cervix. The device with its particular lens and a strong light enables your doctor to see your cervix more clearly. Your doctor then swabs your cervix with vinegar or another liquid substance, which highlights the suspicious regions. Your doctor can see them due to the colposcope&#39;s lens.

Samples are collected from these suspicious areas (biopsy) and are sent to a lab for additional analysis. Multiple biopsy samples can be taken if there are multiple suspicious areas.&nbsp;

After the colposcopy, if there&rsquo;s any bleeding then the doctor would swab your cervix with a chemical solution to limit the bleeding. 
&nbsp;

If you are anywhere between 21 and 65 years of age, the test should be taken every 3 years.&nbsp;

Starting at age 30, you can decide to get both a Pap test and an HPV test. It is recommended to repeat these combined tests every 5 years instead of 3. Alternatively, women aged 30 and above could also opt for HPV testing instead of the Pap smear, this is because HPV is a known risk factor for cervical cancer.

&nbsp;

Your doctor could advise more frequent Pap tests if you have certain health issues, including:

<ul>
	<li>A diagnosis of cervical cancer or an abnormal Pap smear result&nbsp;</li>
	<li>&nbsp;HIV infection</li>
	<li>&nbsp;A weakened immune system due to chemotherapy, organ transplant, or chronic use of corticosteroids</li>
	<li>&nbsp;Exposure to diethylstilbestrol (DES) before birth</li>
</ul>

Note: Inform your doctor of any of the above conditions when considering getting a Pap smear test done.&nbsp; 
&nbsp;

Pap tests are quite precise. Routine Pap tests decrease the incidence of cervical cancer and associated mortality by at least 80%. Although it could be difficult initially, your health will benefit from the short-time pain you endure during the procedure. The Pap smear process is safe and reliable. However, it&#39;s possible that some aberrant cells or cervical malignancies could be missed by the test (false negative).&nbsp;

Note: Discuss getting a Pap smear test done at your next visit with the doctor.&nbsp;&nbsp;

<div>&nbsp;</div>

<ul>
	<li>In addition to your yearly gynecological checkup, you can schedule a Pap smear separately by calling your gynecologist. Most insurance plans cover Pap smears, but you might have to make a co-payment.</li>
	<li>Your doctor might want to reschedule your Pap smear if you are menstruating on the day of the test because then the results would not be as reliable.</li>
	<li>The day before your test, try to avoid having sex, douching, or using spermicidal products as these could affect your results.</li>
	<li>A Pap smear is typically safe to have in the first 24 weeks of pregnancy. It becomes difficult after that. Additionally, you ought to hold it off until 12 weeks after giving birth to improve the accuracy of your findings.</li>
	<li>Maintaining your composure and breathing throughout the Pap smear procedure is crucial since your body will function more efficiently if you are comfortable.</li>
</ul>

&nbsp;

You and your doctor can mutually decide to discontinue Pap smears.

<ul>
	<li>Ask your doctor if you need to continue obtaining Pap smears after a total hysterectomy, which involves the surgical removal of the uterus and the cervix.</li>
	<li>You might be eligible to stop getting Pap smears regularly if your hysterectomy was done to treat uterine fibroids or another non-cancerous condition.</li>
	<li>However, your doctor could advise continuing routine Pap tests if your hysterectomy was performed because of a precancerous or cancerous disease of the cervix.</li>
	<li>Doctors generally concur that if a woman&#39;s previous tests for cervical cancer were negative, she could think about quitting regular Pap tests when she turns 65.</li>
	<li>Together, you may determine what is best for you based on your risk factors. Your doctor might advise continuous Pap testing if you engage in sexual activity with many partners. 
	&nbsp;</li>
</ul>

Cervical cancer can be screened safely by using a Pap smear. A Pap smear is not 100% accurate, though. False-negative results are possible, which means that even though you have abnormal cells, the test shows no abnormality. False-negative results don&#39;t necessarily indicate that something went wrong.

