46 year old lady,underwent Total Abdiman hysterectomy for Fibroids
HPR well differentiated Adenocarcinoma Endometrium involving one third of myometrium
Should she undergo another surgery for bil oopherectomy ?
regards
sanjay
Col S Kapoor
Senior Advisor and Prof
Surg Oncology
Command Hospital (CC)
Lucknow
Sunday, December 7, 2008
Monday, December 1, 2008
Neoadjuvant Chemotherapy in Esrly CA Breast
Neoadjuvant Therapy Enough for Early Stage Some Breast Cancer Patients Don’t Need RadiationEarly-stage breast cancer patients with little or no cancer in their lymph nodes may not require post-surgery radiation if they receive chemotherapy before a mastectomy, according to results of a new study.The findings were reported by M. D. Anderson researchers Sept. 24 at the 50th annual meeting of the American Society for Therapeutic Radiology and Oncology.Significance of resultsThe results could spare early stage patients from having to undergo post-mastectomy radiation that, according to the study, did not offer better results than neoadjuvant chemotherapy (chemotherapy before the primary treatment, in this case a mastectomy) and mastectomy alone."Radiation after surgery has been shown to benefit the survival of patients who have more advanced tumors," says Tse-Kuan Yu, M.D., Ph.D., assistant professor in M. D. Anderson's Department of Radiation Oncology. "However, administering chemotherapy prior to surgery has changed how radiation oncologists need to approach treating patients with stage 1 and 2 breast cancers."Research methodsThe retrospective study, led by Yu, reviewed the cases of 427 women who underwent chemotherapy then mastectomy from 1985-2004 to observe the value of treating early-stage breast cancer with radiation therapy. Radiation was administered to 253 women because they had more aggressive tumor features. Specifically focusing on those who did not receive radiation therapy, researchers looked at whether each patient's breast cancer relapsed over the course of five years to determine if radiation contributed to preventing its return. Primary resultsOf the group of patients who received pre-surgery chemotherapy and were not treated with radiation:20% with four or more pathologically involved lymph nodes relapsed 4.2% with one to three involved lymph nodes relapsed 1% with no involved lymph nodes relapsed Interestingly, researchers noted that patients with zero involved lymph nodes after receiving chemotherapy prior to surgery exhibited a 1% recurrence rate. What’s next?“Our findings indicate neoadjuvant chemotherapy controlled the cancer, and patients with early-stage breast cancer and negative lymph nodes after neoadjuvant chemotherapy may not need radiation,” says the study’s senior author Thomas Buchholz, M.D., chair of M. D. Anderson’s Department of Radiation Oncology. “Though additional research is warranted, we can begin to surmise that patients may be spared from radiation therapy if they’ve been treated with neoadjuvant chemotherapy and have fewer than three involved lymph nodes.”By analyzing initial tumor characteristics in each patient, researchers can begin to classify which patients require post-mastectomy radiation to prevent recurrence. To expand on these findings, M. D. Anderson researchers are planning future prospective clinical trials that would confirm whether radiation can be avoided in selected patients with early-stage breast cancer who are treated with neoadjuvant chemotherapy. – Adapted by Darcy De Leon from an M. D. Anderson news releaseM. D. Anderson resources:Breast cancerTse-Kuan Yu, M.D., Ph.D.Thomas Buchholz, M.D. Division of Radiation
BREAST AWARENESS AND SELF BREAST EXAMINATION
Dear Friends
I am pleased to inform you that an article on 'Breast Awareness versus Breast Self Examination' co authored by me along with a breast cancer survivor from the UK has appeared as a 'Position paper' in the most recent issue of European Journal of Cancer (October 2008).
I have copied the article below for your perusal
With kind regards
Yours sincerely
Raghu Ram
European Journal of Cancer, Volume 44 , Issue 15 , Pages 2118 - 2121 H . Thornton, R . Pillarisetti
Position Paper
`Breast awareness' and `breast self-examination' are not the
same. What do these terms mean? Why are they confused?
What can we do?
Hazel Thorntona,*, Raghu Ram Pillarisettib
aDepartment of Health Sciences, University of Leicester, `Saionara', 31 Regent Street, Rowhedge, Colchester CO5 7EA, UK
bKIMS-Ushalakshmi Centre for Breast Diseases, Krishna Institute of Medical Sciences (KIMS), Hyderabad, India
Article history:
Received 6 August 2008
Accepted 13 August 2008
Keywords:
Breast awareness (BA)
Breast self-examination (BSE)
Early detection of breast cancer
History of prevention of breast cancer
Morbidity associated with early detection
A B S T R A C T
The terms `breast self-examination' and `breast awareness' are often used loosely, causing general confusion, with potential to cause women harm. To explore this confusion, we begin by defining their current meaning. We trace the history of these methods of early detection over the last half century, which has seen considerable cultural, social and attitudinal changes. Breast self-examination is not recommended. We caution that uncertainty exists about the value of practicing breast awareness: evidence is currently lacking to determine whether the benefits outweigh the harms: globally-aware research is needed. We believe that a clear and universally agreed definition of the term `breast awareness' is needed, and that the confusion needs to be further exposed and debated. Meanwhile, we advocate `sensible alertness'.
.
1. Introduction
There is confusion, and sometimes disagreement, about the meaning of the terms `breast awareness' (BA) and `breast self-examination' (BSE). The authors of a Cochrane review concluded that BSE cannot be recommended.1 A meta analysis obtained similar findings.2 Because BA has become the current advocated policy, we believe it is important to attempt to define the terms, understand the differences and find ways to deal with the confusion. We should like to explore the historical reasons for this confusion of terms and consider the current fundamental attitudinal differences that exist behind the concepts of these two different activities. As we shall see, BSE preceded BA, which is currently the preferred term and preferred activity in the United Kingdom (UK), despite uncertainty about the balance of benefit to harm.
