Category Archives: Best Gynecologist in Delhi

DR (PROF) SADHANA KALA
FICOG, FACS (USA), FIAMS, AAGL (USA – Robotic & Laparoscopic Surgery), MS
“at the top of the list,” Number one, in “Best Gynecologists in India;” only one from Delhi in the ‘List.’
Best Gynecologist in Delhi,
Best Gynecologist in South Delhi,
Best Infertility Specialist in South Delhi
Top Gynecologist in South Delhi
Top Gynecologist in Delhi
Professor at age 35, youngest ever in a medical college

University topper, winner several Gold & Silver Medals & Certificates of Honor & the Very rare, “DISTINCTION” in medicine

“I treat the patient, not the diagnosis”

She has 43 years clinical, teaching and research experience in India & abroad.

Specialized Training

Robotic Surgery, North Shore University, New York, USA (2015)
Advanced GynecEndoscopy, University of Arizona, Tuscan, USA (2003)
Infertility, IVF, Reproductive Health, Uppsala University, Sweden (1998)
Infertility, Institute for Research in Reproduction (IRR), Kolkata (1990)
Infertility, IRR, Mumbai (1981).

DOCTOR

In nothing do men more nearly approach the gods than in giving health to men.

― Cicero (106 BCE – 43 BCE)

My take on ‘Being a doctor: How is it really like?’ was published by The Times of India on Doctors’ Day, 01 July 2016.

After forty-two years as a specialist doctor, what is my life like? Better in some ways, and inferior in other ways to what it was when I was a young doctor.

As a young doctor I had little responsibility. I had Seniors to advise me, to correct my errors, to take responsibility for bad outcomes, and to face the patients and relatives with catastrophic news. “The doctor should be opaque to his patients and, like a mirror, should show them nothing but what is shown to him,” the Seniors repeatedly told me. For thirty-two years now, I am that ‘Senior.’

I don’t have eighty or hundred-hours-a-week work. I am on call 24×7. Sacrificing family life and personal interests comes with the job. I sometimes miss weddings and social events. My day is unpredictable, I never know when I will be finished working. I have piles of paperwork, the consumer court peering over my shoulder. After ten years of training to become an expert, and thirty-two years as an expert, I still have to work hard – peruse journals, participate in world and international conferences, seminars, and workshops – to keep up with the rapidly-evolving medical technology and knowledge.

FIGO World Congress, Oct 14 – 19, 2018, at  Rio De Janeiro, Brazil.

But medicine has rewards which far outweigh the negatives. I work on the most complex machine the world has known: the human body. I am challenged every day. Every patient is special: I regularly encounter unique situations. Interacting with the family of a healing patient, and when I save a life, is the moment that seals a bond between me and the patient and his family. That is the moment I realize I can positively impact a patient’s life; that I make a difference. That moment is my reward.

Robotic surgery, North shore University, New York, USA 

Medicine is the most challenging and intellectually satisfying calling. But it is demanding. It is not for the faint hearted or the weak kneed or the weak minded. It is only for persons who have a passion for medicine.

I began with a quote. And I end with a quote:

Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.

Francois Marie Arouet Voltaire

Prof Dr. Kenneth Hatch, University of Arizona, Tuscan, USA, is the pioneer of laparoscopic gynec surgery

INFERTILITY IN WOMEN

INFERTILITY IN WOMEN

SYNOPSIS 

In India, infertility affects one in six couples in urban areas; and about 27.5 million couples actively trying to conceive. Women contribute to about 50% of all infertility cases. In women, common causes of infertility  are ovulation-problems, damage to Fallopian tubes or uterus, or cervix-problems. Diagnosis is mainly by urine and blood tests, ultrasound, laparoscopy and hysteroscopy. Treatment is hormones, medication and minor surgery. Safe sex, hygiene and healthy life style and diet may reduce the probability of infertility. With assisted reproductive technology (ART), most of the women can achieve pregnancy. Infertility and its treatment have psycho-social impact which may need counselling and psychotherapy.

 

INFERTILITY IN WOMEN

Infertility is a loss. It’s the loss of a dream. It’s the loss of an assumed future. And, like every loss, it will be grieved.

INTRODUCTION

In India, infertility affects one in six couples in urban areas; and 10-14% of the population overall; about 27.5 million couples actively trying to conceive suffer from infertility.

If a couple is unable to conceive despite trying for one year, they are diagnosed as infertile. Cause of infertility can be either in male or in female partner. When it is in female partner, it is called female infertility. Female infertility factors contribute to about 50% of all infertility cases; and female infertility alone cause about one-third of all infertility cases.

In a few cases the infertility remains unexplained, or idiopathic, that is, its cause remains unknown.

CAUSES

In males, more than 90% of infertility is due to low sperm counts, poor sperm quality, or both. The remaining cases can be for several reasons: anatomical problems, hormonal imbalance, and genetic defects.