&nbsp;

The following variables can result in a false-negative outcome:

<ul>
	<li>An Inadequate Collection Of Cells: An insufficient amount of collected cells may give false results.</li>
	<li>A Small Number Of Abnormal Cells: Sometimes a doctor is unable to conclude the results because of an insufficient quantity of collected abnormal cells.</li>
	<li>Blood Or Inflammatory Cells Obscuring the Abnormal Cells: Unknown inflammatory conditions and blood accumulation may cause hindrances in identifying results.</li>
</ul>

&nbsp;

Note: Please remember that if one test doesn&#39;t detect the abnormal cells, the next test most likely will. Hence repeated testing is necessary so that if abnormal cells go undetected in the first test, they will most likely be detected in any of the subsequent tests. Repeated testing is also necessary since cervical cancer takes several years to develop and regular pap smear tests allow for early intervention. 
&nbsp;

Conclusion

The incidence of cervical cancer in Pakistan is lower than in other western countries, but the mortality rate is high due to scarcity of awareness, unavailability of Pap smear tests, lack of follow-up, and late presentation of cervical cancers.To curb the late-stage presentation of the disease, implementation of the screening program on the national level is imperative. This would reduce the burden of disease on the health care sector while saving the lives of countless Pakistani women.Even though some specific dos and don'ts must be followed, Pap smear is still a valuable procedure. Healthcare experts must also encourage patients to take the test by alleviating their fears and anxiety associated with the procedure.&nbsp;

Key Points

<ul><li>The Pap smear test is a quick and effective way to test for cervical cancer in women&nbsp;</li><li>Although the procedure is short, Pap smears can be a little painful and tricky.</li><li>This procedure takes place in a proper healthcare environment with specialized tools.</li><li>Pap tests decrease at least 80% of cervical cancer incidence and mortality.</li><li>Women between 21 and 65 years of age are advised to go for a pap smear every 3 years. However starting from age 30 and onwards, it is possible to get either a combined Pap smear and an HPV test OR HPV testing every 5 years.</li><li>It is important to note that not all positive tests equate to cervical cancer. Additional testing is usually done to rule out other causes before a definitive diagnosis of cervical cancer is made. </li></ul>

[1] Syeda Asma Batool (Department of Zoology, L. C. f. W. U. L. P.)., 2017. JPMA. [Online]

[2] WHO, 2003. WHO. [Online]

Neelam Asad

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

Check Yourself Before You Wreck Yourself

&ldquo;A checkup can tell your inside story&rdquo; is something we have seemed to have forgotten over time. Sometimes it is due to a family commitment, and sometimes it is because of a work commitment. We have reached a point when we won&rsquo;t go for a checkup even when we are not feeling well!

&nbsp;

But did you know there is a list of diseases that can be prevented, or caught on early, if proper routine <a href="https://merisehat.pk/page/sehat-scan/">health checkup</a> is done? For starters, a routine <a href="https://merisehat.pk/page/sehat-scan/">health screening</a> would allow you to track any mild symptoms that might not seem dangerous initially. It also allows your health care practitioner to look for diseases that are notoriously asymptomatic.&nbsp;

&nbsp;

People nowadays have honestly started to take their health for granted. They only visit their doctors once a disease has settled in. Some of us even want to challenge the illness and see how far we can take it before we need to get admitted!

&nbsp;

Like any other medication a healthcare practitioner may prescribe for treating the disease, a <a href="https://merisehat.pk/page/sehat-scan/">health checkup</a> is necessary for preventing it. And as many of us will agree, &ldquo;prevention is better than cure&rdquo;.&nbsp; &nbsp;&nbsp; 
&nbsp;

&nbsp;

Understanding The Importance Of Regular Medical Check Ups

It is important to understand that males and females have different types of bodies physiologically. Hence, screening is essential for a range of different diseases, and, in some cases, it is solely dependent on the gender or age.

<h5>Blood Pressure</h5>

If you are a male aged between 18 and 39, you should control your blood pressure by getting it checked once every 2 years. If during these checkups your upper pressure (systolic) is above 120 and the lower pressure (diastolic) is more than 80, the monitoring has to be on a yearly basis<a href="#accordion">[1]</a>.

