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.

Diagnosis and Staging of Breast Cancer

Breast cancer accounts for 23% of all cancer cases and is the most common cause of cancer in women. A woman has a 13% lifetime risk of developing invasive breast cancer, with more than one million women diagnosed with breast cancer every year in the world. A biopsy is used to definitively diagnose breast cancer.

BreastCancer_BlogTypes of breast biopsy procedures:

Fine Needle Aspiration Biopsy: A very thin needle is placed into the lump or suspicious area to remove a small sample of fluid and/or tissue. No incision is necessary. A fine needle aspiration biopsy may be performed to help to differentiate a cyst from a lump.

Core Needle Biopsy: A large needle is guided into a lump or suspicious area to remove a small cylinder of tissue (also called a core). No incision is necessary.

Surgical Biopsy (Open Biopsy): A surgeon removes part or all of a lump or suspicious area through an incision into the breast. There are two types of surgical biopsies: an incisional biopsy, where a small part of the lump is removed, and an excisional biopsy, where the entire lump is removed.

 Lymph Node Involvement

Before or during surgery to remove an invasive breast cancer, the doctor removes one or some of the underarm lymph nodes so they can be examined under a microscope for cancer cells.

Ductal Lavage

For women who are at high risk for breast cancer, a procedure called ductal lavage may be used. Ductal lavage is a procedure that collects cells from inside the milk ductal system – the location where most breast cancers begin. Ductal lavage technique is used to detect pre- cancerous and cancerous breast cell changes in women who are at high risk.

Staging Breast Cancer

Once the clinician has diagnosed breast cancer, the next step would be to establish the extent (stage) of cancer. The patient’s cancer stage helps determine prognosis and the best treatment options. Complete information about cancer’s stage may not be available until one undergoes breast cancer surgery. Tests and procedures used to stage breast cancer may include:

  • Blood Tests, such as a complete blood count
  • Mammogram of the other breast to look for signs of cancer
  • Breast MRI
  • Bone Scan
  • Computerized Tomography (CT) Scan
  • Positron Emission Tomography (PET) Scan

Not all women will need all of these tests and procedures. The doctor selects the appropriate tests based on patient’s specific circumstances. Breast cancer stages range from 0 to IV, with 0 indicating cancer that is very small and non-invasive. Stage IV Breast Cancer, also called metastatic breast cancer, indicates that the cancer that has spread to other areas of the body.

To know more about status and tests related to Breast Cancer, Click on http://blog.oncquest.net/?p=93

Predicting Genetic Risks in Breast Cancer: BRCA-1 and BRCA-2 Mutations

Dr Vinay Bhatia, Assistant Manager – Molecular Biology

Rekha, a 50 year old mother of two, discovered a lump in her breast during self-examination. After completing a careful medical history and physical examination with her physician, a mammogram showed a suspicious lump. A biopsy from the lump indicated breast cancer. The tumor was tested for hormone receptors and for a growth-promoting gene and protein called HER-2/neu. The results pointed to a potentially aggressive tumor (HER2 positive). A PET scan combined with CT confirmed metastasis. To complete her evaluation, laboratory tests, including serum tumor markers (CEA and serum HER-2/neu), and additional blood tests, including CBC were done.

 

Rekha and her physician decided on a treatment course that included biological therapy to specifically prevent HER-2/neu cancer cells from growing. Her serum tumor markers were serially monitored to help track treatment efficacy. With the treatment, the levels of Rekha’s serum tumor markers dropped. Rekha’s ongoing care includes a combination of serial serum prognostic tumor-marker tests and non-invasive imaging studies. Concerned that her daughter might have a genetic predisposition for breast cancer, Rekha asked for a referral. A genetic specialist told Rekha that genetic test panels, combined with clinical data, could help assess her daughter’s risk many years before breast cancer could develop.

Rekha’s is a typical case, where the physician is usually consulted at an advanced stage of breast cancer, leading to a diagnostic dilemma that may affect treatment decisions. Breast cancer accounts for 23% of all cancer cases and is the most common cause of cancer in women. A woman has a 13% lifetime risk of developing invasive breast cancer, with more than one million women diagnosed with breast cancer every year in the world.

HOW IS BREAST CANCER DIAGNOSED IN A LABORATORY?

Tests and procedures used to diagnose breast cancer include:

Breast Exam: Examination of breast for any lumps or other abnormalities.

Mammogram: A mammogram is an X-ray of the breast. Mammograms are commonly used to screen for breast cancer. If an abnormality is detected on a screening mammogram, the clinician might recommend a diagnostic mammogram to evaluate that abnormality further.