In women, common causes of infertility  are ovulation-problems, damage to Fallopian tubes or uterus, or cervix-problems. Also, as a woman ages, her fertility tends to decrease, and this can cause infertility.

Ovulation problems may be caused by one or more of the following:

Damage to the Fallopian tubes or uterus can be caused by one or more of the following:

DIAGNOSIS

One or more of the following tests/exams are used to evaluate fertility:

  • Urine and blood test to check for infections or a hormone problem, including thyroid function
  • Pelvic exam and breast exam
  • Test of cervical mucus and tissue to determine if ovulation is occurring
  • Laparoscopic examination to view the condition of organs and to look for blockage, adhesion or scar tissue.
  • HSG, which is an x-ray used in conjunction with a dye inserted into the fallopian tubes to check for blockage of the Fallopian tubes.
  • Hysteroscopy that uses a tiny telescope with a fibre light to look for uterine abnormalities.
  • Ultrasound to look at the uterus and ovaries. May be done vaginally or abdominally.
  • Sonohystogram combines an ultrasound and saline injected into the uterus to look for abnormalities or problems.
  • Tracking your ovulation through fertility awareness will also help your infertility specialist to assess your fertility status.

A scene of longing that gets at what infertility is like

TREATMENT

Female infertility is most often treated by one or more of the following methods:

  • Taking hormones to address a hormone imbalance, endometriosis, or a short menstrual cycle
  • Taking medications to stimulate ovulation
  • Using supplements to enhance fertility
  • Taking antibiotics to remove an infection
  • Having minor surgery to remove blockage or scar tissues from the fallopian tubes, uterus, or pelvic area.

PREVENTION

Usually nothing can be done to prevent female infertility caused by genetic problems or illness.

But several things can be done to reduce the possibility of infertility:

  • Take steps to prevent sexually transmitted diseases
  • Avoid illicit drugs
  • Avoid heavy or frequent alcohol use
  • Adopt good personal hygiene and health practices
  • Have annual check-ups with your GYN once you are sexually active

You must contact your doctor in case of any of the following symptoms:

  • Abnormal bleeding
  • Abdominal pain
  • Fever
  • Unusual discharge
  • Pain or discomfort during intercourse
  • Soreness or itching in the vaginal area

Some couples want to explore more traditional or over the counter efforts before exploring infertility procedures. However, do consult your fertility specialist about these.

ASSISTED REPRODUCTIVE TECHNOLOGY (ART)

In recent years, several medical procedures have become available to treat infertility. Collectively, these procedures are called assisted reproductive technology (ART). A few of these procedures are, in vitro fertilization (IVF),  intracytoplasmic sperm injection (ICSI), cryopreservation of gametes or embryos, and/or may involve the use of fertility medication. ART includes “all fertility treatments in which both eggs and sperm are handled. In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman.”

With ART and other fertility treatments, it is now highly probable for almost all couples to have a baby.

 

PSYCHO-SOCIAL IMPACT OF INFERTILITY 

Psycho-social impact of infertility is often overlooked because the focus is on physical causes of infertility. But this impact is important. And although it affects both the male and the female partner, the impact on women is greater.

Emotional Impact

Women are astonished, sad and angry when they first find out about their infertility.  As the treatments progresses, they are:

  • stressed
  • depressed
  • confused
  • worried
  • angry
  • upset
  • sad
  • pressured
  • grieved
  • suffer loss of:
    • self-esteem
    • self-confidence
    • sense of control over one’s destiny

Side effects of medication, money worries, and uncertain outcomes heighten the infertility-related stress.

Treatment failure, differences between partners on when to stop seeking treatment, decisions on adoption or living childless, cause further stress.

Coping with Stress

Counselling, Psychotherapy, Medications and Relaxation techniques such as mindfulness meditation, deep breathing, guided imagery, and yoga help cope with the psycho-social impact.

Other ways to cope with stress is to accept your feelings and to know that it happens to most women undergoing infertility treatment; to allow yourself to be angry, to cry to grieve; to stay connected to, and to communicate with, family and friends and your partner; to share with them your questions and fears.

Long invigorating walk, new hobby, listening to soothing music may also help. Also, cut down on intake of sugar, salt, saturated fats, and white flour; reduce or eliminate from diet chemical additives, alcohol, and caffeine, including colas, coffee, black tea, and hot cocoa.

If you feel stressed, angry and frustrated during infertility treatment, remember you are not alone. Everyone undergoing such treatment feels that way. The difference is only in the degree to which one is affected.

CONCLUSION

With ART and other fertility treatments, it is now highly probable for almost all couples to have a baby.

Still, fertility is God’s gift to women. And to men. But the gift is not equitable. A few have more of it, a few have less of it, and a few have none of it.

Fertility treatment is often a long and arduous journey. It generates psycho-social pressures. But don’t lose hope. Don’t give up. Even miracles take a little time.

