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HETAR activity Breast cancer on the Philippines
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  Breast Cancer 101: Early detection is best, says PCS October, the Breast Cancer Awareness Month With breast cancer being the no. 1 among all other cancer types in the country, there is an urgent need to inform and educate Filipino women on the advocacy for “Breast Cancer is curable if detected early and treated properly.”   Here are some more helpful information on breast cancer. What is breast cancer? Breast cancer is a type of cancer (or tumor) found in the tissues of the breast. There are two primary kinds of breast cancer: Ductal Carcinoma (ductal tubes that channel milk to the nipple) and Lobular Carcinoma (from the mammary lobes). How common is breast cancer in the Philippines? According to the Philippine Cancer Facts and Estimates (PCFE) published by the Philippine Cancer Society, breast cancer ranks no. 1 amongst all cancers in the country. What is unfortunate is that most Filipino women still lack information on breast cancer. Some  believe that very few survive from the disease. The perceived cost of medical treatment prevent them from seeking help not knowing that costs are manageable when the disease is detected early. Breast cancer in men is a rare occurrence though it can happen. How will I know if I have breast cancer? There are almost no symptoms in early breast cancer. This is why it is very important for early detection through regular breast examination which should be done once a month. While the tumor is growing, one may have: ã Growing lump, not regular in shape and painless   ã Change in the size, shape or sensitivity of the breast or nipple   ã Discharge on the nipple  If the cancer is advanced, symptoms may be: ã Pain in any part of the bone   ã Pain on the breast   ã Swelling on the arm near the breast that has cancer    ã Sudden loss of weight   What is the cause of breast cancer? There are no definite studies yet to pinpoint the cause of breast cancer. There are only studies to show the risk factors or those prone for breast cancer. These risk factors can be divided into those that can be controlled and those that cannot be controlled. The risk factors that we cannot have any control are:   ã Ge nder. The disease afflicts 100x more women than men. ã Age. Older women are at more risk for breast cancer.   ã Women with cancer on one breast that has been treated may replicate in the other breast. This is called recurrence.   ã The presence of breast cance r in a family member like the mother, sister, aunt or grandmother may increase risk. ã Early menstruation or late menopause.   Risk factors that we may have control (or lifestyle choices) are:   ã Not having children or childbirth for women over 30 years old.   ã Use of Hormonal Replacement Therapy (HRT) after menopause.   ã Cigarette smoking or excessive alcohol intake.   ã Lack of physical activity or exercise which results in being obese or overweight.    If early detection can save lives, how do we detect breast cancer at an early stage? The Philippine Cancer Society recommends regular monthly Breast Self-Examination (BSE), an annual clinical breast exam and mammography. Talking with your doctor is very important for guidance in detection. What about treatment? How does the government intervene with breast cancer prevention and treatment? Traditional forms of breast cancer treatment are surgery, chemotherapy, radiotherapy and immunotherapy. Recommended is a multidisciplinary and inter-disciplinary approach where a team of medical specialists agree on a specific protocol or treatment for each and every cancer patient. The PCS has a pioneering program called Patient Navigation (PNAP) that assists cancer patients with their diagnostics, medical treatment and psycho-social needs. For breast cancer, the PNAP is in partnership with the Breast Cancer Medicine Access Program (BCMAP) of the Department of Health which gives free chemotherapy drugs for qualified patients diagnosed with Breast Cancer Stage 3 B or earlier. Aside from this, the PCS has continuing free lectures in barangays, schools and workplaces to disseminate important information on breast cancer. The PCS also runs a free Consultation and Referral Clinic every Monday and Wednesday mornings. It maintains a directory of support groups, and networks with institutions, facilities and individuals who work on Breast Cancer care. PCS gives demo on BSE at Avon Walk and Run To highlight the importance of Breast Self-Examination (BSE) as an early detection approach to breast cancer for Filipino women, PCS executive director Dr. Rachael Marie Rosario (center) assisted by GMA stars Lyn Ching and Solenn Heusaff, demonstrates the  proper way to do BSE to participants at Avon’s Annual Walk and Run at the SM Mall of Asia recently  ( October 12, 2014 ). Hundreds of Filipino women learned firsthand the benefits of doing BSE and when to do it, as explained by Dr. Rosario. Other early detection methods are clinical breast exam and mammography, Dr. Rosario added. PCS Trustee Dr. Angela Crisostomo and Dr. Rosario led the PCS staff during the 5km walk around the MOA grounds. The PCS Cancer Prevention Guidelines are in 3 categories namely the primary, secondary and tertiary cancer prevention or clinical treatment guideline.   Primary prevention of cancer is the prevention of cancer in an individual who does not have the disease. Secondary prevention of cancer is the early detection of cancer in an individual who has the disease but is asymptomatic for it; disease is at the pre-clinical stage. Screening is the presumptive identification of unrecognized disease or defects by means of tests, examinations, or other procedures that can be applied rapidly among asymptomatic target population on a large scale. Tertiary cancer  prevention or better known as clinical treatment is the treatment of symptomatic clinical cancer to prevent disease progression or complication/s. Among the three categories, breast cancer is categorized as secondary cancer prevention that’s why if  breast cancer can be treated successfully and if detected early, it has one of the highest survival rates among other cancers. The following are risk factors for breast cancer:   1.   