2. Background – evolution of breast selfexamination
(BSE)
The concept of breast self-examination (BSE) was promoted in the 1950s by Cushman Haagensen, a Breast Surgeon from the United States of America (USA), at a time when mammography was yet to be developed, and many women were diagnosed when the tumour had become large and inoperable. Haagensen hoped that encouraging breast self-examination would help catch tumours earlier when they were still treatable, and when amenable to surgical excision without the need for the more disfiguring operation of mastectomy. To challenge mastectomy, the accepted standard operation at that time, was also contentious.
Haagensen appeared in a public education film `breast selfexamination' released by the American Cancer Society (ACS) and the National Cancer Institute (NCI) in 1950.3 A series of educational leaflets were also produced. In 1955, Good Housekeeping reported that over five million women had viewed the educational film. By 1967, 13 million women had seen it.
But even then, the ACS, NCI and the medical profession were aware of the potential pitfalls of promoting routine BSE. Haagensen instructed women to examine their breasts only once every two months `to prevent the development of an abnormal fear of cancer'. Other doubts were voiced by both physicians and by the women themselves. There were criticisms covering many aspects of promoting and undertaking the practice with respect to the language used, and of the pictures of attractive, healthy partly-clothed young women used in the literature that were a clear and shocking departure from clinical descriptions and illustrations of diseased breasts in medical textbooks.4
The notion of the profession engaging in attempting early detection of a disease by these `popular' means, engaging with women themselves through the media, rather than in just treating and curing it, caused a shift in the public perceptions of the medical profession and its role at that time in the 1950s. Haagensen wisely and correctly forecast that the practice could result in exacerbation of the fear of cancer.
3. What is breast self-examination (BSE)?
Breast self-examination is a regular, repetitive monthly palpation to a rigorous set method performed by the woman at the same time each month. Women who perform BSE should be properly trained.
BSE was evaluated for the first time in a randomised controlled trial in Shanghai in 1997. This large study, involving 260,000 women, followed up over a five-year period, did not demonstrate a survival benefit in doing regular BSE.5 Since then, a Cochrane review has been undertaken of regular self-examination or clinical examination for early breast cancer to determine whether these interventions reduce mortality and morbidity from breast cancer. The authors concluded that, using data from two large population-based studies (388,535 women) from Russia and Shanghai that compared BSE with no intervention, their findings do not suggest a beneficial effect of screening by breast self-examination, whereas there is evidence for harms in terms of increased numbers of benign lesions identified and an increased number of biopsies performed. They concluded from this that breast self-examination cannot be recommended.
4. What is breast awareness (BA)?
Being Breast Aware is currently defined as a woman becoming familiar with her own breasts and the way that they will change throughout her life. It encourages women to know how their own breasts look and feel normally so that they gain confidence about noticing any change which might help detect breast cancer early.
The changes that should be looked out for are
• Size – if one breast becomes larger, or lower.
• Nipples – if a nipple becomes inverted (pulled in) or changes position or shape.
• Rashes – on or around the nipple.
• Discharge – from one or both nipples.
• Skin changes – puckering or dimpling.
• Swelling – under the armpit or around the collarbone (where the lymph nodes are).
• Pain – continuous, in one part of the breast or armpit.
• Lump or thickening – different to the rest of the breast tissue.6
`Being breast aware' is gaining increasing acceptance the world over, signalling a move away from the popularly held belief that it is wise to practise rigorous BSE. In 1991, the UK abandoned systematic BSE. This policy was based on the work done by Cancer Research, UK,7 who confirm that breast awareness is important, and detecting a cancer at an early stage may increase the chances of successful treatment.8 The UK information and support organisation, Breast Cancer Care, clearly describes breast awareness.6 The NHS Breast Screening Programme also produces a leaflet.9 This refers to the evidence that shows `that a formally taught, ritual self examination, performed at the same time each month' is not beneficial.
But some websites still carry information about what BSE is and how to practise it.10 There is even money to be made by companies who market special gloves for women to practice BSE.11,12
Coining a new term, `BA', and advocating a new attitude, perhaps reflected the desire to move towards avoiding the `development of an abnormal fear of cancer' that Haagensen so perceptively predicted. But if we are using this new term, everyone should know what is meant by it, clearly convey what is meant when they use it, and acknowledge there are uncertainties about its overall benefits and harms.
5. Practice in the clinics
Many women attending breast clinics in the UK are confused about the term `breast awareness' and, because it involves touching the breast, equate `breast self-examination' with `being breast aware'. Closer uniformity of definition is now used by organisations in the UK in their advice to women.6–8 Breast care nurses, who do much of the counseling in breast clinics, can allay women's anxieties and take opportunities of correcting misconceptions that women may have about these terms.
Many breast centres in the United States, however, still actively advise rigorous BSE despite changed policy directives, and evidence for the harms that can result from its practice. It can be difficult for clinicians to give anxious women the counter- intuitive advice that BSE is not recommended.
But `touching and finding' can occur in different situations motivated by different attitudes of mind. `Chance detection' can occur when women who are sensibly alert are showering, bathing or dressing; `deliberate detection' can occur when women purposefully practice BA with the intention to check for abnormalities.
6. Chance detection by `sensible alertness'
Women who are `breast aware' can find breast cancers not detected during mammographic screening. Most cancers are found by women themselves8 rather than by mammographic screening, which only detects between one third and a half of breast cancers.13 Most women who find the cancer themselves do not routinely practice self-examination.14 It is likely that the more relaxed group of women who are `sensibly alert' to the possibility of finding an abnormality by chance will be less anxious than those who deliberately practice BA.
7. The effects of shared responsibility in a changing society
There have not only been cultural changes in society, but also changes in the way that medicine is practiced, and in the doctor–patient relationship. Automatic patient acceptance without question of doctor's recommendations that obtained a few decades ago has been replaced by various degrees of shared responsibility for decision-making.15,16 This, coupled with wider availability of better quality information and of decision aids,17 has led to patients' increasing ability to make
trade-offs, taking account of perceived risks and their own values.
