Month: July 2015

Hepatitis A: A Common Health Problem during Monsoon

Hepatitis means injury to the liver with inflammation to the liver cells caused by viruses and can lead to fibrosis, cirrhosis and liver cancer. There are five main types of hepatitis- A, B, C, D and E. Hepatitis A and E are highly infectious, caused by ingestion of contaminated food and water. Hepatitis B, C and D are caused by parenteral contact with infected body fluids like blood. These viruses can be transmitted via receipt of contaminated blood and blood products. Since monsoons are here, there is a lot of exposure to many infectious diseases.

Hepatitis A is caused by the Hepatitis A Virus (HAV) and is highly contagious. The HAV is found in the feces of people with HAV infection. It enters through the mouth after someone holds, eats or drinks anything contaminated with HAV.

How is Hepatitis A spread?

Interpersonal contact

  • When a person infected with Hepatitis A Virus does not take care of proper hand washing especially after going to the bathroom
  • When the care -giver does not wash hands properly after changing the diapers or cleaning the stool of an infected person
  • When a person has sexual contact with an infected person

Contaminated food or water – Hepatitis A is spread through the ingestion of food or water contaminated with Hepatitis A Virus. This can be due to poor sanitary conditions and poor personal hygiene.

A person suffering from this disease may or may not show clear symptoms. Moreover, the symptoms don’t show up in an infected person for a few weeks.  He/she may have a mild illness for a few weeks or may have severe illness that lasts several months.

Hepatitis-A_Infographic

How is Hepatitis A diagnosed?

The diagnosis of Hepatitis A is done through a blood test.

Oncquest offers a number of tests for diagnosing and monitoring different types of Hepatitis. For Hepatitis A, we have the following tests:

  • Test: HAV, IgG Antibody, Serum Antibody to Hepatitis A, IgG. The technique used for these tests is Microparticle Enzyme Immunoassay.
  • Test: HAV, IgG, Antibody, Serum Antibody to Hepatitis A, IgM. CMIA technique is used for these tests.

Getting the vaccination for Hepatitis A is the best way to prevent it. Though the vaccines are usually given during infancy, it is recommended that if a person has not got the vaccination in his childhood, he/she should get the vaccine immediately.

World Hepatitis Day on July 28 is organized every year to increase awareness and understanding of viral hepatitis. Hepatitis is not a life-threatening disease. Just being a little careful and cautious during monsoons can really help you enjoy this season to the fullest. Stay infection free by eating healthy and keeping your surroundings clean. Wish you a safe monsoon!

Breast Cancer: Who Is At The Risk?

downloadHOW IS AN INCREASED RISK FOR BREAST CANCER INHERITED?

BRCA1 and BRCA2 are genes involved in cell growth, cell division, and repair damage to DNA. DNA damage occurs when a spelling error is made in the gene sequence. A changed BRCA gene can cause DNA damage in cells to go unrepaired, which increases the chances of cancer. People with BRCA mutations thus may get cancer at an early age, they may develop breast cancer in both breasts, or they may develop more than one type of cancer, e.g., cancers of both the breast and the ovary. The most common type of cancer linked to BRCA1 and BRCA2 changes is breast cancer, but mutated forms of BRCA genes are linked to other cancers as well.

WHAT ARE THE CHANCES OF INHERITING AN ALTERED BRCA1 OR BRCA2 GENE?

Both men and women can pass down a BRCA mutation. All people, whether they have cancer or not, have two copies of both BRCA genes — one copy from each parent. There are 50% chances of inheriting either copy of each parent’s two BRCA gene. If a mutated or nonworking gene is inherited then there is an increased risk of cancer. Even only one altered BRCA gene is sufficient to increase risk for breast or ovarian cancer.

ARE SOME PEOPLE MORE LIKELY THAN OTHERS TO HAVE A BRCAGENE MUTATION?

Women with a mutation in the BRCA1 & 2 genes are at increased risk for cancer of the breast and ovary. These risks may vary. Women with an altered BRCA1 & 2 genes have a 50 to 85% risk of developing breast cancer by age 70. Risk for cancer of the ovary is 40 to 60% by age 85. A woman with cancer in one breast has a higher risk of developing cancer in the other breast. 25 to 30% of those with a BRCA1 change may get a second breast cancer within ten years after their first incidence of breast cancer.