Being female and older age. The risk of breast cancer in a 70 year old woman is about 10 times that of a 30 year old woman. Over her lifetime, a woman's risk of developing breast cancer is about one hundred times a man's risk. 2.   A personal or family history of breast cancer or benign (non-cancer) breast disease  –    even your dad’s      Women with any of the following have an increased risk of breast cancer:    A personal history of breast cancer, ductal carcinoma in situ (DCIS) or  lobular carcinoma in situ (LCIS).    A personal history of  benign (non-cancer) breast disease.    A family history of breast cancer in a first-degree relative (mother, sister, or daughter). 3.   Inherited gene changes. Women who have inherited certain changes in the   BRCA1  and   BRCA2  genes have a higher risk of breast cancer, ovarian cancer and maybe colon cancer. The risk of breast cancer caused by inherited gene changes depends on the type of gene mutation, family history of  cancer, and other factors. Men who have inherited certain changes in the BRCA2 gene have a higher risk of breast, prostate, and pancreatic cancers, and lymphoma.  4.   Dense breasts. The level of risk depends on how dense the breast tissue is. Women with very dense breasts have a higher risk of  breast cancer than women with low breast density. Increased breast density is often an inherited trait, but it may also occur in women who have not had children, have a first pregnancy late in life, take postmenopausal hormones, or drink  alcohol.  5.   Estrogen made in the body. Estrogen is a hormone made by the body. It helps the body develop and maintain female sex characteristics. Being exposed to estrogen over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating. A woman's exposure to estrogen is increased in the following ways:    Early menstruation : Beginning to have menstrual periods at age 11 or younger increases the number of years the breast tissue is exposed to estrogen.     Late menopause  : The more years a woman menstruates, the longer her breast tissue is exposed to estrogen.    Late pregnancy or never being pregnant : Because estrogen levels are lower during pregnancy, breast tissue is exposed to more estrogen in women who become pregnant for the first time after age 35 or who never become pregnant. 6.   Combination hormone replacement therapy/Hormone therapy. Hormones, such as estrogen and progesterone, can be made into a pill form in a laboratory. Estrogen, progestin, or both may be given to replace the estrogen no longer made by the ovaries in  postmenopausal women or women who have had their ovaries removed. This is called hormone replacement therapy (HRT) or hormone therapy (HT). Combination HRT/HT is estrogen combined with progestin. This type of HRT/HT increases the risk of  breast cancer. Studies show that when women stop taking estrogen combined with progestin, the risk of breast cancer decreases. 7.   Exposure to radiation.  Radiation therapy to the chest for the treatment of cancer increases the risk of breast cancer, starting 10 years after treatment. The risk of breast cancer depends on the dose of  radiation and the age at which it is given. The risk is highest if radiation treatment was used during puberty, when breasts are forming. However, radiation therapy to treat cancer in one breast does not appear to increase the risk of cancer in the other breast.    For women who have inherited changes in the  BRCA1  and  BRCA2  genes, exposure to radiation, such as that from chest x-rays, may further increase the risk of breast cancer, especially in women who were x-rayed  before 20 years of age. 8.   Obesity. Obesity increases the risk of breast cancer, especially in postmenopausal women who have not used hormone replacement therapy. 9.   Alcohol. Drinking alcohol increases the risk of breast cancer. The level of risk rises as the amount of alcohol consumed rises. The following are protective   factors for breast cancer:   1.   Less exposure to estrogen. Decreasing the length of time a woman's breast tissue is exposed to estrogen may help prevent  breast cancer. Exposure to estrogen is reduced in the following ways:    Early pregnancy : Estrogen levels are lower during pregnancy. Women who have a full-term pregnancy before age 20 have a lower risk of breast cancer than women who have not had children or who give birth to their first child after age 35.    Breast-feeding : Estrogen levels may remain lower while a woman is breast-feeding. Women who breastfed have a lower risk of  breast cancer than women who have had children but did not breastfeed.    Ovarian ablation  : The ovaries make estrogen. The amount of estrogen made by the body can be greatly reduced by removing one or  both ovaries. Also, drugs may be taken to lower the amount of estrogen made by the ovaries.    Late menstruation : Beginning to have menstrual periods at age 14 or older decreases the number of years the breast tissue is exposed to estrogen.    Early menopause  : The fewer years a woman menstruates, the shorter the time her breast tissue is exposed to estrogen. 2.   Exercise. Women who exercise four or more hours a week have a lower risk of breast cancer. The effect of exercise on breast cancer risk may be greatest in premenopausal women who have normal or low body weight. 3.   