The composition of the stakeholders who now have an input into how breast cancer is researched, managed and treated has changed: it has altered the power dynamics, influencing the shape of `knowledge-making'.18 This process began in 1950 with the first attempts of the medical profession at encouraging women to take some responsibility for earlier detection, coinciding with the birth of women's advocacy movements; use of formal methods of prospectively evaluating interventions; changes in social attitudes and changes in the doctor–patient relationship. Many women were, and are, no longer content to be the passive recipients of healthcare.
8. Repercussions of `breast self examination' promotions
Breast cancer support and advocacy organisations have a high public profile and exert considerable influence over large numbers of women. It is essential that they recognise their responsibilities.27 These organisations should help curb the over-enthusiastic damaging practice of BSE; advocate an approach that recommends `sensible alertness' to finding abnormalities and advocate for better evidence.
9. Research; ethical aspects
It is important that methods chosen for obtaining evidence are the most appropriate21 and include both health economic and psychological studies. A broad perspective and understanding is required if we are to help women globally. There are considerable inequalities of resource availability between rich and poor, both between countries and within countries. A global perspective shows that although breast cancer incidence is substantially higher in the more affluent developed countries, breast cancer mortality rates are similar.22 Firm agreement is needed about what constitutes a competent self-examination, how often it should be carried out,23 together with transparent methodologies.24
Compliance must be thoroughly monitored, not just of the practice itself, but also with respect to women with abnormalities to determine whether they pursue diagnosis and treatment.25 Measurement of outcomes can be problematic in a range of social climates ranging from affluent regions that strongly believe in prevention and screening to others where there is little awareness and fewer resources. How applicable are findings from studies in one region or continent to another?
Ethical aspects of distributive justice should be considered when planning any evaluation of the usefulness of different modes of early detection to reduce mortality from breast cancer. BA or clinical breast examination may be a more just and appropriate method of early detection in the developing world than mammographic screening which diverts scarce resources away from interventions that might give greater benefit in that society.26 Financial cost/benefit ratios and the benefit/harm ratios of the various methods of early detection are different in resource rich and resource poor countries.
10. Conclusion
BSE continues in spite of evidence that it cannot be recommended.1 Efforts should be made to halt the promotion of this damaging practice of rigorous breast palpation as a screening tool in `well women'. Promotions – on websites; by companies selling gloves; by misguided advocacy groups, etc. – do women a disservice, misleading them about what is best for their well-being.
The consequences of practicing BSE, both to the individual and to health services, are not trivial. We must also remember that there is overall uncertainty about the balance of benefit to harm in the intentional practice of BA generally. We do not know whether, on balance, BA is beneficial or harmful. No intervention is harmless: we need to determine the ratio of harm to benefit. BA might be more worthwhile in some regions of the world than others. Meanwhile, there should be honesty – with kindness – in explaining this uncertainty in promotions to the general public, and to individual women in breast clinics. More precise and accurate use of `breast awareness' is needed if harm and confusion are to be avoided.
Summary
• Breast self-examination (BSE) is not recommended (Cochrane review1).
Conflict of interest statement
None declared.
Acknowledgements
We are very grateful to the following people for their helpful criticisms and comments on an earlier draft of this paper: Mary Dixon-Woods, Imogen Evans, Peter Gøtzsche, Sally Taylor, Liz Wager, Marlene Winfield and Mary Last. It should not be assumed that they endorse all of our
I am pleased to inform you that an article on 'Breast Awareness versus Breast Self Examination' co authored by me along with a breast cancer survivor from the UK has appeared as a 'Position paper' in the most recent issue of European Journal of Cancer (October 2008).
I have copied the article below for your perusal
With kind regards
Yours sincerely
Raghu Ram
European Journal of Cancer, Volume 44 , Issue 15 , Pages 2118 - 2121 H . Thornton, R . Pillarisetti
Position Paper
`Breast awareness' and `breast self-examination' are not the
same. What do these terms mean? Why are they confused?
What can we do?
Hazel Thorntona,*, Raghu Ram Pillarisettib
aDepartment of Health Sciences, University of Leicester, `Saionara', 31 Regent Street, Rowhedge, Colchester CO5 7EA, UK
bKIMS-Ushalakshmi Centre for Breast Diseases, Krishna Institute of Medical Sciences (KIMS), Hyderabad, India
Article history:
Received 6 August 2008
Accepted 13 August 2008
Keywords:
Breast awareness (BA)
Breast self-examination (BSE)
Early detection of breast cancer
History of prevention of breast cancer
Morbidity associated with early detection
A B S T R A C T
The terms `breast self-examination' and `breast awareness' are often used loosely, causing general confusion, with potential to cause women harm. To explore this confusion, we begin by defining their current meaning. We trace the history of these methods of early detection over the last half century, which has seen considerable cultural, social and attitudinal changes. Breast self-examination is not recommended. We caution that uncertainty exists about the value of practicing breast awareness: evidence is currently lacking to determine whether the benefits outweigh the harms: globally-aware research is needed. We believe that a clear and universally agreed definition of the term `breast awareness' is needed, and that the confusion needs to be further exposed and debated. Meanwhile, we advocate `sensible alertness'.
.
1. Introduction
There is confusion, and sometimes disagreement, about the meaning of the terms `breast awareness' (BA) and `breast self-examination' (BSE). The authors of a Cochrane review concluded that BSE cannot be recommended.1 A meta analysis obtained similar findings.2 Because BA has become the current advocated policy, we believe it is important to attempt to define the terms, understand the differences and find ways to deal with the confusion. We should like to explore the historical reasons for this confusion of terms and consider the current fundamental attitudinal differences that exist behind the concepts of these two different activities. As we shall see, BSE preceded BA, which is currently the preferred term and preferred activity in the United Kingdom (UK), despite uncertainty about the balance of benefit to harm.
