Cancer screening
The term screening is commonly used for a test that is used for evaluation of a person for possible disease without the person ever having any symptoms or signs of the disease. Screening tests are usually undertaken in a target population, which has significantly high risk of developing the disease. Mammogram is a screening technique used for breast cancer, and the target population for mammogram is women who are aged 40 and above. PSA testing is a screening test for prostate cancer and the target population is men over 50 years of age. Screening tests cannot be employed in all diseases. In some cases a useful screening test may not be available, and in some other cases it may not be worth screening for a disease because screening and finding out the disease early may not change the natural history of disease. The later is probably true in case of screening of lung cancer. From the studies so far published, there is no clear evidence to suggest that screening for lung cancer in high-risk population (smokers) would improve survival.

Breast cancer screening
Unlike lung cancer, breast cancer can be screened using available techniques with beneficial results. Mammogram is the only accepted screening test for breast cancer. Mammogram till this date may have saved lives of thousands of women, by detecting the disease at a very early stage, when it is mostly curable. Screening for mammogram does not prevent the occurrence of breast cancer, but instead it provides a very simple and useful technique to detect breast cancer at a very early stage. Mammogram is capable of detecting breast cancer at a stage prior to infiltration of the tumor to the surrounding structures, called stage 0 breast cancer or carcinoma in situ. Recommendations for breast cancer screening vary from country to country and within the same country according to the views of different organizations who recommend the screening. American Cancer Society recommends that “women age 40 and older should have a screening mammogram every year and should continue to do so for as long as they are in good health.”

What is a mammogram?
Mammogram is just an X-ray photograph of your breast, and works in principle the same way as your chest X-ray. The breast tissue is compressed between two plates and an X-ray picture is taken. Doctors would look at the X-ray and determine if there are any abnormalities in the picture. Breast cancer usually appears in the form of calcifications, architectural distortions, or abnormal densities. Since mammogram uses X-rays, there may be slight risk associated with exposure to radiation in women who get mammograms. However the amount of radiation associated with mammogram examination is very small and is strictly controlled by regulatory agencies like National Department of Health and Human Services. Very strict regulations are enforced by this agency to make sure that mammography equipment is safe and uses the lowest dose of radiation possible. The dose of radiation used by the modern mammogram machines does not significantly increase the risk of breast cancer.

Digital mammography
Digital mammograms are similar to conventional X-ray film mammograms except that the pictures are produced in the digital media in a computer. Digital pictures have the advantages of manipulation of light and contrast and hence would be more useful for the studying the mammography picture. It was claimed in the past that digital mammogram is superior to conventional mammograms in terms of accuracy, however a recent study has shown that digital mammography no better than regular mammography.

Computer Aided Detection (CAD)
CAD is sophisticated computer program that can compare areas of the digital mammography picture and aid the physician to more easily detect breast cancer. Studies have shown that CAD system improved diagnostic accuracy by about 20 percent.

Clinical breast examination and self breast examination
An article on breast cancer screening will not be complete without mentioning clinical breast examination and (CBE) and self breast examination (SBE). CBE and SBE are useful adjuvant to mammogram for detection of breast cancer. It is also to be mentioned that about 10 percent of all tumors that can be felt by the physicians may not be seen in a mammogram, hence if the physician feels a tumor, the absence of abnormality in the mammogram does not ensure absence of a breast tumor. Such patients should be evaluated by biopsy. Self-breast examination as the name implies denotes examination of breast by women, without the help of a physician. This can be undertaken in the privacy of their home. Probably the best time to do a self-breast examination is while taking showers. Women can ask their physicians to teach them the technique of self-breast examination. American Cancer Society recommends “women in 20s and 30s should have a clinical breast examination (CBE) as part of a periodic (regular) health exam by a health professional preferably every 3 years. After age 40, women should have a breast exam by a health professional every year.” Regarding self-breast examination, American Cancer Society gives the following recommendations: “BSE is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any breast changes to their health professional right away.”

We hear it all the time…lose weight for your health. Few people however, realize the extent to which this is critical to their physical well-being and ultimately their life expectancy.