Art work made from think glass medication vials, Q-caps (used to administer fertility meds), and gauze, along with ceramic pieces and glue. Titled ‘Letting Go,’ made by Denise after infertility treatment failed and she decided to live childless.

ABNORMAL VAGINAL DISCHARGE (LEUCORRHOEA)

SYMPTOMS

Women often feel embarrassed to speak about vaginal discharge, leucorrhoea, though it usually is a harmless, natural, occurrence. Except when the discharge, which normally is clear and white and odorless, becomes yellow, green or grey, or white and curdy like cottage cheese, or frothy, or foul-smelling usually a fish-odor.

The other symptoms of Leucorrhoea are:

  • Rashes or sore spots on the genitals
  • Intense itching of the vagina
  • Pain during sex
  • Burning urination and frequent urge to urinate even with very little urine
  • Constipation and other Digestive disturbances
  • Backache, pain in the leg, pain in lower abdomen
  • Irritability and lack of concentration in work
  • Fatigue because of loss of fluids as discharge
  • Headaches

CAUSES

Leucorrhoea may be caused by:

  • Antibiotic or steroid use
  • Bacterial vaginosis (a bacterial infection)
  • STD
  • Pelvic infection
  • Pelvic inflammatory disease (PID)
  • Urinary tract infection
  • Injuries to the cervix or any of the tissues in the reproductive system during pregnancy
  • Diabetes
  • Anemia
  • Birth control pills
  • Douches, scented soaps or lotions, bubble bath
  • In young girls, hormonal imbalance caused by severe mental stress and trauma
  • Overindulgence in sexual activity
  • Improper diet and lifestyle during menstrual cycle
  • Lack of nutrients
  • Improper vaginal hygiene
  • Alcohol and smoking
  • Cervical or endometrial cancer

DIAGNOSIS

The doctor will take your health history, note the symptoms, and may test the discharge and may also do a Pap test to find the cause of the problem.

 

TREATMENT

Treatment will depend on the cause of the problem.

 

PREVENTION

To prevent Leucorrhoea:

  • Keep the vagina clean by washing regularly with a gentle, mild soap and warm water
  • Never use scented soaps and feminine products or douche. Also avoid feminine sprays and bubble baths
  • After going to the bathroom, always wipe from front to back to prevent bacteria from getting into the vagina and causing an infection
  • Wear 100% cotton underpants
  • Avoid too tight clothing

Whenever you feel that the vaginal discharge is abnormal, consult your gynecologist.

 

 

MEDICAL YOGA

June 21 is International Yoga Day

Yoga: for the young

Yoga is a 5000-year old practice that originated in India. it is mostly thought of as a practice to enhance flexibility, balance, muscle tone, body-strength, endurance and mindfulness. But multiple studies in recent years have shown that it is also useful in the prevention and treatment of certain medical conditions. And also has important psychological benefits.

Medical Yoga (MY), योग चिकित्सा, is a combination of poses (योगासन), breathing techniques (प्राणायाम), meditation (ध्यान) and mindfulness (सचेतन). It is holistic. It takes into account the patient’s mind, body and spirit; and their family, support network, work situation, and culture. It is tailored to an individual just as medical treatment is. It is prescribed by persons trained in MY. It is therefore different from the yoga taught by persons who are trained yoga teachers but are not trained yoga therapist.

Yoga: for the old

MY is natural, low-tech, inexpensive, safe and avoids the potential adverse effects of medication. It is therefore preferred by patients as an alternative approach to wellness. Because of its medical and wellness benefits, many healthcare providers have begun to incorporate yoga in their practice as a supplement or complement to medical treatment. And MY has emerged as a Complementary and Alternative Medicine (CAM) practice.

The American Heart Association says yoga helps to lower blood pressure, increase lung capacity, improve respiratory function and heart rate, improve circulation, boost muscle tone, and enhance cardiovagal function. A study has suggested that even a short-term yoga-based program may reduce the risk for cardio vascular disease (CVD). Another study has suggested that yoga therapy could be of great benefit as an adjunct to medical treatment in patients with heart failure. Especially because patients with severe and/or decompensated heart failure may not tolerate well physical exercise; but they may tolerate well yoga, particularly gentle asanas, breathing exercises and meditation.

Yoga: for the old

The American College of Rheumatology says that exercise and physical activity is an effective treatment program for patients with both osteoarthritis and rheumatoid arthritis; and has a vital role in promoting joint health without worsening disease. Yoga is helpful here. Also, for chronic low back pain (CLBP), Yoga is more effective than physical exercise to improve pain, back function, spinal mobility, depression and anxiety; and, in short term, to improve the functional disability.

Research has shown that meditation helps reduce chronic stress and anxiety. In the brain, it increases cortical thickness and gray matter in areas controlling emotional regulation and executive functioning that includes planning, problem solving and emotional regulation. It also increases levels of oxytocin, the “bonding hormone,” thus helping with feelings of connectedness and “being seen and heard;” it helps sleep quality and regulation; it helps increase alertness and positive feelings, and decrease negative feelings of aggressiveness, depression and anxiety; it helps build resilience, and ability to  cope with stress and anxiety. MY is strong adjunct and complement to medications and psychotherapy to prevent, cure, and/or ameliorate chronic stress and anxiety.