2. Background – evolution of breast selfexamination
(BSE)
The concept of breast self-examination (BSE) was promoted in the 1950s by Cushman Haagensen, a Breast Surgeon from the United States of America (USA), at a time when mammography was yet to be developed, and many women were diagnosed when the tumour had become large and inoperable. Haagensen hoped that encouraging breast self-examination would help catch tumours earlier when they were still treatable, and when amenable to surgical excision without the need for the more disfiguring operation of mastectomy. To challenge mastectomy, the accepted standard operation at that time, was also contentious.
Haagensen appeared in a public education film `breast selfexamination' released by the American Cancer Society (ACS) and the National Cancer Institute (NCI) in 1950.3 A series of educational leaflets were also produced. In 1955, Good Housekeeping reported that over five million women had viewed the educational film. By 1967, 13 million women had seen it.
But even then, the ACS, NCI and the medical profession were aware of the potential pitfalls of promoting routine BSE. Haagensen instructed women to examine their breasts only once every two months `to prevent the development of an abnormal fear of cancer'. Other doubts were voiced by both physicians and by the women themselves. There were criticisms covering many aspects of promoting and undertaking the practice with respect to the language used, and of the pictures of attractive, healthy partly-clothed young women used in the literature that were a clear and shocking departure from clinical descriptions and illustrations of diseased breasts in medical textbooks.4
The notion of the profession engaging in attempting early detection of a disease by these `popular' means, engaging with women themselves through the media, rather than in just treating and curing it, caused a shift in the public perceptions of the medical profession and its role at that time in the 1950s. Haagensen wisely and correctly forecast that the practice could result in exacerbation of the fear of cancer.
3. What is breast self-examination (BSE)?
Breast self-examination is a regular, repetitive monthly palpation to a rigorous set method performed by the woman at the same time each month. Women who perform BSE should be properly trained.
BSE was evaluated for the first time in a randomised controlled trial in Shanghai in 1997. This large study, involving 260,000 women, followed up over a five-year period, did not demonstrate a survival benefit in doing regular BSE.5 Since then, a Cochrane review has been undertaken of regular self-examination or clinical examination for early breast cancer to determine whether these interventions reduce mortality and morbidity from breast cancer. The authors concluded that, using data from two large population-based studies (388,535 women) from Russia and Shanghai that compared BSE with no intervention, their findings do not suggest a beneficial effect of screening by breast self-examination, whereas there is evidence for harms in terms of increased numbers of benign lesions identified and an increased number of biopsies performed. They concluded from this that breast self-examination cannot be recommended.
4. What is breast awareness (BA)?
Being Breast Aware is currently defined as a woman becoming familiar with her own breasts and the way that they will change throughout her life. It encourages women to know how their own breasts look and feel normally so that they gain confidence about noticing any change which might help detect breast cancer early.
The changes that should be looked out for are
• Size – if one breast becomes larger, or lower.
• Nipples – if a nipple becomes inverted (pulled in) or changes position or shape.
• Rashes – on or around the nipple.
• Discharge – from one or both nipples.
• Skin changes – puckering or dimpling.
• Swelling – under the armpit or around the collarbone (where the lymph nodes are).
• Pain – continuous, in one part of the breast or armpit.
• Lump or thickening – different to the rest of the breast tissue.6
`Being breast aware' is gaining increasing acceptance the world over, signalling a move away from the popularly held belief that it is wise to practise rigorous BSE. In 1991, the UK abandoned systematic BSE. This policy was based on the work done by Cancer Research, UK,7 who confirm that breast awareness is important, and detecting a cancer at an early stage may increase the chances of successful treatment.8 The UK information and support organisation, Breast Cancer Care, clearly describes breast awareness.6 The NHS Breast Screening Programme also produces a leaflet.9 This refers to the evidence that shows `that a formally taught, ritual self examination, performed at the same time each month' is not beneficial.
But some websites still carry information about what BSE is and how to practise it.10 There is even money to be made by companies who market special gloves for women to practice BSE.11,12
Coining a new term, `BA', and advocating a new attitude, perhaps reflected the desire to move towards avoiding the `development of an abnormal fear of cancer' that Haagensen so perceptively predicted. But if we are using this new term, everyone should know what is meant by it, clearly convey what is meant when they use it, and acknowledge there are uncertainties about its overall benefits and harms.
5. Practice in the clinics
Many women attending breast clinics in the UK are confused about the term `breast awareness' and, because it involves touching the breast, equate `breast self-examination' with `being breast aware'. Closer uniformity of definition is now used by organisations in the UK in their advice to women.6–8 Breast care nurses, who do much of the counseling in breast clinics, can allay women's anxieties and take opportunities of correcting misconceptions that women may have about these terms.
Many breast centres in the United States, however, still actively advise rigorous BSE despite changed policy directives, and evidence for the harms that can result from its practice. It can be difficult for clinicians to give anxious women the counter- intuitive advice that BSE is not recommended.
But `touching and finding' can occur in different situations motivated by different attitudes of mind. `Chance detection' can occur when women who are sensibly alert are showering, bathing or dressing; `deliberate detection' can occur when women purposefully practice BA with the intention to check for abnormalities.
6. Chance detection by `sensible alertness'
Women who are `breast aware' can find breast cancers not detected during mammographic screening. Most cancers are found by women themselves8 rather than by mammographic screening, which only detects between one third and a half of breast cancers.13 Most women who find the cancer themselves do not routinely practice self-examination.14 It is likely that the more relaxed group of women who are `sensibly alert' to the possibility of finding an abnormality by chance will be less anxious than those who deliberately practice BA.
7. The effects of shared responsibility in a changing society
There have not only been cultural changes in society, but also changes in the way that medicine is practiced, and in the doctor–patient relationship. Automatic patient acceptance without question of doctor's recommendations that obtained a few decades ago has been replaced by various degrees of shared responsibility for decision-making.15,16 This, coupled with wider availability of better quality information and of decision aids,17 has led to patients' increasing ability to make
trade-offs, taking account of perceived risks and their own values.
