Dr. Aruna Kalra, OBGYN, CK Birla Hospital, suggests that maintaining a healthy lifestyle helps you keep healthy breasts and protects you from breast cancer.
What are considering the possible risk factors for breast cancer? And how is it avoidable?
Dr Aruna Kalra: As we are aware that it is a breast cancer awareness month and breast cancer cases are increasing at a younger age group also. Why these are increasing at a younger age, mostly it is because of our lifestyle changes. Once we know the reason what causes it, we can prevent it also. As we know that breast cancer mostly is estrogen dependent or hormone-dependent cancer, in previous years, breast cancer was more common in each group of more than 40 or 50 years of age, but nowadays, even, 20 years old, girl can have breast cancer, because we start our Menses as early as 12 or 13 years of age, and it goes on till 51 to 55 years of age. We are always under the effect of estrogen and when it comes to a pause such as during pregnancy and lactation, the risk decreases and it provides protection from breast cancer. Nowadays, we are not getting married at an early age around in our 20 or 30’s. We are not getting pregnant and as frequently as our mothers or Granny’s used to be. So we are opting for either no child or delayed conception and that is why we are exposed to hormones for a longer period of time. Every month we are getting menses and there is no nine months pause for pregnancy or a year long pause for breastfeeding.
Second reason can be very major lifestyle change, which is mostly related to our health or diet. So, we are not having healthy diet nowadays, we are dependent upon junk food or easily, digested carbohydrate diet, mostly a simple carbohydrate diets, and we are having longer fasting hours. All we are eating unhealthy food very frequently and gaining unnecessary weight. We are not doing exercise at all. Almost 80% of us are stressed because of longer hours of our work, online work, which are sitting jobs and you’re not getting time for walk or exercise, which causes obesity.
As the fat accumulates in estrogen receptors, we get thrown for extra estrogen and estrogen related cancers, which is breast cancer. Many girls are obese, or because of unhealthy lifestyle PCOS, and PCOD (Polycystic Ovarian Disease Syndrome) again causes increased risk of breast cancer as well as uterus cancer or any each other cancer.
Smoking and alcohol is another very common and high risk for breast cancer. People are getting PCOS as well as other types of cancer because of smoking and infertility also is high because of smoking. So, all these factors and another Factor can be genetic which you do not have any control over but you can definitely decrease your chances of breast cancer if you maintain a healthy lifestyle and regular checkup for early detection of breast cancer and early treatment of breast cancer.
What are the basic lifestyle changes that can prevent hereditary breast cancer?
Dr Aruna Kalra: I should be knowing my genetic composition like whether I am a carrier of BRCA 1 or BRCA 2, and if I am a carrier of these genes, I should be vigilant and regular about my breast cancer screening. You should be knowing how to do a breast self examination. You should be getting your breast ultrasound done yearly and because less than 40 years of age breasts are denser, we do not go for mammogram, we go for MRI breast, if there is any lump, which is felt by you and which your breast surgeon or your gynecologist thinks that it should be diagnosed further with other diagnostic modalities. So if you are a breast aware and you are getting regular screening done for you, you can prevent yourself from developing higher stage of breast cancer. It can be detected early if you are genetically predisposed to breast-cancer and you should be knowing about your new genetic predisposition through genetic mapping or testing.
Is there a certain age that were girls should be start getting mammograms or it is not age restricted?
Dr Aruna Kalra: It is like after the age of 40, we get mammogram done before the age of 40 because breasts are denser we get MRI breast if at all. Every month you should check your breasts post periods. So if you’re checking your breasts, post periods like 5 or 6 day of your periods and you find that there is any lump, you go to your breast surgeon, ask him or her to check your breasts for lump. And if they also feel that there is suspicious lump, then if you are less than 40 years of age, you should go for MRI.
What is self-examination coming to that point. How is it possible for, at all for all of us?