Yoga: for the middle-age

Studies have shown that meditation and Yoga helps prevent premature aging and a broad range of aging-related diseases, including cardiovascular disease, cancer, stroke, dementia, obesity, osteoporosis, Alzheimer’s, macular degeneration, acquired immunodeficiency syndrome (AIDS), and osteoarthritis.

A controlled trial in 2008, with a follow up in 2013, showed that comprehensive lifestyle changes – yoga, meditation, breathing, stress management and a healthy whole-food, plant-based diet – reduced withering with age, aging, disease and premature morbidity.

Yoga: for all ages

Research till date has shown multiple health-benefits of Yoga. Ongoing research is adding to the current list of benefits. But the research till date has small sample sizes, non-standardized methodologies and short follow-up periods.  Larger, standardized, studies are needed.

MY should therefore be used as a supplement or complement, not a replacement, to medical treatment.

Yoga is not easy or quick. It demands time, patience and perseverance. But it is worth devoting these. Because the benefits are immense. And in truth, yoga doesn’t take time – it gives time.

Desert Yoga

 

 

POST MENOPAUSAL BLEEDING

See your doctor if you have vaginal bleeding after menopause. See the doctor even if the bleeding is small, even if it is only once, even if you don’t have any other symptoms. Because such bleeding can be caused by cancer.

CAUSES

The main causes of Postmenopausal Bleeding are:

• Polyps: These are tissue growths inside the uterus or the cervical canal, or on the cervix. They can cause spotting, heavy bleeding, or bleeding after sex. They’re usually not cancer.
• Endometrial atrophy: Endometrium is the tissue that lines the uterus. Low hormone levels after menopause can cause it to get too thin. This may trigger bleeding.
• Endometrial hyperplasia : Too much estrogen and too little progesterone, likely after menopause, can result in thicker endometrium that can bleed. It can also lead to cancer.
• Vaginal atrophy: Low estrogen levels after menopause can cause the vaginal walls to become thin, dry, and inflamed. That often leads to bleeding after sex.
• Cancer: Bleeding is the most common symptom of endometrial or uterine cancer after menopause. It can also signal vaginal or cervical cancer.
• Sexually transmitted diseases: STD like chlamydia and gonorrhea, may cause spotting and bleeding after sex. Herpes sores can also bleed.
• Medications: Bleeding is often a side effect of certain drugs, like hormone therapy, tamoxifen, and blood thinners.
• Other causes: Other possible, though less likely, causes of bleeding can be: clotting problems, infection of the uterine lining (endometritis), bleeding from the urinary tract and thyroid disorders.

DIAGNOSIS

Doctor will take your health-history, do a physical examination, and may do one or more of these diagnostic tests:

• Transvaginal ultrasound: To check for growths and see the thickness of the endometrium.
• Endometrial biopsy: To take a small sample of the tissue lining the uterus. The sample will be examined in a lab for infections or cancerous cells or any other abnormality.
• Hysteroscopy: To look inside the uterus.
• D&C (dilation and curettage): To take a sample of the uterus lining. The sample is checked in a lab for polyps, cancer, or thickening of the uterine lining.

TREATMENT

Treatment depends on the cause of bleeding.

• Estrogen therapy is used to treat vaginal and endometrial atrophy. It may be taken as:
o Pills taken by mouth.
o Vaginal cream put inside the body using an applicator.
o Vaginal ring put it in place by you or the doctor. It releases a steady dose of estrogen for about three months.
o Vaginal tablet inserted daily, or a few times a week, using an applicator.

• Progestin therapy: Progesterone is lab-made. It is used to treat endometrial hyperplasia. It can be a pill, or a shot, or a vaginal cream, or an intrauterine device.
• Hysteroscopy is used to remove polyps, and thickened parts of the uterine lining.
• D&C (dilation and curettage) is used to remove polyps or thickened areas of the uterine lining.
• Hysterectomy is a surgery to remove part or all of uterus. It is a treatment for endometrial or cervical cancer. It may also be needed in cases of precancerous form of endometrial hyperplasia. In some cases, ovaries, fallopian tubes, or nearby lymph nodes may also need to be taken out.
• Radiation, chemotherapy, and hormone therapy if needed for cancer treatment after surgery.
• Medications to treat cervical or uterine infections and sexually transmitted diseases.

Do not ignore postmenopausal vaginal bleeding. It may be cancer. And early detection is the cure for cancer. See your doctor.

INDIA’S BEST GYNECOLOGIST

DR (PROF) SADHANA KALA, MS, FICOG

‘INDIA’S TOP 8 GYNECOLOGIST’
“at the top of the list is Dr Prof Sadhana Kala”
She is the only one from Delhi in the List

“View the list of best gynecologists in India, with their Review Rating, experience and Services offered. Dr (Prof) Sadhna Kala (Delhi) and Dr. Shobha Venkat (Bangalore) top the list because of their experience, review ratings and service quality.”