&nbsp;

<h5>Cholesterol</h5>

Due to dietary and lifestyle habits, cholesterol monitoring becomes crucial, particularly for men. The recommended age for cholesterol screening is 35 for men with no known risk factors for coronary heart disease, and 20 for men with known risk factors for coronary heart disease. If there are any comorbidities involved, you should get it checked more often. However, if the results are normal, the screening could simply be repeated after a span of 5 years<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

<h5>Diabetes</h5>

Diabetes and hypertension often go hand in hand. So, if you are a known hypertensive patient, you are more likely to be screened for diabetes. HbA1c is usually tested along with the oral glucose tolerance test (OGTT).&nbsp;

&nbsp;

For OGTT, blood sugar levels between 141 mg/dL and 200 mg/dL (7.8 - 11.1 mmol/L) is considered impaired glucose tolerance, whereas a result above 200 mg/dl (11.1mmol/L) means the person is diabetic. A normal HbA1C level is below 5.7%, levels of 5.7% - 6.4% indicates pre-diabetic condition, and 6.5% or more is a strong indicator of diabetes<a href="#accordion">[2]</a>. After obtaining your medical history in detail, your healthcare practitioner will decide whether screening for certain infections, like syphilis, chlamydia, and HIV is important or not.

&nbsp;

<h5>Prostate Cancer</h5>

Regarding malignancies, there are some horrific statistics seen in men, which makes it all the more necessary for them to be screened on a routine basis. According to the American Cancer Society&rsquo;s estimates for prostate cancer in the United States, in 2022, 268,490 new cases were reported and 34,500 people lost their lives due to the disease. This is equivalent to 1 in 8 men, with increasing risk once they turn 65<a href="#accordion">[3]</a>.&nbsp;

&nbsp;

The Prostate Cancer Early Detection Guidelines established by the National Comprehensive Cancer Network urges men above 45 years of age to get a screening done, and then plan a routine checkup according to the results.&nbsp;

&nbsp;

Prostate Specific Antigen (PSA) along with a digital rectal examination (DRE) is done to screen you for prostate cancer<a href="#accordion">[5]</a>. The PSA is a blood test to check for prostate specific chemicals, whereas the DRE is the insertion of a finger in the anus to feel the physical aspects of the prostate<a href="#accordion">[4]</a>.&nbsp;

&nbsp;

<h5>Bladder Cancer</h5>

Even though it&rsquo;s a disease of elderly, with the mean age being 73, bladder cancer is another malignant disease that is four times more prevalent in men compared to women<a href="#accordion">[5]</a>.&nbsp;

&nbsp;

Data collected by GLOBOCAN in 2018 estimated that 550,000 people were diagnosed with bladder cancer<a href="#accordion">[6]</a>. The screening method for bladder cancer is done by a basic urine detailed report and urine cytology which helps detect abnormalities.&nbsp;

&nbsp;

<h5>Colorectal Cancer</h5>

Colorectal cancer is yet another cancer which takes around 27,000 lives in the US alone each year.&nbsp;

&nbsp;

It is recommended that a colonoscopy be done as a screening method in men at the age of 45 years. A family history of malignancies makes the screening even more crucial<a href="#accordion">[5]</a>.&nbsp;&nbsp;

&nbsp;

<h5>Sexually Transmitted Infections&nbsp;</h5>

Men who have sex with women should get screening for:&nbsp;

<ul>
	<li>Chlamydia, gonorrhoea, syphilis, herpes, HIV, and hepatitis B and C&nbsp;</li>
</ul>

&nbsp;

Men who have sex with men should get screening for:&nbsp;

<ul>
	<li>Chlamydia, gonorrhoea, syphilis, herpes, HIV, HPV, anal cancer, and hepatitis B and C&nbsp;</li>
</ul>

&nbsp;

Women also need to be screened for their overall health. Reason being that a woman has to go through menstruation, pregnancies, and then post-menopause, all of which can cause multiple relevant health condition like dysmenorrhea, premature delivery, and increased risk of malignancies, respectively.&nbsp;

&nbsp;

Following are a few vitamins and minerals, and their recommended daily allowance which a woman can take to ensure optimal health<a href="#accordion">[7]</a>:

<ul>
	<li>Iron: For those aged 19-50 years, it&rsquo;s 18 mg/day whereas for those aged 51 and up, it&rsquo;s 8 mg/day</li>
	<li>Magnesium: If aged 19-30, then 310 mg/day; if aged 31 years and above, then 320 mg/day</li>
	<li>Vitamin D:&nbsp;If aged 1-70 years, 15 mcg/day (600 IU or international units)</li>
	<li>Vitamin C: 75mg/day</li>
	<li>Vitamin E: 15mg/day</li>
</ul>