Breast Ultrasound: Ultrasound uses sound waves to produce images of structures deep within the body. Ultrasound may help distinguish between a solid mass and a fluid-filled cyst.

Breast Magnetic Resonance Imaging (MRI): An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast.

Biopsy: Imaging studies such as mammogram and MRI, often along with physical exams of the breast, can lead doctors to suspect that a person has breast cancer. However, the only way to know for sure is to take a sample of tissue from the suspicious area and examine it under a microscope. Biopsy samples are sent to a laboratory for analysis where experts determine whether the cells are cancerous. A biopsy sample is also analyzed to determine the type of cells involved in the breast cancer, the aggressiveness (grade) of the cancer, and whether the cancer cells have hormone receptors or other receptors that may influence the patient’s treatment options.

To know about different types of biopsy procedure and staging of breast cancer, click this link http://blog.oncquest.net/?p=67 .

5 Great Tips for Malaria Prevention



Malaria is a mosquito-borne disease, transmitted when a mosquito infected with the parasitic protozoa Plasmodium bites a person. While the mosquito remains unaffected by the Plasmodium, it can be lethal to humans that are bitten. Malaria is entirely preventable if you take the right steps to protect yourself. With World Malaria Day right around the corner, here are our 5 top tips for malaria prevention:

1. Avoid Open Spaces
Do not sleep in open spaces. Avoid sleeping around areas where mosquitoes breed and places with stagnant water (lakes, sewage canals, garbage dumps). At home, keep all the doors and windows closed whenever possible.

2. Adopt Nets
While it is recommended that you keep windows and doors closed at all times, it is also important to keep your home ventilated. This helps in the circulation of fresh air in your house and keeps your house cool and fresh. For this reason, we recommend that you fix nets on your windows and doors. Use a bed net in your bedroom, making sure that it is properly fixed and tucked in under your bed.

3. Use Mosquito Repellents
One option you can use are insect sprays that contain pyrethroids. Spray these in all living and sleeping areas, particularly during evening and night time. Other options are DEET-based repellents (AllOut, Good Knight) or natural repellents (Neem Oil). You can also apply mosquito repellent creams (Odomos) or lotions to exposed parts of your skin.

4. Wear Long Sleeves and Trousers
As mosquitoes bite your exposed skin, it makes sense to wear long trousers and shirts with long sleeves during evening and night time. The less skin you expose to the air, the harder it is for mosquitoes to bite you. In addition to this you can also apply some Permethrin on your clothes for extra protection from mosquitoes.

5. Apply Creams First and Repellents Second
If applying sunscreen or moisturizer, please note that you must apply either first and only then apply mosquito repellent creams. It is important to observe that the repellent cream must be exposed to the air for it to work effectively. It will not work if it is covered with a layer of moisturizer or sunscreen. If possible, choose the best of both worlds with a sunscreen or moisturizer that contains mosquito repellent.

Recognizing Malaria Symptoms
If you’ve followed all our tips, you should be well equipped to prevent any onset of Malaria. However, we feel it is just as important to be able to recognize malaria symptoms, in case of any unforeseen circumstances. The top malaria symptoms you should watch for are fever, nausea, sweating, vomiting, chills, headache, dry cough, body pain and fatigue.

Symptoms will appear in a cyclic manner, with cycles varying between 48 to 72 hours. At the onset of 2 or more of these symptoms, consult your doctor immediately.

The ABCD Mnemonic
Before we conclude, we wanted to share with you the ABCD mnemonic for fighting malaria, as shown below:
Awareness of Malaria Risk: Understanding malaria symptoms, its prevention help you gain a higher understanding, in order to avoid contraction of the disease.

Bite Prevention: Discussed in depth in our previous blog post , dealing with the root of the problem can help you avoid the problem before it manifests.
Chemoprophylaxis: A prescribed antimalarial medication that helps counteract the effects of malaria.
Diagnosis and Treatment: Prompt diagnosis helps in effective treatment and recovery.

A Life Free From Malaria
We hope these you follow these simple DIY tips to ensure a healthy life for you and your family. For more tips, read our article on . Simple Ways to Keep Mosquitoes at Bay

Simple Ways to Keep Mosquitoes at Bay



There are about 3000 species of mosquitoes in the world. In South-east Asia, India alone accounts for about 80% of all malaria cases. According to the WHO, malaria is a completely avoidable and treatable disease, but preventive strategies must be put in place in order to battle this dreaded illness. Protecting yourself from mosquito bites guards you from mosquito-borne illnesses like encephalitis, yellow fever, dengue and malaria. With World Malaria Day around the corner, here are some simple ways to help you protect yourself from mosquito bites.