 

1. Best Gynecologists in India with Highest Review Ratings (published: 15 November 2017)https://www.elawoman.com/…/best-gynecologists-in-india-with…

 

2. Top 10 Best Gynecologists in India (published: Oct 25, 2017) http://essencz.com/piyalis…/top-10-best-gynecologists-india/

(At the World Congress of Gynecologist, Rio De Janerio, October 2018)

3. Top 10 Best Gynecologists in Delhi
http://essencz.com/piyalis…/top-10-best-gynecolaogist-delhi/

(At the World Congress of Gynecologist, Rio De Janerio, October 2018)

4. Best Gynecologists in Delhi NCR with Highest Ratings and Reviews
https://www.elawoman.com/…/best-gynecologist-in-delhi-ncr-w…

(Robotic Surgery Workshop, New York, 2016)

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CANCER SELF SCREENIG VIDEO

302 K Views, 11 K Likes, 278 comments, 1,231 shares

Posted on 12 October

Pl do view and comment. Pl do share and spread the breast cancer AWARENESS because:

• breast cancer is the biggest killer-cancer of women in the world. And in India

• it cannot be prevented. Early detection is the only cure. Late detection is fatal.

 

BREAST CANCER SELF SCREENING

2,68,566 views, 678 shares – in three days – and counting.

Pl do view and comment. Pl do share and spread the breast cancer AWARENESS because:

• breast cancer is the biggest killer-cancer of women in the world. And in India

• it cannot be prevented. Early detection is the only cure. Late detection is fatal.

https://www.facebook.com/Scoopwhoop/videos/254610738572947/

BREAST CANCER

Every woman is at risk of Breast cancer
“The only person who can save you is you” – Sheryl Crow

SYNOPSIS

Breast cancer (BC) is the biggest killer-cancer of women in the world, and in India. In the next fifteen years, BC will kill over twelve lakh women in India. But it doesn’t have to. A few life style changes can reduce the incidence of BC; and early detection can increase the survival rate.

BC was a disease of old age. No longer. Twenty-five years ago, 69% of BC patients in India were age 50 and above. But now only 52% are 50 and above; 48% are less than 50; and a few are in the teens.

Every woman is at risk of BC. It cannot be prevented. The risk increases with age, heredity and genetic predisposition; and the risk reduces with healthy weight, regular exercise and healthy diet.

Early detection is the key to survival. Early detection can be by self-examination of breasts, or by screening by imaging devices such as X-ray, Ultra sound, and MRI. However, confirmation is only possible by biopsy.

Depending on the stage at which the cancer is detected, the treatment can be surgery, radiation, chemotherapy and other adjuvant therapies.

If detected early, BC is treatable. If detected late, it is fatal. Five-year survival rate for Stage 1 BC is 100%; for stage 4 is 22%.

So exercise and eat healthy and you would have done your bit to reduce your cancer risk. And do regular cancer screening and you would increase the probability of early detection and of successful treatment.

INTRODUCTION

Breast cancer (BC) will kill about 80,000 women in India in 2020. For every two women with BC, one will die. Many of these deaths are preventable simply by early detection. But detection is often late and thus fatal. Lack of awareness is the major reason for late detection.

Breast cancer is the most common cancer in women in India, 27% of all cancers, closely followed by cervical cancer at 22%. Incidence of and death due to BC is more than that due to cervical cancer. BC is rising at a rapid rate. By 2030, the number of BC cases will rise to about 200,000 a year and deaths to about 100,000 a year. India has the worst survival rate from BC, and the highest number of women dying from BC, in the world. Even if we start a cancer awareness program today, 20-30 years will pass before its effect becomes discernible.

BC was a disease of old age. Twenty-five years ago, 69% of BC patients were above the age of 50. Now 48% are below the age 50; and 20% of them below the age of 40.

Breast cancer cannot be prevented. But BC incidence can be reduced by a few simple lifestyle changes; and the survival rate can be improved by early detection.

WHAT IS CANCER ?

Our body is composed of many different types of cells. These cells grow and divide in a controlled manner to produce more cells as required by the body. Also, the older cells and the damaged cells die.

However, sometimes, the genetic material of one cell gets damaged or changed [mutation] and the cell becomes immortal: that is, it will not die. When this ancestor cell divides, its descendant cells are also immortal. This gives rise to a limitless number of immortal descendant cells. The number of cells is far in excess of what the body needs. The extra cells then form a mass that is called a tumour.

These immortal cells are called cancer cells. The cancer cells are: immortal; capable of limitless division, and thus of limitless growth in the number of cells; and capable of spreading [Metises] to other parts of the body through blood and lymph system.