In January 2003, the Journal of the American Medical Association featured a study finding that obesity appears to lessen life expectancy, especially among young adults. The researchers compared Body-Mass Index (BMI) to longevity and found a correlation between premature death and higher BMIs. For example, a 20-year-old white male, 5’10” weighing 288 pounds with a BMI of greater than 40 was estimated to lose 13 years of his life as a result of obesity.

Jamie McManus, M.D., F.A.A.F.P. and author of “Your Personal Guide to Wellness” notes that while this study referenced extreme levels of obesity, there are still millions of overweight people in developed countries with a life expectancy rate that is three to five years less than their healthy-weight counterparts. She also estimates that there are 600,000 obesity related deaths each year in America.

Just how does obesity shorten our lifespan? The answer to this question is complex, yet there is a clear link between obesity and the development of cancer. An extensive study conducted by the American Cancer Institute involving 750,000 people showed that obesity significantly increased the risk of cancer developing in the following organs: breast, colon, ovaries, uterus, pancreas, kidneys and gallbladder.

Michael Thun, MD, vice-president of epidemiology and surveillance research for the American Cancer Society (ACS) says one reason obesity may raise cancer risk is because fat cells produce a form of estrogen called estradiol that promotes rapid division of cells, increasing chances of a random genetic error while cells are replicating, which can lead to cancer. In addition, fat centered around the abdomen may increase insulin and insulin-like growth factors in the blood, which may increase cancer risk.

“Women who are obese after menopause have a 50% higher relative risk of breast cancer,” notes Thun, “and obese men have a 40% higher relative risk of colon cancer…. Gallbladder and endometrial cancer risks are five times higher for obese individuals”.

There is evidence that cancer rates in developed countries are increasing at 5 to 15 times faster than developing countries. A major contributor to this alarming reality has proven to be diet. In populations where the diet consists mostly of fresh fruit and vegetables and whole grains – in contrast to the typical Western diet of fatty meats, refined flours, oils and sugars – the risk of cancer is much lower.

The interaction of diet and the development of cancer is an active field of research and Dr David Heber, M.D., Ph.D. and author of “What Color is Your Diet”, says “It appears that diet has its most significant effects after the cancer has already formed, acting to inhibit or stimulate the growth of that cancer”. At the risk of oversimplifying a complex set of interactions, the typical Western diet that leads to obesity may actually act to stimulate the growth of cancer cells.

It is never too late to improve your health through healthful eating and adopting a more health-giving lifestyle. Here are simple steps to follow which can make an immediate improvement to your health and vitality.

1. Check your Body Mass Index (BMI) to determine if weight has become health risk. According to the Centers for Disease Control and Prevention, 60% of Americans are overweight, defined as having a BMI (a ratio of height to weight) over 25. Of those, nearly half (27%) qualify as obese, with a body mass index of 30 or more. In 1980, just 15% of Americans were considered obese. You can check your BMI at the website below.

2. Match your diet to your body’s requirements. If you eat and drink more calories than your body requires you will put on weight. Learn to control calories and portion sizes, make recipes leaner, and eat infrequently from fast food restaurants. Also learn how to snack with healthful choices.

3. Color your diet with a large variety of colorful, cancer-fighting fruit and vegetables. There are seven different color ranges of both fruit and vegetables and by choosing between 5 to 9 daily serves from a wide range of fruit and vegetables, we are extending our consumption of cancer (and other disease) fighting nutrients.

4. Eat lean protein with every meal. Protein provides a powerful signal to the brain providing a longer sense of fullness. The right source of protein is essential to controlling your hunger with fewer calories and necessary to maintain your lean muscle mass. Choices of protein should be flavored soy shakes with fruit; the white meat of chicken and turkey, seafood such as shrimps, prawns scallops and lobster and ocean fish or vegetarians may prefer soy based meat substitutes.