WHAT ARE THE POSSIBLE RISK AND BENEFITS OF BRCA1 AND BRCA2 TESTING?

Anyone considering genetic testing should be aware of the possible benefits and risks. There are four possible benefits of testing for BRCA1 and BRCA2 mutations.

  • First, the results may provide a better measure of the cancer risk.
  • Second, the results allow clinicians tailor cancer screening as needed.
  • Third, the results can help in choosing options for cancer-risk reduction, such as surgery.
  • Finally, knowing the test results may benefit family members as well.

While genetic testing poses no physical risk other than that of a blood draw, it may have an emotional impact. This is of special concern if a BRCA1 or BRCA2 mutation is found and may also have an impact on family members, some of whom may not want to know the results. Genetic counselling can be offered for such individuals including the family members.

WHAT FORMS OF CANCER SCREENING ARE AVAILABLE FOR A WOMAN WITH A MUTATED BRCA GENE?

A woman with a mutated BRCA gene has several options for cancer screening, the goal being to:

  1. Prevent cancer
  2. Find the cancer at an early enough stage that it can be treated

Women with BRCA changes should be sure to employ breast cancer screening, of which there are many different types. These include mammograms, MRI exams, ultrasound, breast examinations performed by a physician, and monthly breast self- examinations. Women with altered BRCA genes that are age 25 and older should receive regular mammograms. MRI scans may also be recommended as this test can find breast cancers not detected by mammograms or ultrasound.

Status of Breast Cancer and Related Tests

Breast-CancerBlood Marker Tests – Protein Markers & Circulating Tumor Cells (CTC)

CA 15.3 -> Detects breast cancer

CA 125 -> Breast cancer recurrence

CEA -> Marker of metastasis

CTC -> Metastatic breast cancer

Hormone Receptor Status (ER & PR)

A cancer is called estrogen-receptor-positive (ER+) or progesterone- receptor-positive (PR+) if it has receptors for estrogen or progesterone respectively. Roughly two out of every three breast cancers test positive for hormone receptors.

EGFR Status

As with the HER2 gene, there can be too many copies of the EGFR (Epidermal Growth Factor Receptor) gene, sometimes known as the HER1 gene in some breast cancer cells—known as EGFR amplification—which affects how the cancer cells behave.

HER2 Status

The HER2 (human epidermal growth factor receptor 2) gene makes HER2 protein receptors on breast cells. Normally, HER2 receptors help control how a healthy breast cell grows, divides and repairs itself. But in about 25% of breast cancers, the HER2 gene doesn’t work correctly and makes too many copies of itself (gene amplification) leading to HER2 protein overexpression. This makes breast cells grow and divide in an uncontrolled way.

Triple-Negative Breast Cancer

When breast cancer cells test negative for estrogen receptors (ER-), progesterone receptors (PR-), and HER2 (HER2-), the cancer is triple-negative. Triple- negative breast cancer does not respond to hormonal therapy (such as tamoxifen or aromatase inhibitors) or therapies that target HER2 receptors, such as H ercep-tin (chemical name: trastuzumab). However, other medicines can be used to treat triple- negative breast cancer.

About 10-20% of breast cancers i.e. more than one out of every 10 – are found to be triple-negative. EGFR Status HER2 Status Triple-Negative Breast Cancer

Prevention Strategies for Known BRCA 1/2 Mutation Carriers

Reduce Risk of Breast Cancer
  • Annual mammogram – Between 25-35 years of age
  • Clinical breast exam – Every 6-12 months
  • Self-breast exam – Monthly
  • Consider chemoprevention (tamoxifen)
  • Consider prophylactic oophorectomy
  • Consider other options for post- menopausal hormone replacement therapy
  • Diet, exercise

GENETIC TESTS

Most inherited cases of breast cancer are associated with two abnormal genes: BRCA1 (Breast Cancer Gene 1) or BRCA2 (Breast Cancer Gene 2). Women who inherit a mutation or abnormal change in either of these genes have a much higher than the average lifetime risk of developing breast and ovarian cancer. Women with an abnormal BRCA1 or BRCA2 gene have about a 60%-85% risk of being diagnosed with breast cancer during their lifetimes (compared to 12-13% for women overall).  (Source: National Cancer Institute)

Oscar-winning film star Angelina Jolie revealed that she underwent a preventive double mastectomy after discovering that she has a mutated version of the BRCA1 gene that made it extremely likely she would get breast cancer. (Source: New York Times)

Cancer is currently the cause of 12% of all deaths worldwide. You must be aware that breast cancer is one of the most common and emerging cancers all over the world.