There are more than 100 types of cancers. Not all cancers form tumours: cancers of the blood and the bone-marrow [leukaemia], for example, do not form tumours.

Most cancers are named for the body part in which they begin: colon cancer, prostate cancer, ovarian cancer, breast cancer and so on.

WHAT IS BREAST CANCER ?

Breast consists of lobules (milk producing glands), ducts (tiny tubes that carry the milk from lobules to the nipple) and blood and lymphatic vessels.
Breast cancer is a malignant tumour that starts in the cells of the breast. It begins in the ducts; sometimes in the lobules; and rarely, in other cells of the breast.

It then spreads through the breast lymph vessels to lymph nodes under the arms and thence to other parts of the body.

WHO IS AT RISK OF BREAST CANCER ?

Every woman is at risk of breast cancer. In India, one in 28 women will get breast cancer. Certain factors increase the risk of BC.

  •  AGE. Cancer is a disease of old age: most cancers begin to strike at age 60 and above. But now cancer is also striking, though only rarely as yet, the teenagers. Risk of breast cancer, for example, is about 0.25% for a 30-year old woman but increases to about 11% in a seventy-year old. In different countries, breast cancer risk in a 70-year old is 54% to 154% higher than in a 30-year old. Thus, as longevity has increased, so has the cancer incidence.
  • HEREDITARY. If first degree relatives [mother/father/brother/sister] had cancer, the risk of cancer is increased.
  • GENETICS. A person can be genetically predisposed to get cancer. A woman who has a family history of breast cancer is statistically more likely to get breast cancer. However, only a small percentage, less than 0.3% of population, is genetically disposed to get cancer. And less than 3-10% of all cancers are because of genetic predisposition. In women with BRCA 1 and BRCA 2, the probability of getting breast and ovarian cancer is more than 75%. Mutations in a few other genes [PTEN, CDH 1, TP 53 etc.] also increase the risk though not as much.
  • OBESITY. In obese postmenopausal women breast cancer risk is twice as much as in the non-obese women.
  •  DIET. Diet contributes to up-to 80% of cancers of colon, prostate and breast; and also contributes to cancers of pancreas, lung, stomach and esophagus. Alcohol, red meat, sugar increase the risk of cancer.
  • SMOKING, night work, no children or child born after age 30, recent use of oral contraceptives (reverts to normal on stopping), HRT, and Chemicals in environment – increase the cancer risk.
  •  MENOPAUSE. Late menopause increases the risk.

REDUCING THE RISK

Healthy weight, physical activity – brisk walking, cycling, swimming – 45-60 minutes five or more days a week, Breast feeding, no red meat, less sugar and less alcohol lowers the risk.

Controversy about whether diet rich in whole grains, fruits, vegetables and legumes and low in total fat (butter, oil), more vitamins, Marine Omega 3 fatty acids (found in seafood (e.g. fish oils) and in walnut, seeds, flaxseed oil etc.), and antiperspirants and bras reduce the risk. Abortion and Breast Implants have no effect.

Selective Estrogen Receptor Modulators such as tamofoxien reduce BC risk but increase the risk of thromboembolism and endometrial cancer.
So eat well and exercise and you would have done your bit to reduce your cancer risk.

EARLY DETECTION

Since cancer-prevention is not possible, the saying, “prevention is the cure” is amended to “early detection is the cure.”

Only about 10% of cancer deaths are because of primary tumour. Most of the deaths are because of metastasis – spreading of the cancer to other parts of the body. Once metastasis happens, it is very difficult to treat. Early detection of cancer is therefore of utmost importance.

Several ways of early detection:

1. SELF-EXAMINATION OF BREASTS
More than 80% cancers are detected by women doing self-examination of breasts. The examination should be done every month, 5-7 days after menorrhoea. Do the examination as shown in the three pictures. Look for the following:

  • Lumps in breast (less than 20% are cancer) or in lymph nodes in armpits.
  • Thickening of breasts
  • One breast becoming larger than other
  • A nipple changing position or shape or becoming inverted
  • Discharge from nipple
  • Constant pain in part of breast or armpit
  • Swelling beneath the armpit or around the collarbone

In case of palpated anomaly, consult your gynecologist.

The limitations of self-examination are:

• Only 20% women do self-examination of breasts.
• The tumour/changes are large by the time they are felt and this delay in detection can adversely affect the treatment outcome.

2. IMAGING TECHNIQUES
Early detection of cancer is required and is possible by using Imaging Techniques. Six Imaging Techniques are available:

• X-ray (Mammography)
• Ultra sound (Sonography)
• MRI
• Computer Assisted Detection (CAD)
• CT-scan
• PET

A visual inspection by endoscopy can also be done.

• MAMMOGRAPHY.
X-rays examination. Small neoplasmatic tissue formations can be seen.
• SONOGRAPHY
Sonography is done in addition to Mammography to rule out possible cysts and to estimate the size of the tumour. However, tumours smaller than 5 mm cannot be detected.
• MRI
MRI is used to find out if the breast has been affected by more than one tumour.
• COMPUTER ASSISTED DETECTION (CAD)
CAD is used to point out possibly diseased regions. It is used mainly as a second opinion to the report of the doctor.