The composition of the stakeholders who now have an input into how breast cancer is researched, managed and treated has changed: it has altered the power dynamics, influencing the shape of `knowledge-making'.18 This process began in 1950 with the first attempts of the medical profession at encouraging women to take some responsibility for earlier detection, coinciding with the birth of women's advocacy movements; use of formal methods of prospectively evaluating interventions; changes in social attitudes and changes in the doctor–patient relationship. Many women were, and are, no longer content to be the passive recipients of healthcare.
8. Repercussions of `breast self examination' promotions
Breast cancer support and advocacy organisations have a high public profile and exert considerable influence over large numbers of women. It is essential that they recognise their responsibilities.27 These organisations should help curb the over-enthusiastic damaging practice of BSE; advocate an approach that recommends `sensible alertness' to finding abnormalities and advocate for better evidence.
9. Research; ethical aspects
It is important that methods chosen for obtaining evidence are the most appropriate21 and include both health economic and psychological studies. A broad perspective and understanding is required if we are to help women globally. There are considerable inequalities of resource availability between rich and poor, both between countries and within countries. A global perspective shows that although breast cancer incidence is substantially higher in the more affluent developed countries, breast cancer mortality rates are similar.22 Firm agreement is needed about what constitutes a competent self-examination, how often it should be carried out,23 together with transparent methodologies.24
Compliance must be thoroughly monitored, not just of the practice itself, but also with respect to women with abnormalities to determine whether they pursue diagnosis and treatment.25 Measurement of outcomes can be problematic in a range of social climates ranging from affluent regions that strongly believe in prevention and screening to others where there is little awareness and fewer resources. How applicable are findings from studies in one region or continent to another?
Ethical aspects of distributive justice should be considered when planning any evaluation of the usefulness of different modes of early detection to reduce mortality from breast cancer. BA or clinical breast examination may be a more just and appropriate method of early detection in the developing world than mammographic screening which diverts scarce resources away from interventions that might give greater benefit in that society.26 Financial cost/benefit ratios and the benefit/harm ratios of the various methods of early detection are different in resource rich and resource poor countries.
10. Conclusion
BSE continues in spite of evidence that it cannot be recommended.1 Efforts should be made to halt the promotion of this damaging practice of rigorous breast palpation as a screening tool in `well women'. Promotions – on websites; by companies selling gloves; by misguided advocacy groups, etc. – do women a disservice, misleading them about what is best for their well-being.
The consequences of practicing BSE, both to the individual and to health services, are not trivial. We must also remember that there is overall uncertainty about the balance of benefit to harm in the intentional practice of BA generally. We do not know whether, on balance, BA is beneficial or harmful. No intervention is harmless: we need to determine the ratio of harm to benefit. BA might be more worthwhile in some regions of the world than others. Meanwhile, there should be honesty – with kindness – in explaining this uncertainty in promotions to the general public, and to individual women in breast clinics. More precise and accurate use of `breast awareness' is needed if harm and confusion are to be avoided.
Summary
• Breast self-examination (BSE) is not recommended (Cochrane review1).
Conflict of interest statement
None declared.
Acknowledgements
We are very grateful to the following people for their helpful criticisms and comments on an earlier draft of this paper: Mary Dixon-Woods, Imogen Evans, Peter Gøtzsche, Sally Taylor, Liz Wager, Marlene Winfield and Mary Last. It should not be assumed that they endorse all of our
Sunday, November 2, 2008
INTERNATIONAL CANCER PREVENTION DAY
Dear Cancer Crusaders,
Thanks for the response that you have given on International Day of Breast Cancer Awareness . As a matter of fact it is the breast awareness month now. Your e-mails suggest only one thing ,collectively we may sort out all the problems that have been neglected so far with regards to cancer awareness, control and the treatment.
Ahead are 7th November the International Cancer Awareness Day and Baal Diwas Children's Day 14th Nov. on Which many of us want to discuss about the future health of Indian children and cancer prevention , timely treatment and cure in them .This has to be with special references to ALL, Lymphomas, Leukaemias Brain tumors and Soft tissue sarcoma that are mind bulging .
With regards to International Cancer Awareness day, in addition to the proposed programmes as you might have read in the AROI bulletin, following are the additional proposals, the situations as have suddenly arisen out of the total smoking ban in public places.
As a mater of fact what was also missed was total tobacco chewing in public places .
Fowling is the text of the representation sent to Dr. Anbumani , our Union Health Minister, A representation from individual oncologists as well as the association will go a long way in dealing these problems. At least plinth work and psu\ychological tunig ofthe mind set need to be started of the policy mankers on declaring cancer as a notifiable disease. The reasns are very well justified.
You see, you will agree in principle that we like-minded people have one concern and that is to reduce the usage of tobacco.
The ban on smoking in a public place has been promoted with main reason behind it and that is to prevent passive smoking and to help those who do not want the tobacco smell around them in the atmosphere.
However we have forgotten to make a very important observation and that is the increasing number of Bihari and Eastern Up tobacco chewers that are not only eating various forms of tobacco but are also spreading this culture to other states where such practices were non existent or less existent.
If you go around and see you will find that this tobacco chewing has created more menace that the passive smoking could. It is for the simple reason that there is more number of tobacco chewers than smokers!
The Khainee and Gutkha chewing in public place should be also banned because of the following reason:
1- It is self-inflicting and damaging to the chewer causing cancers of oral , gullet and esophageal areas in younger age group.
2- The khainee chewers are seen spitting here and there every where not discriminating any age, sex or the place. Hence causing a major hygienic hazard and spread of disease.
3- When they prepare or process the khainee on their palms by a process of mincing it they throw out the "not required" portions of the tobacco mixed with choonambu and hence putting undesirable effects in the atmosphere.
4- The wall of the hospital, public places Govt hospitals have become their spittoons and the whole area looks so dirty because of this Khainee, Surti and tobacco Paan chewing people keep spitting in every nook and corner or wall .