Estrogen-only hormone therapy after hysterectomy. Hormone therapy with estrogen only may be given to women who have had a hysterectomy. In these women, estrogen-only therapy after menopause may decrease the risk of breast cancer. There is an increased risk of  stroke and heart and blood vessel disease in postmenopausal women who take estrogen after a hysterectomy. 4.   Selective estrogen receptor modulators. Tamoxifen and raloxifene  belong to the family of drugs called selective estrogen receptor modulators(SERMs). SERMs act like estrogen on some tissues in the body, but block the effect of estrogen on other tissues. Treatment with Tamoxifen or Raloxifene lowers the risk of breast cancer in postmenopausal women. Tamoxifen also lowers the risk of breast cancer in high-risk premenopausal women. With either drug, the reduced risk lasts for several years after treatment is stopped. Lower rates of broken bones have been noted in patients taking Raloxifene. Taking Tamoxifen increases the risk of  hot flashes, endometrial cancer, stroke, cataracts, and blood clots(especially in the lungs and legs). The risk of having these problems increases with age. Women younger than 50 years who have a high risk of breast cancer may benefit the most from taking Tamoxifen. The risk of having these problems decreases after Tamoxifen is stopped. Talk with your doctor about the risks and benefits of taking this drug. Taking Raloxifene increases the risk of blood clots in the lungs and legs, but does not appear to increase the risk of endometrial cancer. In postmenopausal women with osteoporosis (decreased bone density), Raloxifene lowers the risk of breast cancer for women who have a high or low risk of breast cancer. It is not known if Raloxifene would have the same effect in women who do not have osteoporosis. Talk with your doctor about the risks and benefits of taking this drug. Other SERMs are being studied in clinical trials.  5.   Aromatase inhibitors and inactivators.  Aromatase inhibitors (Anastrozole, Letrozole) and inactivators (Exemestane) lower the risk of a new breast cancer in women who have a history of breast cancer. Aromatase inhibitors also decrease the risk of breast cancer in women with the following conditions:    Postmenopausal women with a personal history of breast cancer.    Women with no personal history of breast cancer who are 60 years and older, have a history of ductal carcinoma in situ with mastectomy, or have a high risk of breast cancer based on the Gail model tool (a tool used to estimate the risk of breast cancer). In women with an increased risk of breast cancer, taking aromatase inhibitors decreases the amount of estrogen made by the body. Before menopause, estrogen is made by the ovaries and other tissues in a woman's body, including the brain, fat tissue, and skin. After menopause, the ovaries stop making estrogen, but the other tissues do not. Aromatase inhibitors block the action of an enzyme called aromatase, which is used to make all of the body's estrogen. Aromatase inactivators stop the enzyme from working. Possible harms from taking aromatase inhibitors include muscle and joint  pain, osteoporosis, hot flashes, and feeling very tired. 6.   Prophylactic mastectomy. Some women who have a high risk of breast cancer may choose to have a prophylactic mastectomy (the removal of both breasts when there are no signs of cancer). The risk of breast cancer is much lower in these women and most feel less anxious about their risk of breast cancer. However, it is very important to have a cancer risk assessment and counseling about the different ways to prevent breast cancer before making this decision. 7.   Prophylactic oophorectomy. Premenopausal women who have a high risk of breast cancer due to certain changes in the BRCA1 and BRCA2 genes may choose to have a prophylactic oophorectomy (the removal of both ovaries when there are no signs of cancer). This decreases the amount of estrogen made by the body and lowers the risk of breast cancer. Prophylactic oophorectomy also lowers the risk of breast cancer in normal premenopausal women and in women with an increased risk of breast cancer due to radiation to the chest. However, it is very important to have a cancer risk assessment and counseling before making this decision. The sudden drop in estrogen levels may cause the symptoms of menopause to begin. These include hot flashes, trouble sleeping, anxiety, and depression. Long-term effects include decreased sex drive, vaginal dryness, and decreased bone density. 8.   Bisphosphonates. Bisphosphonates are drugs used to treat osteoporosis and hypercalcemia and to prevent bone fractures in cancer patients. When taken by mouth or by intravenous infusion for more than 1 year they may lower the risk of breast cancer. 9.   There are studies that show that breastfeeding for more than one year lowers the risk for breast cancer. It is not clear whether the following affect the risk of breast cancer:   1. Oral contraceptives . Taking oral contraceptives ( the pill ) may slightly increase the risk of breast cancer in current users. This risk decreases over time. Some oral contraceptives contain estrogen. Progestin-only contraceptives that are injected or  implanted do not appear to increase the risk of breast cancer. 2. Environment . Studies have not proven that being exposed to certain substances in the environment, such aschemicals, increases the risk of breast cancer. The following do not affect the risk of breast cancer.      Having an abortion.    Making diet changes such as eating less fat or more fruits and vegetables.    Taking vitamins, including fenretinide (a type of  vitamin A).    Cigarette smoking, both active and passive (inhaling secondhand smoke).    Using underarm deodorant or antiperspirant. (Definitely a no!)    Taking statins such as atorvastatin, simvastatin, etc. (cholesterol -lowering drugs).
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