5. Rev up your metabolism with activity. If you want to enjoy a lifetime of well-being, exercise is a key ingredient. Colleen Doyle, MS, RD, director of nutrition and physical activity for the American Cancer Society (ACS), says adults should do something for 30 minutes each day that takes as much effort as a brisk walk. Children should be active for an hour each day. We are more likely to develop habits around things we enjoy, so seek activities which you enjoy doing. It is also helpful to build physical activity into your daily routine: use the stairs instead of the escalator or lift at work, park your car in the parking bay furthest from the super marketing and don’t use the remote control to change TV channels.

6. Get support to ensure you develop a healthful eating plan and reach your goal weight. Whilst a small percentage of people possess the discipline to lose weight, many obese people have developed strong thoughts and habits concerning the food they eat. In order to establish new habits, most people respond well to some form of consistent encouragement and coaching. A study, “Effects of Internet Behavioral Counseling on Weight Loss in Adults at Risk of Type 2 Diabetes” shows that participants who had the support of weight loss coaching lost more weight than those who didn’t. The study concluded that the support of a weight loss coach can significantly improve weight loss results.

Being overweight or obese has been identified next to smoking, as the most preventable major risk to developing cancer. Even small weight losses have been shown to have beneficial health effects. So it’s never to late to start and you can never be too young or too old to be concerned about your health and do something about achieving a more healthy weight.

Being diagnosed with breast cancer is a life-changing event. A torrent of feelings wash over the survivor. Suddenly, the world feels like an unsafe place. Little things seem unimportant to the survivor. And the big things, like life, seem tenuous. Knowing the emotional responses she is experiencing will help friends, family and fellow survivors support and nurture her, and each other. She needs to be encouraged to fully feel and express each of her feelings.

The most helpful thing you can do is “just stand there” while she goes through the range of emotions. Often we try to “fix” or stop the flow of feelings so we don’t experience the pain and discomfort. But transformation and healing occur when feelings are felt and honored, not when they are repressed or denied.

Here are some emotions you might witness:

1. Shock and Disbelief

“There must be some mistake. It can’t be happening to me! I’m healthy. I take care of myself!” Disbelief is one of the most prevalent first emotional responses.

2. Overwhelm

Breast cancer survivors are faced with many critical decisions. Often there is a time pressure to make treatment decisions. It helps to have support with research about traditional, alternative and complementary treatment options.

3. Fear

“Am I going to die? Will I be disfigured? Will you still love me? Will I love myself?” These are the major questions hovering in the dark recesses of the survivor’s mind. It helps tremendously to bring them up for discussion.

4. Worry

“How sick will I be? Who will take care of the children? How will I deal with loss of income? Will I lose my job?” Once the first wave of personal survival questions are dealt with, these questions wear on the survivor’s mind.

5. Anger

“Why me? I don’t deserve this! I don’t have time or money to deal with this!” Anger, if not expressed, is the most insidious of all emotions. In itself, repressed anger can create disease. Having a healthy outlet for these feelings needs to be part of the breast cancer patient’s treatment program.

6. Resentment

” I’m not the one this should be happening to! I eat well, exercise, get mammograms, take vitamins! Why should I have to suffer with this disease!” Often there is no logical explanation for the onset of cancer. It’s natural that feelings of resentment may arise.

7. Loneliness

“No one ever is here for me. I’m all alone. I have no friends I can count on. I feel so alone!” Even when family and friends are around to help, often survivors feel isolated and alone. They are unable to ask for the help they want and need.

8. Sadness

Sadness prevails when any loss is imminent. Tears may flow profusely as the loss of precious body parts is contemplated. The thought of further illness from chemo treatments may seem unbearable. She needs gentle comfort and frequent reassurance.

9. Misunderstood

She may feel that nobody is listening or really understands her. In actuality, no one else can really understand what she is going through. Every person’s experience is unique. Honor her and her uniqueness. Give her space to express her feelings and thoughts.

10. Hopefulness

Seen as a learning opportunity, the breast cancer experience could create a feeling of hope for an entirely new and different life, one filled with passion, fulfillment, joy and love. Knowing that life is ongoing, and only the body dies, can give great comfort during this otherwise stressful time.

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