LIMITATIONS OF IMAGING

• Imaging techniques magnify the tumour much as the magnifying glass magnifies the letters in a book. Normal letter size, called font, is 12. If the font size is halved, that is made 6, you may still be able to identify the letter. But if the font is reduced still further, say to 3 or 4, you will not be able to identify the letter even with the magnifying glass. In a similar way, the imaging techniques cannot identify tumours that are small.
• The QUALITY of cancer is more important than the QUANTITY. A small tumour can be more dangerous than a large tumour. Imaging can tell the quantity of the tumour, that is, its size, but cannot tell the quality of the tumour.

• Most of the time, Imaging cannot even tell whether a tumour is cancerous or not.

CONFIRMING CANCER

The only absolute way to confirm cancer is by biopsy: a small tissue from the tumour is taken and microscopically examined to check for cancer.

TYPES OF BIOPSY

• Punching Biopsy. Done in a locally-sedated state.
• Needle Biopsy. Done with a syringe and a special needle. As painful as venepuncture.
• Advanced Breast Biopsy Instrumentation (ABBI). Done with X-ray to ensure localisation of target. Only a few doctors are experienced in this technique.

Microscopic examination of biopsy is sufficient; but in a few rare cases specialized lab tests are required.

CANCER TREATMENT

Even small localised tumours have the potential of metastasis and therefore need to be treated. The treatment is surgery, medications (hormonal therapy and chemotherapy), radiation and immunotherapy.

Surgery offers the single largest benefit. Used along with chemotherapy and radiation, the local relapse rate is reduced and the overall survival rate may increase.

SURGERY

  • Mastectomy: remove whole breast.
  • Quadrantectomy: remove quarter breast.
  • Lumpectomy: remove small part of breast.
  • Breast Reconstruction Surgery or breast prostheses: to simulate breast.

Neo-adjuvant, that is prior to surgery, and Adjuvant that is after and in addition to surgery, medication is used as part of treatment. For example, Neo-adjuvant use of aspirin may reduce the mortality from Breast Cancer.

Adjuvant Therapies are:

Radiation (negative effect on normal cells) to kill cancer cells in tumour bed and regional lymph nodes that may have escaped surgery. It reduces the risk by 50 – 66 % (i.e., 1/2 to 2/3 reduction of risk). It is confined to region being treated. But only solid tumour can be treated.

Therapies using drugs/agents etc.

  • Chemotherapy (negative effect on normal cells). Uses drugs, usually two or more drugs in combination, to destroy cancer cells.
  • Targeted Therapy that became available in 1990s that uses drugs that inhibit enzymes.
  • Monoclonal Antibody Therapy in which the agent is an antibody
  • Immunotherapy that uses patient’s immune systems to fight cancer using drugs.
  • Hormone Blocking Therapy. Uses Estrogen Receptors (ER +) Tamoxifen and Progesterone Receptors (PR +) Anastrozole that block the receptors.

Experimental Cancer Treatment
1. Gene Therapy
2. Ultrasound Energy.

Alternative Medicine.

Patients with good prognosis are offered less invasive treatment – e.g. lumpectomy + radiation + hormone.
Patients with poor prognosis are offered more aggressive treatment – extensive mastectomy + radiation + chemotherapy + adjuvant medication.

TREATMENT SUCCESS RATE

If the cancer is detected early, that is at Stage 1, prognosis is excellent and usually chemotherapy is not required.

If detected in Stage 2 & 3 prognosis is progressively poorer with a greater risk of recurrence. Surgery, chemotherapy, and radiation are required.

If detected in Stage 4, that is metastatic cancer (spread to distant sites), prognosis is poor. Surgery, radiation, chemotherapy, and targeted therapies are used. But the 10-year survival rate is 5% without treatment and 10 % with optimal treatment.

In India, more than 60% of the BC’s are diagnosed at stage III or IV. Hence the low survival rate.

For Consultation with Best Gynecologist in Delhi  contact us : +91-9999886583, +91-9999889464

PSYCHOLOGICAL AND EMOTIONAL ASPECTS

Cancer patients need psychological and emotional support. Besides the family, such support can be provided by support groups who are trained and experienced in providing such support. ‘Cancer Sahyog’ is one such support group in India.

CONCLUSION

Cancer is a 3200 year old disease. It is endogenous, a part of life-process. So it can neither be eradicated, nor prevented, nor cured.

As yet.

Over the past 2000 years, the survival rate for many cancers has improved dramatically: life expectancy increased by 20-30 years. But for a few other cancers – metastatic pancreas cancer, metastatic breast cancer, in-operable gallbladder cancer – improvement has been marginal: life extended by just a few months.