&nbsp;

<h5>Lung Cancer</h5>

If you smoke one pack a day, it is necessary for you to be screened for lung cancer.&nbsp;Screening is done by a Computed Tomography (CT) and has to be done annually.&nbsp;

&nbsp;

<h5>Cervical Cancer</h5>

Cervical cancer is the 4th most common malignancy found in women worldwide. Around 604,000 new cases and 342,000 deaths were reported in 2020, with 90% of this data being sourced from low and middle income countries<a href="#accordion">[8]</a>.&nbsp;

&nbsp;

In order to screen a woman with cervical cancer, a Pap test is recommended every 3 years for women aged 21-65 years. A Pap smear test is one in which your health care practitioner takes samples from your cervix and evaluates them under a microscope.&nbsp;

&nbsp;

<h5>Breast Cancer</h5>

Another alarming malignancy in females is breast cancer. A total of 7.8 million cases, diagnosed between 2015-2020, made it the most prevalent cancer worldwide. In 2020 alone, there were 2.3 million women who were diagnosed and 685,000 deaths worldwide that occurred due to breast cancer<a href="#accordion">[9]</a>.&nbsp;

&nbsp;

Screening for breast cancer is done through mammography (an x-ray of your breast) every 2 years from the age of 50 years onwards<a href="#accordion">[10]</a>.&nbsp;

&nbsp;

<h5>Sexually Transmitted Infections&nbsp;</h5>

Women who are 24 years and older and sexually active should get screened for sexually transmitted infections like chlamydia, gonorrhoea, herpes, trichomoniasis, HIV, HPV, cervical cancer, hepatitis B, hepatitis C, and syphilis. Chlamydia screening particularly should be done every year once girls turn 24.&nbsp;

&nbsp;

Pregnant women should be screened for chlamydia, gonorrhoea, herpes, HIV, HPV, cervical cancer, hepatitis B, hepatitis C, and syphilis.&nbsp;

&nbsp;

Screening for diseases in children is another ball game and one that&rsquo;s quite important too.&nbsp;

&nbsp;

<h5>Severe Acute Malnutrition</h5>

Severe acute malnutrition (SAM), also known as severe wasting, is the most crucial form of undernutrition and has a mortality rate of 10-30%.&nbsp;

&nbsp;

Studies show that children in developing countries have a strong correlation of undernutrition and development outcomes. It should be noted that even if the child survives the undernutrition at the moment, it would have a drastic effect on adulthood, especially with regards to physical and cognitive development.&nbsp;

&nbsp;

According to the Pakistan Demographic Survey (2017&ndash;18), 37.6% of children under 5 years were stunted, with 17% severely stunted. Furthermore, 7.1% were found to be wasted, with 2% severely wasted and 23% were underweight<a href="#accordion">[11]</a>. Hence, it becomes necessary to monitor a child who is 5 years or under, to counteract any existing deficiencies .&nbsp;

&nbsp;

Developmental Screening Test II (Denver), also known as DDST II, is used to screen a child for his or her development. DDST II has 4 components: personal-social behavior development, fine motor development, language, and gross motor development.&nbsp;

&nbsp;

Apart from this, anthropometric measurements are also taken to check for physical development. Anthropometric measurements include height, weight, head circumference, body mass index (BMI), body circumferences to assess for adiposity (waist, hip, and limbs), and skinfold thickness.

&nbsp;

It can be settled from the statistics mentioned above that some diseases are silent killers and need to be identified as early as possible. Anything could happen to anyone, so the best way to look out for yourself is to give yourself a fair opportunity. Just going to your doctor reduces your risk by 50%. Some diseases like pancreatic cancers are usually symptomatic at advanced stages. However, if routine blood work is done, it can warrant for early on imaging and, hence, diagnosis. There can be a lot of examples like this, but the main question remains, “do you love yourself enough?”&nbsp;&nbsp;

