Dr Sudha Sinha is the Head of Department, Medical Oncology at CARE Hospitals, Hyderabad answers frequently asked questions about cancers that affect women, and how to prevent and detect them early with regular screening, and more.
Q: What are the most common types of cancers that affect women in India today?
A: There has been an increasing incidence of cancer among women in our country, over the past decade. The most common cancer among women is breast cancer. This is followed by cancer of the cervix and ovarian cancer. In addition to this, endometrial cancer and colon cancer are also common. All these cancers put together form about 50% of the cancers we see in women.
Patients who experience a breast lump or nipple discharge should see a doctor right away. If you feel an abnormal lump in any other part of your body, it too needs to be checked out by a doctor as soon as possible. Abnormal distention, bloating, persistent acidity, any vague feeling in the abdomen might also be signs of ovarian cancer and need to be examined further. For cervical cancer, the common symptoms include white discharge and bleeding from the vagina.
If you have any symptom that doesn’t go away for more than two weeks, then it is time to visit a doctor. Cancer can present itself in many ways, depending on where it is situated, where it started and to which organ it has spread. So if you have any ailment that is not going away, or if you feel something is just not right, then it needs to be checked out.
Q: Please tell us about screening tests.
A: Screening tests detect cancer early, so that we can begin on effective treatment. The most common screening tests that we recommend are:
- Mammography for breast cancer:
When can you get a mammography? This could be controversial depending on which country you live in. In India, we advise that anyone who is above 45 years of age should get a mammogram done. It is important to remember that just one mammogram is not enough. It needs to be done sequentially, every year. This improves the chances of detecting breast cancer in the early stages.
In addition to this, we also recommend that all women perform a self-examination of their breasts. The reason for this is that we need to become aware of how our breasts feel. Only if we are familiar with the shape and feel of our own breasts, will we be able to notice a change in them. The best time to do a breast examination is one or two days after your periods are over. That’s when the breasts are lightest and lumps can be detected more easily. Also, a clinical breast exam, after the age of 35, should be done by a doctor so that any suspicious lumps can be evaluated immediately.
To summarize, for the early detection of breast cancer we recommend breast self-examination, clinical breast examination on a yearly basis after the age of 35, and a mammogram after the age of 45.
- Pap smear for Cervical cancer:
Cervical cancer can be detected very easily, through a simple procedure called a pap smear test. The gynecologist examines the cervix and conducts a pelvic exam. The tissue from the cervix is brushed and put on a slide and examined under the microscope to see if there is any abnormality in the cells. A pap smear is not painful . It is a quick test. Based on the type of abnormality that is detected through this test, the next course of action can be determined.
Pap smears can be taken from the age of thirty years. Based on the risk factors for cervical cancer, your gynecologist can advise you on when and how often you should take the pap smear. Usually, we recommend a pap smear once every two to three years.
- Colonoscopy for colon cancer:
Colon cancer was not very common in India in the past, but the incidence is increasing among both men and women. It accounts for about 6 to 8% of cancers in our country. Colonoscopy is the screening test for colon cancer. It should be taken from the age of fifty , once every 10 years, as long as the last colonoscopy showed completely normal results.
Q: Can you tell us about the harmful effects of smoking for women?
A: We are seeing a rising incidence of smoking among women in our country. The trends that were observed in the US in the 1970s, wherein there was a decline in the incidence of smoking among men and an increase in the incidence of smoking among women, can be observed in India now. Smoking increases the risk of not just lung cancer, but multiple other cancers like cervical cancer, head and neck cancer, esophageal cancer and bladder cancer, among others. Therefore I would advise both men and women to give up smoking.
Q: Do child-birth and breastfeeding reduce the risk of breast cancer? If so, how?
A: Yes, breastfeeding does reduce the risk of breast cancer. Similarly, multiple child births and early child births which refers to the age of the mother at the time of childbirths, also reduces the risk of breast cancer. The reason for this can be explained. Estrogen exposure is what increases the risk for breast cancer. When a woman is pregnant, and when she is breastfeeding, there is a decrease in the production of estrogen, and that protects against breast cancer.
Q: What are the lifestyle changes that we should adopt to prevent cancer and to reduce our risk of cancer?
A: I think we need to keep it as simple as possible. On the internet, you will find several products like alkaline water, selenium, vitamin E supplements etc that are marketed as a preventive measure for cancer. A lot of these claims have not been proved, but anything done in moderation should be fine.
Let’s look at the top lifestyle changes that can be undertaken to reduce the risk of cancer.
- Consume one or two fruits daily.
- Consume two to three cups of vegetables every day. Many people assume that because they are vegetarians, they consume a lot of vegetables. That is not always true. The quantity of vegetables in our diet has to be increased to two to three cups.
- Substitute at least one meal with unprocessed food. Our diets tend to be high in processed foods like white bread, white rice, wheat etc. Try to substitute this with brown rice or millets.
- Ensure sufficient fibre in your diet. If your intake of vegetables is high, this will automatically be taken care of.
- Active exercise needs to be incorporated into our daily lifestyle. The exercise should be moderate to intense. You need to know what the optimum heart rate to reach during exercise is for your age. You can find this information on health websites through a google search. Having a healthy lifestyle means you need to reach the optimum heart rate, and sustain that heart rate for 15 to 20 minutes. So 150 minutes of moderate activity exercise, or 75 minutes of vigorous activity exercise is recommended.
These lifestyle changes will reduce not just the risk of cancer but also for several other diseases including cardiovascular diseases.
Q: What advice do you have for primary caregivers of cancer patients?
A: What I tend to advise caregivers is that it is important to take care of yourself. Unless you are taking care of yourself, you cannot take care of your loved one. There is nothing wrong with spending time on yourself.
Secondly, don’t feel guilty. There are a lot of things you need to do and this puts additional pressure on you. Many caregivers feel guilty during the course of caregiving. They think they are not doing enough because they are having to juggle between work and caregiving. They are pulled in different directions as many things require their constant attention. There is only so much that a person can do. So you have to be kind to yourself when you are taking care of another person. So don’t beat yourself up too much.
Take time out for yourself every day or at least once a week, to do something for yourself. Be a little selfish. Lastly, I tell both caregivers and patients that there is nothing wrong in taking help from people. Many times, people around you want to help but they feel they need to give you privacy. Maybe they don’t know how to offer help. So it is okay to ask for help. It could be help with cooking, or dropping your child at work. They could help by spending a day at your home so that you can spend some time for yourself. It needs to be understood that asking for help is not wrong.
Q: Are there any side-effects of mammograms?
A: Mammography is a test that is well tolerated. I agree it’s not a fun test to undergo. It is basically an x-ray of the breast. We take the breast and put it between two plates and take an x-ray from different angles. During the procedure, they might be a small amount of discomfort to the breasts. Women who have very sensitive breasts might experience some pain. The procedure is done by trained hands, in centres that conduct mammography. The procedure is quick and there are no long term side-effects of mammography. Overall, the benefits are far more than the discomfort that women experience during the test.