Late detection of cancer is fatal. The causes for late detection are many but lack of awareness is the principal cause. Other main causes are: patient being shy, social stigma and doctors’ ignorance because of which the treatment is delayed. An awareness program with Best Gynecologist in south Delhi will address all these issues.

Present state of our knowledge makes us believe that cancer prevention or cure is not possible because cancer is a product of the processes essential to the life process.

Will some radical discovery in the future make cancer prevention and cure possible? We don’t know. But we can always hope.

Because as Richard Clauser, Director, National Cancer Institute, USA, says about the future of cancer cure, “There are far more good historians than there are prophets.”

REFERENCES

1. India still has a low breast cancer survival rate of 66%: study: For every 2 women newly diagnosed with breast cancer, one woman dies of it in India https://www.livemint.com/Science/UaNco9nvoxQtxjneDS4LoO/India-still-has-a-low-breast-cancer-survival-rate-of-66-st.html
2. Epidemiology of breast cancer in Indian women: Breast cancer epidemiology: https://www.researchgate.net/publication/313545712_Epidemiology_of_breast_cancer_in_Indian_women_Breast_cancer_epidemiology
3. Epidemiology of breast cancer in Indian women
https://www.ncbi.nlm.nih.gov/pubmed/28181405
4. BREAST CANCER INDIA
Correct information is .. half the war won already
http://www.breastcancerindia.net/statistics/trends.html
5. Breast Cancer Survival Rates
https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html
6. The Top 5 Cancers Affecting Women Top 5 Cancers Affecting Women
https://www.everydayhealth.com/womens-health/cancers-affecting-women-today.aspx https://www.everydayhealth.com/womens-health/cancers-affecting-women-today.aspx https://www.everydayhealth.com/womens-health/cancers-affecting-women-today.aspx
7. The Emperor of All Maladies: A Biography of Cancer – a book by Siddhartha Mukherjee, a physician and oncologist. Available at Amazon and at Flipcart

RAFALE & STEALTH

 

Lalu in jail, Sonia Rahul on bail, numerous other politico small and big declared scoundrels and worse by the courts. Politico’s stock is so low that we will believe anything – bad – about them.

And so to Rafale and Ambani and Modi. We don’t know if anything underhand took place. But Rafael is a ₹ 59,000 crore deal, Ambani is an industrialist with only a little experience in defence production, and Modi is a politico. So we are prepared to believe that some hanky-panky took place, even though no evidence as yet that it did.

Having suffered in 2014 the consequences of people’s perception of corruption in politics, Congress is quick to latch on to Rafale deal. Why only 24 aircraft, why Ambani, why the cost escalation, why, why, why – they are screaming. Forgetting that it was their fifteen years’ of inaction that has led to the alarming situation where the Indian Air Force, tasked with fighting a two-front war, is hard pressed to cope with even a one-front war! Against a requirement of 42 combat squadrons, it is down to 33 squadrons, to only 31 effevtive-squadrons. And of these 17 squadrons are of vintage Mig 21 [first flight (ff) 1956], Jaguar [ff 1968], and Mig 27 [ff 1970]. Fighters with design-age of more than fifty years! A crisis that needed urgent resolving.

A back of the envelope calculation would show that over the next twenty years, the IAF needs to induct about 500 combat aircraft, about 230 of these in the next ten years, that is, by 2027; and that the program cost would be about ₹ 06 lakh crore in the next ten years, and about ₹ 13 lakh crore in the next fifteen years. At today’s prices.

If most, or at least some of this money has to come to India, then we need to build defence-industry in the country. And for that, participation of private industry is essential. None in the private industry in the country has experience of defence production. So one and all of them will be newcomers. Lockheed Martin has forged a partnership with Tata Advanced Systems Limited (TASL), SAAB with the Adani group, and Dassault with Reliance. All the Indian partners are new to defence production.

The advantage and ills of a defence-industry complex are too well known to recount here. The economist and social scientists can argue and pronounce on its benefits or otherwise to the country. But finally the buck stops at the politico. It is their call. Should, or shouldn’t the country have a defence–industry? And if yes, then how do we create it if we ban entry in to it of Indian companies without experience of defence production?

But let’s return to Rafale and why only 24 of them. Simple answer is that we needed an immediate answer to an emergency situation to give ourselves time to ponder. Do we want all 500 aircraft to be Rafale? Do we want a mix of single-engine fighters like F-16 and Gripen, and twin-engine fighters like F/A-18 and the Rafale? And what about beyond the 500 fighters? Do we need the fifth generation fighters, the stealth fighters, like F 22 raptor and F 35 Lightning II of the US, Chengdu J-20 and Shenyang J-31 of China, Sukhoi Su-57 of Russia, and Mitsubishi X-2 Shinshin research aircraft of Japan. Surely the IAF which looks 30-40 years ahead is thinking about the fifth generation stealth fighters and where and when they fit in to IAF’s inventory.

Argue not about Rafale. Argue about military-industry complex. Argue about stealth.