5- Whenever a tobacco chewer talks to other person with the quid in his mouth he tends to eject the projectiles of saliva droplets and the vapors and that may be dangerous because if the person is suffering from any other infectious disease such as tuberculosis or pyorrhea that may be contagious to the society.
6- The plastic pouches of these Gutkha and Khainee has caused a major cleanliness problems all over the country and are responsible for blocking the drainage.
It is high time, we anti tobacco enthusiast wish that please initiate the procedure to ban tobacco chewing in any form in public place.
1- Declaring Cancer as a Notifiable disease as has been written to Dr. Anbumani in the following lines:
You have been considerate finally to provide a provision for alternative crop and industry to the tobacco. It is not enough. The tobacco replacement programme need to be started in a structured manner if we have to get rid of the financial burden on the health services due to tobacco related cancers and other diseases.
You will have to declare cancer " A Notifiable disease " so that a proper data compilation and demographic understanding of disease can be reached. This is more so because there are neither adequate numbers of cancer treatment centers nor there is adequate expertise available in them if we take Cancer Institute of Chennai as a "Bench Mark"..
It is about time, that like Dengue the cancer should also be notified so that the arrangements for its prevention and treatment are done on war footing.
We know very well that majority of cancers found in India are preventable but very few survive once they get cancer because of
1- Lack of awareness
2- Their inability to reach the place of treatment
3- Their inability to get their treatment started on time due to waiting lists in the cancer treatment centers or escalations in the cost of treatment of cancers these days.
4- The financial burden and lure of the "Great New Treatment" that is given to the patient due to the corporatization of cancer management has created a serious problem in the home economy of an individual and the family. It has added to the serious psychological depressions when the patient is given hope for life with such costly treatments but the patient is not able to afford it.
It will be necessary to remind that the male female population ratio is also being disturbed due the deaths caused by large varieties of cancers that are occurring in Indian female and are not prevented or treated adequately due to poorly equipped institutions or under utilization of available equipments in many institutions..
Thanks for the response that you have given on International Day of Breast Cancer Awareness . As a matter of fact it is the breast awareness month now. Your e-mails suggest only one thing ,collectively we may sort out all the problems that have been neglected so far with regards to cancer awareness, control and the treatment.
Ahead are 7th November the International Cancer Awareness Day and Baal Diwas Children's Day 14th Nov. on Which many of us want to discuss about the future health of Indian children and cancer prevention , timely treatment and cure in them .This has to be with special references to ALL, Lymphomas, Leukaemias Brain tumors and Soft tissue sarcoma that are mind bulging .
With regards to International Cancer Awareness day, in addition to the proposed programmes as you might have read in the AROI bulletin, following are the additional proposals, the situations as have suddenly arisen out of the total smoking ban in public places.
As a mater of fact what was also missed was total tobacco chewing in public places .
Fowling is the text of the representation sent to Dr. Anbumani , our Union Health Minister, A representation from individual oncologists as well as the association will go a long way in dealing these problems. At least plinth work and psu\ychological tunig ofthe mind set need to be started of the policy mankers on declaring cancer as a notifiable disease. The reasns are very well justified.
You see, you will agree in principle that we like-minded people have one concern and that is to reduce the usage of tobacco.
The ban on smoking in a public place has been promoted with main reason behind it and that is to prevent passive smoking and to help those who do not want the tobacco smell around them in the atmosphere.
However we have forgotten to make a very important observation and that is the increasing number of Bihari and Eastern Up tobacco chewers that are not only eating various forms of tobacco but are also spreading this culture to other states where such practices were non existent or less existent.
If you go around and see you will find that this tobacco chewing has created more menace that the passive smoking could. It is for the simple reason that there is more number of tobacco chewers than smokers!
The Khainee and Gutkha chewing in public place should be also banned because of the following reason:
1- It is self-inflicting and damaging to the chewer causing cancers of oral , gullet and esophageal areas in younger age group.
2- The khainee chewers are seen spitting here and there every where not discriminating any age, sex or the place. Hence causing a major hygienic hazard and spread of disease.
3- When they prepare or process the khainee on their palms by a process of mincing it they throw out the "not required" portions of the tobacco mixed with choonambu and hence putting undesirable effects in the atmosphere.
4- The wall of the hospital, public places Govt hospitals have become their spittoons and the whole area looks so dirty because of this Khainee, Surti and tobacco Paan chewing people keep spitting in every nook and corner or wall .
5- Whenever a tobacco chewer talks to other person with the quid in his mouth he tends to eject the projectiles of saliva droplets and the vapors and that may be dangerous because if the person is suffering from any other infectious disease such as tuberculosis or pyorrhea that may be contagious to the society.
6- The plastic pouches of these Gutkha and Khainee has caused a major cleanliness problems all over the country and are responsible for blocking the drainage.
It is high time, we anti tobacco enthusiast wish that please initiate the procedure to ban tobacco chewing in any form in public place.
1- Declaring Cancer as a Notifiable disease as has been written to Dr. Anbumani in the following lines:
You have been considerate finally to provide a provision for alternative crop and industry to the tobacco. It is not enough. The tobacco replacement programme need to be started in a structured manner if we have to get rid of the financial burden on the health services due to tobacco related cancers and other diseases.
You will have to declare cancer " A Notifiable disease " so that a proper data compilation and demographic understanding of disease can be reached. This is more so because there are neither adequate numbers of cancer treatment centers nor there is adequate expertise available in them if we take Cancer Institute of Chennai as a "Bench Mark"..
It is about time, that like Dengue the cancer should also be notified so that the arrangements for its prevention and treatment are done on war footing.
We know very well that majority of cancers found in India are preventable but very few survive once they get cancer because of
1- Lack of awareness
2- Their inability to reach the place of treatment
3- Their inability to get their treatment started on time due to waiting lists in the cancer treatment centers or escalations in the cost of treatment of cancers these days.