Dr Aruna Kalra: If you are in your reproductive age group, when you are getting regular periods, before periods, your breasts are denser and water-filled. We do not do breast examination during that phase. We do breast examination, post period around fifth or sixth day of your periods when your breasts are softer, and how to do breast examination, once you’re having shower, once you’ve removed your clothes, check your breasts. And in front of mirror, see whether they are placed rightly at same level. Nipple is not pulled up or held down, skin is intact, there is no ulcer or dimpling of skin nipple is not retracted inside, all those signs or changes in your breast skin, nipple can tell us that there is definitely some abnormality and then you press your nipple and see whether there is some kind of blood stain discharge. Normally greenish or little white discharge is really very common in breast. But if it is transparent or if it is a blood-stained mainly, it can be an underlying pathology or disease. then you have to your arms up above your head and see whether the nipple is moving together or not. If one nipple is still down and another breast nipple has moved up the nipple, which is still down is must be pulled by a lump or a cancer. Once you have had your shower lie down on bed. If you have a bigger breast, try to place it on your ribcage, it should not be hanging and then with the flat of your hand, you have to examine your breasts. If you’re able to feel any lump, if it is mobile, might be fibroadenoma (hormonal lump). If it is fixed to skin or underlying muscle, chances are that it might be a little suspicious lump, here we should be going to doctor. If you are doing breast examination every month, you can detect a lump as big as two- or two-point five centimeter, but once you go to physician or clinician or your doctor, they are able to detect as small as 1 cm lump. It is better as soon as you find some lump, even if you feel that it must be a benign fibroadenoma, you should go and get it checked with your clinician. After you have examined your breasts, breast surgeon would will examine underneath your axilla, so they would examine lymph nodes in your axilla and lymph nodes above your clavicle bone. These areas are also involved in breast cancer if it is stage 2 or stage 3 breast cancer. So that is also very important to be examined by breast surgeon.
What would you say about that breast health?
Dr Aruna Kalra: Breast Health as we know that first thing would be awareness, that you should be aware about your genetic history about your hereditary predisposition to breast cancer. Then you should not gain unnecessary weight because we know that obesity has extra estrogen and other hormonal problems related with extra hormones, which is breast cancer, PCOS, endometrial cancer. we should be aware that our diet should be less in those fats, anything like Ghee or saturated fatty acids, and less of simple carbohydrate and sugar. So, if we maintain a healthy diet, lots of vegetables, fruits, dairy products, which are low fat, and do regular exercise. Whether it’s 60 minutes of brisk walk or jog, or Gym, we are going towards healthy breast. Breast examination is also very important and can be done vertically, in circular manner or in a cartwheel manner, but do not leave any area unchecked.
It is said that long lactation can also cause breast cancer. How far is it true?
Dr Aruna Kalra: I don’t think there is any truth in this, because once we are lactating estrogen and progesterone level goes down and prolactin level increases. We say that breast cancer are mostly hormone dependent cancers, and once these hormones are low in our body chances that we would be prevented from breast cancer. if you lactate for a year or so studies proved that you would be protected from breast cancer.
Do you still see the hesitancy in your patients when it comes to breast cancer?
Dr Aruna Kalra: The population we are catering nowadays, they are aware about their health. as young as 15 years older girl knows about PCOS, breast cancer, sexual health and contraception. When I was in a government hospital like 20 years ago, people were hesitant to come or they were feeling shameful about it. But nowadays, I feel that girls are really aware about their own health. Only thing, which I could be a little sad to tell is that they know that breast cancer risk is increasing and it can be corrected by healthy lifestyle, but still because of cooperate lives or job, they are not following it. They want to have a quick fix to the problem.
Avoiding stress may not be possible for those with cooperate jobs, but is there any substitute to it?
Dr Aruna Kalra: The lifestyle that we are following, we know that it’s really a strenuous lifestyle where mental health and physical health are getting affected and there is no end to it and it is not that you are productive for these five years or ten years. This is going to go on for much more years than what you feel, but discipline in life is really important. You can always modify your lifestyle. If you feel that you come by 7:30 or 9 PM, shut down your mobile and computer, give yourself some quality time. If you are sleeping on time around 10, you would be getting up at five o’clock in the morning, have your tea go for walk have a healthy breakfast, make a quick Dalia with lots of vegetables or oats. If you are having high fiber diet which is dalia (proteins) in the morning, multi grains chapatti in the afternoon with in between proteins, like, kala chana, sprouts, raita, and as soon as you come back to not eat carbohydrates because you’re coming late from office. Then you have Daal, vegetable, double-toned milk and then go back to sleep. But girls do not want to do even if they know that healthy lifestyle can prevent every kind of hormonal imbalance.
But what is your word to the viewers on this Breast Cancer Awareness Month special?
Dr Aruna Kalra: To the younger girls and to everyone, I would say that everybody should do breast self-examination. You should maintain a healthy diet, which consumes lots of fruits, vegetables, low-fat milk or dairy products, lots of proteins, and you can have polyunsaturated fatty acids, which are just nuts, like Almond, Walnut, but less peanuts or cashews which contain fat. Healthy lifestyle includes one hour of walk or half an hour of jogging every day, deep breathing exercises, and early to bed, early to rise. Be aware that you have screening methods available. You have breast screening method available. You have canceled a uterus cancer screening; cervical cancer screening is available. You have vaccines for many cancers like cervical cancer. So you go as early as possible. We are giving vaccine to a girl who is 11 or 12 years of age for Cervical cancer. You have to go a long way because you are not planning a pregnancy as early as 25, we want to preserve your fertility, breasts and ovaries. So for yourself, maintain a disciplined, lifestyle, a healthy lifestyle.