Around 21 different breast cancer genes have been studied in relation to hereditary cancer syndrome. Among these genes, Breast Cancer Susceptibility Gene 1 (BRCA1) and Breast Cancer Susceptibility Gene 2 (BRCA2) have been significantly associated with familial risk for breast/ovarian cancer.12

The gene locus for BRCA1 is 17q21. BRCA1 is a large gene, with 24 exons encoding a 220 kD nuclear protein (1863 amino acids). Gene locus for BRCA2 is 13q12.3. It encodes for 384 kD nuclear protein (3418 amino acids). BRCA2 contains 27 exons spread over 70 kb of genomic DNA. Over 1000 different mutations in BRCA1 and BRCA2 gene are reported till date. Screening of these mutations aids in assessing the familial risk for Breast Cancer. With the growing awareness of Breast Cancer and its genetic links, there has been interest for screening BRCA1 and BRCA2 gene mutations, particularly in high-risk patients with family history.123

Hypertension at Work: What You Need to Know

BlogImage_HypertensedHypertension in the Workplace

As the workplace becomes more demanding and highly competitive, organizations have started witnessing a new culture of employees being ‘always on’ – working extra hours and over weekends. Increasing work stress and lack of leisure time has a negative impact on health, which can be directly linked to attrition, decreased productivity and lowering overall business performance. Hypertension, or high blood pressure, is one of the most common problems faced by working people.

Blood Pressure is considered normal at a reading < 140 (Systolic Pressure) and <90 (Diastolic Pressure). High blood pressure is a pressure of 140 systolic or higher and/or 90 diastolic or higher that stays high over time. Hypertension may lead to heart failure, organ damage, kidney failure and stroke, and yet most people consistently exhibit negligence towards this disease.

Costs to the Employer

Here’s how hypertension affects employers:

Lost Productivity: It causes loss of productivity and subsequent loss in output.

Absenteeism:  Studies shows that a majority of the employee absences are related to poor health and hypertension is one of the most frequent core causes.

Presenteeism: Low productivity leads people to stay at work longer hours, which not only causes them more stress and worsens health in a vicious cycle, it also lowers the morale of all employees.

How Can the Organization Help?

It is an employer’s responsibility to protect and enforce employee health, safety and welfare by taking a proactive approach in keeping their workers happy and well cared for.

While difficult, it is not impossible to control work stress. Workplace hypertension screening and health risk assessment must be developed to benefit employees, their families and the whole organization in general. This includes specific programs for blood pressure management, stress reduction and smoking and alcohol cessation.

To promote staying healthy while working, the organization can take following steps:

  1. Stress-relief Activities: The employer can promote stress relief through activities centered on recreation and health. Employees may be encouraged to participate in physical activities like climbing stairs, routine stretches and exercises at their desk, meditation, and yoga sessions. Building a gym in the workplace or providing discounts on fitness club memberships also goes a long way in fighting hypertension.
  1. Healthy Eating: Exercise and Diet are complimentary. The organization should encourage employees to have a balanced diet – low in sugar, salt, fat and high in fibre. Office canteens should serve healthy food for meals. Stocking healthy snacks, providing sugar-free options for tea and coffee, etc. can also help.
  1. Employee Motivation: HR Managers can help motivate employees to move towards a healthy lifestyle, which can prevent work hypertension. Employees should be motivated to avoid bad habits like smoking and alcohol and get an appreciation for good work. This helps in dealing with work stress while increasing efficiency and productivity. Encourage employees to take walks around the office.

Staying Healthy

Since there is still no cure for primary hypertension, a good diet, regular exercise and a healthy lifestyle, along with appropriate medication are the only options to control high blood pressure, prevent complications, and help maintain good health conditions for work. Regular health checks will not only encourage employees to stay healthy, it will also help diagnose any health problems right at the onset. Employees are the most valuable resource on any organization and safeguarding their health should be a priority.