4- The financial burden and lure of the "Great New Treatment" that is given to the patient due to the corporatization of cancer management has created a serious problem in the home economy of an individual and the family. It has added to the serious psychological depressions when the patient is given hope for life with such costly treatments but the patient is not able to afford it.
It will be necessary to remind that the male female population ratio is also being disturbed due the deaths caused by large varieties of cancers that are occurring in Indian female and are not prevented or treated adequately due to poorly equipped institutions or under utilization of available equipments in many institutions..
Saturday, October 11, 2008
CLINICAL RESEARCH
Dear allWe are conducting a short course on clinical research methodology in our hospital. This is meant to be a short, yet comprehensive course which will cover all the basics of clinical research, ethics, basics of medical statistics and scientific communication. To make it possible for everyone to attend the course, it is being scheduled for six consecutive saturday afternoons beginning from Oct 25th. There are limited registrations possible as we would like it to be interactive. Please register early to avoid disappointment. You may register with Ms Bindu, CRS, on Extn 4254 or 4259.I am sending a copy of the course modules and schedule as an attachment to this mail.Best regardsPramesh
This mail is a follow up to my previous mail regarding the clinical research methodology course. As a number of enquiries have come up regarding the procedure for registration for the course, I am sending the registration form as an attachment to this mail.RegardsPramesh
C S Pramesh, MS, FRCS
Associate Professor, Thoracic Surgery
Department of Surgical Oncology
Officer in charge, Clinical Research Secretariat
Tata Memorial Hospital
Parel, Mumbai 400012
Tel: +91-22-24177000
Fax: +91-22-24154005
This mail is a follow up to my previous mail regarding the clinical research methodology course. As a number of enquiries have come up regarding the procedure for registration for the course, I am sending the registration form as an attachment to this mail.RegardsPramesh
C S Pramesh, MS, FRCS
Associate Professor, Thoracic Surgery
Department of Surgical Oncology
Officer in charge, Clinical Research Secretariat
Tata Memorial Hospital
Parel, Mumbai 400012
Tel: +91-22-24177000
Fax: +91-22-24154005
SYMPOSIUM ON LIFESTYLE,DIET and CANCER
Symposium on
Lifestyle, Diet and Cancer
November 28th 2008
Venue: Conference hall, I floor, AIIMS
Registration FREE
Interested candidates may contact before October 15th 2008:
Dr Lalit Kumar
Professor
Room No 245, 2nd floor
Department of Medical Oncology
Institute Rotary Cancer Hospital
All India Institute of Medical Sciences
New Delhi-110029
E-mail: lifestylesymposium@gmail.com
Lifestyle, Diet and Cancer
November 28th 2008
Venue: Conference hall, I floor, AIIMS
Registration FREE
Interested candidates may contact before October 15th 2008:
Dr Lalit Kumar
Professor
Room No 245, 2nd floor
Department of Medical Oncology
Institute Rotary Cancer Hospital
All India Institute of Medical Sciences
New Delhi-110029
E-mail: lifestylesymposium@gmail.com
CANCER SAHAYATA
As we remember 'Bapu' at least on this day, remember his sacrifice, we realize how little we have done to make a change. We have talked, discussed the problems we know exist in the society. The politician and the system of course are blamed for all the evils.
No more clichés or platitudes- let's DO NOW!
A small gesture from you can make a BIG difference.
Indiacancer launches "SAHAYATA"
Direct Donor to Donee linkage for reaching out to patients with Cancer.
Here's your chance to help real people directly
<https://www.indiacancer.org/donate.php>
Share the info with as many as you can..
-- ***********************************************Dr. P. Jagannath Chairman, Dept. of Surgical OncologyLilavati Hospital & Research CentreBandra (West), Mumbai 400 050 INDIATel.: +91 22 32659895 (direct) +91 22 26438281/82 Extn. 3034Fax: +91 22 26406841Email: drjagannath@gmail.com***********************************************Visit http://www.indiacancer.org/
No more clichés or platitudes- let's DO NOW!
A small gesture from you can make a BIG difference.
Indiacancer launches "SAHAYATA"
Direct Donor to Donee linkage for reaching out to patients with Cancer.
Here's your chance to help real people directly
<https://www.indiacancer.org/donate.php>
Share the info with as many as you can..
-- ***********************************************Dr. P. Jagannath Chairman, Dept. of Surgical OncologyLilavati Hospital & Research CentreBandra (West), Mumbai 400 050 INDIATel.: +91 22 32659895 (direct) +91 22 26438281/82 Extn. 3034Fax: +91 22 26406841Email: drjagannath@gmail.com***********************************************Visit http://www.indiacancer.org/
Thursday, September 25, 2008
HOSPICE
HOSPICE - NEED OF THE HOUR
“Care Beyond Cure”
Col S Kapoor VSM, Senior Advisor & Prof,Surgical Oncology,
Command Hospital (CC) Lucknow
A large number of patients suffering from cancer reach a stage when they are either unfit to continue any further definitive treatment or beyond the scope of it. These patients do not need active hospital care but do require supportive, symptomatic and palliative care till they succumb to their disease. This may not be possible at home and hence they need a Hospice for the same
A significant number of patients suffering from cancer reach a finality of treatment, after which they do not need active indoor hospital care or definitive treatment. These patients may survive from few days to few months during which time they need supportive and symptomatic care in form of pain relief, dressing, care of tubes and stomas, nutritional supplements and emotional support
Hospice care is a philosophy of caring for the terminally ill patients, and providing guidance and support to their families and loved ones. It provides palliative care and quality of life for whatever time remains, is the primary focus. This care concentrates on managing pain, controlling symptoms and providing emotional and spiritual guidance
Patients needing Hospice care are those who are unfit to continue further definitive treatment or
beyond the scope of it
These patients do not need active hospital care, but require supportive, symptomatic and palliative care which may not be feasible at home due to lack of financial, material and human resources
Keeping such patients in the Hospital has the following problems
Increases bed occupancy augmenting the already existing bed availability crunch
Adds extra load on the manpower and resources of the hospital
Terminally ill patients and their death is demoralizing for the other patients
Hospice provides
Pain relief
Nutritional supplementation
IV fluids and oxygen
Care of stomas and tubes
Dressings
Emotional and spiritual support to patient and relatives