<ul>
	<li>A health screening routine allows to track any mild symptoms that might not seem dangerous initially.</li>
	<li>Screening is important for different diseases and in some cases it&rsquo;s solely dependent on the gender or your age.</li>
	<li>If you are a male, aged between 18 and 39, you should keep your blood pressure in check by getting it checked once every 2 years.</li>
	<li>The recommended age for cholesterol screening is 35 for men with no known risk factors regarding coronary heart disease, and 20 for men with known risk factors for coronary heart disease.</li>
	<li>Blood sugar levels between 141 mg/dL and 200 mg/dL (7.8 to 11.1 mmol/L) is considered impaired glucose tolerance, whereas above 200 mg/dl (11.1mmol/L) is diagnostic of diabetes in an OGTT.</li>
	<li>A normal HbA1C level is below 5.7%, whereas a level of 5.7-6.4% indicates pre-diabetes. 6.5% or more is a strong indicator of diabetes.</li>
	<li>2022 studies show 268,490 new cases were reported and 34,500 people lost their lives due to prostate cancer in the US.</li>
	<li>Prostate Specific Antigen (PSA) along with a digital rectal examination (DRE) are done to screen one for prostate cancer</li>
	<li>Bladder cancer is 4 times more prevalent in men compared to women.</li>
	<li>Data collected by GLOBOCAN in 2018 estimated that 550,000 people were diagnosed with bladder cancer.</li>
	<li>The screening method for bladder cancer is a basic urine detailed report and urine cytology.</li>
	<li>Colorectal cancer is the 4th most common cancer in the US which takes around 27000 lives each year.</li>
	<li>Colonoscopy should be done to screen men around 45 years.</li>
	<li>Women need to tend to their overall health as vigilantly as possible, to ensure proper menstrual cycle and pregnancies.</li>
	<li>Lung cancer screening is done by a Computed Tomography (CT) and has to be done on an annual basis.</li>
	<li>Cervical cancer is the 4th most common malignancy found in women worldwide. Around 604,000 new cases were reported in the year 2020 and 342,000 deaths, with 90% of this data being sourced from low- and middle-income countries.</li>
	<li>Pap test is recommended every 3 years for women aged 21-65 years, for screening for cervical cancer.</li>
	<li>In 2020 alone, there were 2.3 million women diagnosed with breast cancer and 685,000 deaths globally.</li>
	<li>Screening for breast cancer is done by mammography every 2 years from the age of 50 years.</li>
	<li>Sexually active men (included males who have sex with males) and women (including pregnant women) should get screened for sexually transmitted infections.</li>
	<li>According to the Pakistan Demographic Survey (2017&ndash;18), 37.6% of children under 5 years of age were stunted, with 17% severely stunted. Furthermore, 7.1% were found to be wasted, with 2% severely wasted, and 23% were underweight.</li>
	<li>Developmental Screening Test II (Denver), also known as DDST II, and anthropometric measurements are used to screen a child for his or her development.</li>
</ul>

&nbsp;

[1] Health screenings for men ages 18 to 39: Medlineplus Medical Encyclopedia. MedlinePlus.

[2] All about your A1C. Centers for Disease Control and Prevention.

[3] Key statistics for prostate cancer: Prostate cancer facts. American Cancer Society.

[4] What is screening for prostate cancer? Centers for Disease Control and Prevention.

[5] 5 most common cancers in men. Roswell Park Comprehensive Cancer Center.

[6] Saginala K, Barsouk A, Aluru JS, Rawla P, Padala SA, Barsouk A. Epidemiology of Bladder Cancer. Med Sci (Basel). 2020;8(1):15. Published 2020 Mar 13. doi:10.3390/medsci8010015

[7] Vitamins and minerals: How much should you take? WebMD.

[8] Cervical cancer. World Health Organization.

[9] Breast cancer. World Health Organization.

[10] What is a mammogram? Centers for Disease Control and Prevention.

[11] Saleem, J., Zakar, R., Bukhari, G.M.J. et al. Developmental delay and its predictors among children under five years of age with uncomplicated severe acute malnutrition: a cross-sectional study in rural Pakistan. BMC Public Health 21, 1397 (2021).

Arbaz Ansari

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;

Key Takeaways

<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

Sarah Mhowwala

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;

<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.

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

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

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).

Nimrah H. Sattar

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;

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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;

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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.

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<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.

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<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>

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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.

<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>

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[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.