Mosquito Repellents
Use a mosquito repellent, a substance that prevent mosquitoes from approaching/settling in your surrounding area. Chemical mosquito repellents found in liquid electric machines, mosquito coils and mats contains the chemical called DEET (diethyl-meta-toluamide). Research has shown that apart from leaving a bad odour, DEET also damages brain cells, cause behavioral changes and lead to harmful side-effects on interaction with certain medications.

Here are some natural alternatives:

Neem Oil: Studies conducted at the US National Research Council—confirmed by scientists at the National Institute of Malaria Research—indicate that neem oil is more effective than DEET.

Lavender Oil: A commonly used mosquito repellent that smells great, lavender oil is best used when diluted in almond or coconut oil.

Organic Soy Oil: According to research quoted in The New England Journal of Medicine, soybean oil is as effective as DEET for repelling mosquitoes. Cheap, easily available and a great body moisturizer, soy oil works as an excellent mosquito repellent.

Applying Natural Mosquito Repellents
1) Mix 50 drops of lavender and neem together into a solution.
2) Add 1 ml of this solution into 30 ml of unscented coconut or almond oil, or moisturizer.
3) Apply a little on your skin before you leave home. You can also mix 30 drops of these essential oils into organic soy oil for extra protection.

Note: Always conduct a 24-hour skin test to check for any skin sensitivity to oils.

Avoid using Flowery Perfumes
The fragrant smells in lotions, soaps and shampoos attract mosquitoes. Female mosquitoes generally feed on flower nectar when they are not breeding.

Preventative Measures
Drain: Drain your surroundings of any stagnant water which may serve as a breeding ground for mosquitoes. This includes garbage bins, tyres and gutters.

Defend: Instead of chemical DEET-based repellents, go the unconventional way with the natural mosquito repellents mentioned above.

Dress: Dress in light coloured loose clothes—shirts with long sleeves, long pants and socks.

More than Just Malaria
According to the WHO, mosquitoes cause at least 50 million cases of dengue fever each year globally. It is also estimated that Southeast Asia is prone to the highest risk. There is currently no vaccination or preventive measure for dengue fever—other than avoiding mosquito bites.

Prevention is the best defense against mosquitoes. We hope these tips help you in keeping your home free from mosquitoes. For tips on how you can prevent malaria, read our post on Our Top 5 Malaria Prevention Tips .

5 Simple Steps to Check For Breast Cancer

While the most effective way to check for Breast Cancer is through a mammogram and a clinical breast exam, a self-examination can be conducted at the convenience of your home as a preliminary check. When detected in early stages, chances of survival against the breast cancer are significantly higher.

 

What Is A Breast Self-Examination?

A breast self-examination is a check-up that a woman does herself at home to check for any changes that may indicate the development of breast cancer. It is a preliminary check that involves seeing and feeling the breast area for any unusual formations or changes in tissue.

The ideal time for conducting a self-examination every month is about 3-5 days after you get your period. This examination should be performed at least once in every six months, from early twenties. If a woman has passed menopause, it is recommended that she conduct the examination on the same day each month.

 

How Do I Perform It?

If you choose to do a breast self-exam, follow the 5 simple steps described below:

    1. Stand in front of a mirror with hands on hips and tighten chest muscles beneath breasts. Inspect outer breast area.bc01What to look for:
      Breasts:           Changes in shape or contour.
      Nipples:           Sores, peeling or change in direction.
      Skin:                Puckering, dimpling, sores or discoloration.
    2. Next, raise your arms and look for the same changes.bc02
    3. Place thumb and forefinger on tissue around nipples and pull outward. Check for fluid discharge from either nipple. This could be blood or a watery, milky or yellow fluid.
    4. Lie down and use your right hand to feel your left breast. In a circular motion with a firm, smooth touch, keep the fingers flat and use the first few finger pads to cover the entire breast from top to bottom (from collarbone to top of abdomen) and side to side (from armpit to cleavage). You may follow a circular pattern, starting from nipple and moving outward or a vertical pattern, moving your fingers up and down vertically in rows. Feel all the tissue from front to back of breasts. Use:

      Light pressure for the skin and tissue just beneath breasts.
      Medium pressure for tissue in the middle of breasts.
      Firm pressure for deep tissue in the back (you should be able to feel your ribcage).bc03
    5. Finally, feel breasts while standing or sitting. Many women find it easiest when their skin is wet and slippery, and do this in the shower. Cover your entire breast using the instructions in step 4.bc04

What If I Find a Lump?

      • If you see any of the following changes, bring them to your doctor’s attention:

Breasts:    Any abnormal changes in shape or contour.

Nipples:     Look for sores, peeling, inversion or change in position.

Skin:          Look for puckering, dimpling, bulging, sores or discoloration.