Training to the relatives to provide terminal care at hospice and at home
Few Hospices in India are
Shanti Avedna At Mumbai and Delhi
Cipla Cancer Care Centre at Pune
Aastha at Lucknow
Hospice provides the terminally ill patients, a dignified and comfortable supportive care and a respectable end, without burdening hospitals, and is hence the need of the hour to provide care beyond cure
“Care Beyond Cure”
Col S Kapoor VSM, Senior Advisor & Prof,Surgical Oncology,
Command Hospital (CC) Lucknow
A large number of patients suffering from cancer reach a stage when they are either unfit to continue any further definitive treatment or beyond the scope of it. These patients do not need active hospital care but do require supportive, symptomatic and palliative care till they succumb to their disease. This may not be possible at home and hence they need a Hospice for the same
A significant number of patients suffering from cancer reach a finality of treatment, after which they do not need active indoor hospital care or definitive treatment. These patients may survive from few days to few months during which time they need supportive and symptomatic care in form of pain relief, dressing, care of tubes and stomas, nutritional supplements and emotional support
Hospice care is a philosophy of caring for the terminally ill patients, and providing guidance and support to their families and loved ones. It provides palliative care and quality of life for whatever time remains, is the primary focus. This care concentrates on managing pain, controlling symptoms and providing emotional and spiritual guidance
Patients needing Hospice care are those who are unfit to continue further definitive treatment or
beyond the scope of it
These patients do not need active hospital care, but require supportive, symptomatic and palliative care which may not be feasible at home due to lack of financial, material and human resources
Keeping such patients in the Hospital has the following problems
Increases bed occupancy augmenting the already existing bed availability crunch
Adds extra load on the manpower and resources of the hospital
Terminally ill patients and their death is demoralizing for the other patients
Hospice provides
Pain relief
Nutritional supplementation
IV fluids and oxygen
Care of stomas and tubes
Dressings
Emotional and spiritual support to patient and relatives
Training to the relatives to provide terminal care at hospice and at home
Few Hospices in India are
Shanti Avedna At Mumbai and Delhi
Cipla Cancer Care Centre at Pune
Aastha at Lucknow
Hospice provides the terminally ill patients, a dignified and comfortable supportive care and a respectable end, without burdening hospitals, and is hence the need of the hour to provide care beyond cure
Sunday, September 7, 2008
CANCER CURE AND CARE
CANCER CURE AND CARE
Cancer is the epidemic of our times and the incidence is increasing globally and in India
The prediction is that by 2025, one out of every six person will have cancer, and at least one member per family may be suffering from this deadly disease
Knowledge of cancer is still full of, myths and doubts and negligence and delay in diagnosis, lead to improper cancer care
The constantly changing modalities, give a great challenge to the oncologists to keep abreast of the latest treatment modalities and also create confusion in the mind of the patient
Cancer can be cured if detected early
This Blog page aims at
Creating awareness about cancer
Giving an opportunity to patients to put up their questions which will be addressed by experts
Continuing Medical Education for the under and post graduates in Oncology
Academic interactions between Oncologists
Case discussions on Cancer Care
Updating our knowledge on recent advances in oncology
As my contribution I shall be putting up short write ups on cancer awareness and treatment, and lessons learnt from articles, books, journals and from CMEs and Conferences
I would request all to participate to learn and teach about cancer care and to help the cancer patients and their relatives and to create awareness about cancer amongst the general population
So please
Feel free to ask any question relating to cancer
Any cancer patient or the relative is welcome put up their queries
Oncologists are requested to contribute towards the CME write-ups
Do project your case discussions as we have been doing through group mails
Do let us know of any new procedure or technique that you are following
Any successful series?
Any change in treatment protocols in guidelines like NCCN
Any information regarding cancer cure and care is welcome
Looking forward to co operation of one and all in spreading cancer awareness and in fighting the demon of cancer
Regards
Sanjay
Col Sanjay Kapoor VSMSenior Advisor & Prof
Surgical Oncology
Command Hospital (CC)
Lucknow, India
skapoors@gmail.com
09794765054
Cancer is the epidemic of our times and the incidence is increasing globally and in India
The prediction is that by 2025, one out of every six person will have cancer, and at least one member per family may be suffering from this deadly disease
Knowledge of cancer is still full of, myths and doubts and negligence and delay in diagnosis, lead to improper cancer care
The constantly changing modalities, give a great challenge to the oncologists to keep abreast of the latest treatment modalities and also create confusion in the mind of the patient
Cancer can be cured if detected early
This Blog page aims at
Creating awareness about cancer
Giving an opportunity to patients to put up their questions which will be addressed by experts
Continuing Medical Education for the under and post graduates in Oncology
Academic interactions between Oncologists
Case discussions on Cancer Care
Updating our knowledge on recent advances in oncology
As my contribution I shall be putting up short write ups on cancer awareness and treatment, and lessons learnt from articles, books, journals and from CMEs and Conferences
I would request all to participate to learn and teach about cancer care and to help the cancer patients and their relatives and to create awareness about cancer amongst the general population
So please
Feel free to ask any question relating to cancer
Any cancer patient or the relative is welcome put up their queries
Oncologists are requested to contribute towards the CME write-ups
Do project your case discussions as we have been doing through group mails
Do let us know of any new procedure or technique that you are following
Any successful series?
Any change in treatment protocols in guidelines like NCCN
Any information regarding cancer cure and care is welcome
Looking forward to co operation of one and all in spreading cancer awareness and in fighting the demon of cancer
Regards
Sanjay
Col Sanjay Kapoor VSMSenior Advisor & Prof
Surgical Oncology
Command Hospital (CC)
Lucknow, India
skapoors@gmail.com
09794765054
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